Clinical and Translational Radiation Oncology (Jan 2022)

Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients

  • Pierre Blanchard,
  • Anne W.M. Lee,
  • Alexandra Carmel,
  • Ng Wai Tong,
  • Jun Ma,
  • Anthony T.C. Chan,
  • Ruey Long Hong,
  • Ming-Yuan Chen,
  • Lei Chen,
  • Wen-Fei Li,
  • Pei-Yu Huang,
  • Dora L.W. Kwong,
  • Sharon S.X. Poh,
  • Roger Ngan,
  • Hai-Qiang Mai,
  • Camille Ollivier,
  • George Fountzilas,
  • Li Zhang,
  • Jean Bourhis,
  • Anne Aupérin,
  • Benjamin Lacas,
  • Jean-Pierre Pignon,
  • Anne Aupérin,
  • Pierre Blanchard,
  • Ellen Benhamou,
  • Jean Bourhis,
  • Alexandra Carmel,
  • Somvilai Chakrabandhu,
  • Anthony TC Chan,
  • Lei Chen,
  • Ming-Yuan Chen,
  • Qiu-Yan Chen,
  • Yong Chen,
  • Richard J Chappell,
  • Horace Choi,
  • Daniel TT Chua,
  • Melvin Lee Kiang Chua,
  • George Fountzilas,
  • Julian Higgins,
  • Ming-Huang Hong,
  • Ruey-Long Hong,
  • Pei-Yu Huang,
  • Edwin Pun Hui,
  • C.F. Hsiao,
  • Michael Kam,
  • Georgia Angeliki Koliou,
  • Dora LW Kwong,
  • Benjamin Lacas,
  • Shu-Chuan Lai,
  • Ka On Lam,
  • Michael L LeBlanc,
  • Anne WM Lee,
  • Ho Fun Victor Lee,
  • Wen Fei Li,
  • Brigette Ma,
  • Jun Ma,
  • Hai-Qiang Mai,
  • Frankie Mo,
  • James Moon,
  • Wai Tong Ng,
  • Roger Ngan,
  • Camille Ollivier,
  • Brian O'Sullivan,
  • Claire Petit,
  • Jean Pierre Pignon,
  • Sharon X. Poh,
  • Gerta Rücker,
  • Jonathan Sham,
  • Yoke Lim Soong,
  • Ying Sun,
  • Terence Tan,
  • Lin-Quan Tang,
  • Yuk Tung,
  • Joseph Wee,
  • Xuang Wu,
  • Tingting Xu,
  • Li Zhang,
  • Yuan Zhang,
  • Guopei Zhu

Journal volume & issue
Vol. 32
pp. 59 – 68

Abstract

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Purpose: Chemotherapy, when added to radiotherapy, improves survival in locally advanced nasopharyngeal carcinoma (NPC). This article presents the second update of the Meta-Analysis of Chemotherapy in NPC. Methods: Published or unpublished randomized trials assessing radiotherapy (±a second chemotherapy timing) with/without chemotherapy in non-metastatic NPC patients were identified. Updated data were sought for studies included in the previous rounds of the meta-analysis. The primary endpoint was overall survival. All trials were analyzed following the intent-to-treat principle using a fixed-effects model. Treatments were classified in five subsets according to chemotherapy timing. The statistical analysis plan was pre-specified. Results: Eighteen new trials were identified. Individual patient data were available for seven. In total, the meta-analysis now included 26 trials and 7,080 patients. The addition of chemotherapy reduced the risk of death, with a hazard ratio (HR) of 0.79 (95% confidence interval (CI) [0.73; 0.85]), and an absolute survival increase at 5 and 10 years of 6.1% [+3.9; +8.3] and + 8.4% [+5.7; +11.1], respectively. The largest effect was observed for concomitant + adjuvant, induction (with concomitant in both arms) and concomitant chemotherapy, with respective HR [95%CI] of 0.68 [0.59; 0.79] (absolute survival increase at 5 years: 12.3% (7.0%;17.6%)), 0.73 [0.63; 0.86] (6.0% (2.5%;9.5%)) and 0.81 [0.70; 0.92] (5.2% (0.8%;9.6%)). The benefit of chemotherapy was also demonstrated by improvement in progression-free survival, cancer mortality, locoregional control and distant control. There was a significant interaction between patient age and chemotherapy effect. Conclusion: This updated meta-analysis confirms the benefit of concomitant chemotherapy and concomitant + adjuvant chemotherapy, and suggests that addition of induction or adjuvant chemotherapy to concomitant chemotherapy improves tumor control and survival. The benefit of chemotherapy decreases with increasing patient age.

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