Gustave Roussy, Villejuif, France
Claire Petit , Anne WM Lee , Alexandra Carmel , Wai Tong Ng , Jun Ma , Anthony TC Chan , Ruey-Long Hong , Ming-Yuan Chen , Lei Chen , Guopei Zhu , Wen-Fei Li , Sharon Poh , Roger Ngan , Hai-Qiang Mai , Pei-Yu Huang , Li Zhang , George Fountzilas , Jean Bourhis , Jean-Pierre Pignon , Pierre Blanchard
Background: Based on an individual patient data (IPD) network meta-analysis (NMA) of 20 randomized trials and 5,144 patients (pts), the MAC-NPC collaborative group has shown that the addition of adjuvant chemotherapy (AC) to chemo-radiotherapy (CRT) achieved the highest survival benefit in nasopharyngeal carcinoma (NPC; Ribassin-Majed JCO 2017). Here, we updated the meta-analysis with the addition of 8 trials. Methods: Trials of Radiotherapy (RT) with or without chemotherapy (CT) in patients with non-metastatic NPC were identified and updated IPD obtained. Both Western and Chinese medical literatures were searched. Overall Survival (OS) was the main endpoint. Fixed and random-effects frequentist NMA models were applied, network heterogeneity and consistency were evaluated. P-score was used to rank the treatments. R software - netmeta package was used to perform the analyses. Treatments were grouped in the following categories: RT alone (RT), induction chemotherapy followed by RT (IC-RT), induction chemotherapy without taxanes followed by concomitant chemoradiotherapy (ICtax(-)-CRT), induction chemotherapy with taxanes followed by concomitant chemoradiotherapy (ICtax(+)-CRT), concomitant chemoradiotherapy (CRT), concomitant chemoradiotherapy followed by adjuvant chemotherapy (CRT-AC) and RT followed by adjuvant chemotherapy (RT-AC). Results: Overall 28 trials and 8,214 pts were included. Median follow-up was 7.2 years. There was no heterogeneity in the NMA. There was inconsistency in the main analysis, which disappeared after the exclusion of 2 outlier trials. ICtax(+)-CRT ranked the best treatment for OS with a P-Score of 91%. Hazard ratio [HR, 95% Confidence Interval] for ICtax(+)-CRT was 0.75 [0.59-0.96] compared to CRT and 0.92 [0.69-1.24] compared to CRT-AC (second best treatment in raking with a P-Score of 85%; see league table below). When the 2 types of IC were merged, CRT-AC ranked the first followed by IC-CRT with P-Scores of 93% and 86% respectively, with a HR of 0.97 [0.84-1.14] for CRT-AC vs. IC-CRT. Conclusions: This IPD NMA of the treatment of locally advanced NPC demonstrates that the addition of IC or AC to CRT improves disease control probability and survival over CRT alone. Data on progression-free survival, locoregional and distant control will be presented at the meeting.
ICtax(+)-CRT p-score = 91% | |||
---|---|---|---|
0.92 [0.69-1.24] | CRT-AC p-score = 85% | ||
0.87 [0.65-1.17] | 0.94 [0.79-1.13] | ICtax(-)-CRT p-score = 74% | |
0.75 [0.59-0.96] | 0.82 [0.69-0.97] | 0.87 [0.74-1.02] | CRT p-score = 45% |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Valentina Burgio
2022 ASCO Annual Meeting
First Author: Danilo Giffoni M. M. Mata
2023 ASCO Annual Meeting
First Author: Benjamin Besse
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Dai Okemoto