Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis

Claire Petit; Benjamin Lacas; Jean Pierre Pignon; Quynh Thu Le; Vincent Grégoire; Cai Grau; Allan Hackshaw; Björn Zackrisson; Mahesh K.B. Parmar; Ju Whei Lee; Maria Grazia Ghi; Giuseppe Sanguineti; Stéphane Temam; Maurice Cheugoua-Zanetsie; Brian O'Sullivan; Marshall R. Posner; Everett E. Vokes; Juan J. Cruz Hernandez; Zbigniew Szutkowski; Eric Lartigau; Volker Budach; Rafal Suwiński; Michael Poulsen; Shaleen Kumar; Sarbani Ghosh Laskar; Jean Jacques Mazeron; Branislav Jeremic; John Simes; Lai Ping Zhong; Jens Overgaard; Catherine Fortpied; Pedro Torres-Saavedra; J. Bourhis; A. Aupérin; Pierre Blanchard; MACH-NC and MARCH Collaborative Groups; J. Johansen

doi:10.1016/S1470-2045(21)00076-0

Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis

Claire Petit
, Benjamin Lacas
, Jean Pierre Pignon
, Quynh Thu Le
, Vincent Grégoire
, Cai Grau
, Allan Hackshaw
, Björn Zackrisson
, Mahesh K.B. Parmar
, Ju Whei Lee
, Maria Grazia Ghi
, Giuseppe Sanguineti
, Stéphane Temam
, Maurice Cheugoua-Zanetsie
, Brian O'Sullivan
, Marshall R. Posner
, Everett E. Vokes
, Juan J. Cruz Hernandez
, Zbigniew Szutkowski
, Eric Lartigau

Volker Budach, Rafal Suwiński, Michael Poulsen, Shaleen Kumar, Sarbani Ghosh Laskar, Jean Jacques Mazeron, Branislav Jeremic, John Simes, Lai Ping Zhong, Jens Overgaard, Catherine Fortpied, Pedro Torres-Saavedra, J. Bourhis, A. Aupérin, Pierre Blanchard^*, MACH-NC and MARCH Collaborative Groups, J. Johansen (Medlem af forfattergruppering)

^*Kontaktforfatter

University of Paris-Saclay
Institut Gustave Roussy
Groupe d'Oncologie Radiothérapie Tête Et Cou
Stanford University
The Léon Bérard Cancer Center
Aarhus Universitetshospital
Cancer Research UK
Umeå University
Institute for Global Health
Dana–Farber Cancer Institute
Veneto Institute of Oncology–IRCCS
Regina Elena National Cancer Institute
University of Toronto
Icahn School of Medicine at Mount Sinai
University of Chicago
University of Salamanca
Maria Sklodowska-Curie National Research Institute of Oncology
Centre Oscar Lambret
Berlin Institute of Health
Mater Centre
Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow
Tata Memorial Hospital
Public Hospital System of Paris
BioIRC Center for Biomedical Research
NHMRC Clinical Trials Center
Shanghai Jiao Tong University
EORTC Headquarters
American College of Radiology, Reston
Lausanne University Hospital

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

Background: Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. Methods: We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). Findings: 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0–9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51–0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRT_P) was 0·82 (95% CI 0·66–1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRT_P (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (IC_TaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and IC_TaxPF followed by CLRT (80%). Interpretation: The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or IC_TaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. Fundings: French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.

Originalsprog	Engelsk
Tidsskrift	The Lancet Oncology
Vol/bind	22
Udgave nummer	5
Sider (fra-til)	727-736
ISSN	1470-2045
DOI	https://doi.org/10.1016/S1470-2045(21)00076-0
Status	Udgivet - maj 2021

Bibliografisk note

Publisher Copyright:
© 2021 Elsevier Ltd

Finansiering

CP reports a grant from Fondation ARC during the conduct of the study. J-PP reports grants from Ligue National Contre le Cancer, during the conduct of the study. AA reports grants from Ligue Contre le Cancer and Programme Hospitalier de Recherche Clinique en Cancérologie–Institut National du Cancer, during the conduct of the study; grants from F Hoffmann-La Roche, and from the French Radiation and Oncology Group for Head and Neck (GORTEC), outside the submitted work. EEV and QTL report personal fees AbbVie, Amgen, AstraZeneca, Biolumina, BMS, Celgene, Eli Lilly, EMD Serono, Genentech, Merck, Regeneron, Novartis for EEV, and Grail for QTL outside the submitted work. J-WL reports grants from the US National Institutes of Health, during the conduct of the study. JJCH reports other payment from Sanofi Aventis during the conduct of the study; payment for an advisory role and conferences from Merck, Bristol Myers Squibb, Merck Sharp & Dohme España, Novartis, and Roche Pharma outside the submitted work. All other authors declare no competing interests. This research was funded by grants from Institut National du Cancer (Programme Hospitalier de Recherche Clinique), Ligue Nationale Contre le Cancer, and Fondation ARC pour la recherche contre le cancer. We thank the trialists and the MARCH and MACH-NC collaborative groups who agreed to share their data. The contents of this publication and methods used are solely the responsibility of the authors and do not necessarily represent the official views of the ECOG-ACRIN Cancer Research Group, and NRG Oncology.

Dokumenter og links

10.1016/S1470-2045(21)00076-0

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

Petit, C., Lacas, B., Pignon, J. P., Le, Q. T., Grégoire, V., Grau, C., Hackshaw, A., Zackrisson, B., Parmar, M. K. B., Lee, J. W., Ghi, M. G., Sanguineti, G., Temam, S., Cheugoua-Zanetsie, M., O'Sullivan, B., Posner, M. R., Vokes, E. E., Cruz Hernandez, J. J., Szutkowski, Z., ... Johansen, J. (2021). Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis. The Lancet Oncology, 22(5), 727-736. https://doi.org/10.1016/S1470-2045(21)00076-0

@article{07b652a674df4115941d2c564cdb10d3,

title = "Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis",

abstract = "Background: Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. Methods: We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). Findings: 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0{\textendash}9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97\%; hazard ratio 0·63 [95\% CI 0·51{\textendash}0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95\% CI 0·66{\textendash}1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78\%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89\%), accelerated radiotherapy with concomitant chemotherapy (82\%), and ICTaxPF followed by CLRT (80\%). Interpretation: The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. Fundings: French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.",

keywords = "Chemoradiotherapy, Dose Fractionation, Radiation, Female, Head and Neck Neoplasms/mortality, Humans, Male, Network Meta-Analysis",

author = "Claire Petit and Benjamin Lacas and Pignon, \{Jean Pierre\} and Le, \{Quynh Thu\} and Vincent Gr{\'e}goire and Cai Grau and Allan Hackshaw and Bj{\"o}rn Zackrisson and Parmar, \{Mahesh K.B.\} and Lee, \{Ju Whei\} and Ghi, \{Maria Grazia\} and Giuseppe Sanguineti and St{\'e}phane Temam and Maurice Cheugoua-Zanetsie and Brian O'Sullivan and Posner, \{Marshall R.\} and Vokes, \{Everett E.\} and \{Cruz Hernandez\}, \{Juan J.\} and Zbigniew Szutkowski and Eric Lartigau and Volker Budach and Rafal Suwi{\'n}ski and Michael Poulsen and Shaleen Kumar and \{Ghosh Laskar\}, Sarbani and Mazeron, \{Jean Jacques\} and Branislav Jeremic and John Simes and Zhong, \{Lai Ping\} and Jens Overgaard and Catherine Fortpied and Pedro Torres-Saavedra and J. Bourhis and A. Aup{\'e}rin and Pierre Blanchard and \{MACH-NC and MARCH Collaborative Groups\} and J. Johansen",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",

year = "2021",

month = may,

doi = "10.1016/S1470-2045(21)00076-0",

language = "English",

volume = "22",

pages = "727--736",

journal = "The Lancet Oncology",

issn = "1470-2045",

publisher = "Elsevier",

number = "5",

}

Petit, C, Lacas, B, Pignon, JP, Le, QT, Grégoire, V, Grau, C, Hackshaw, A, Zackrisson, B, Parmar, MKB, Lee, JW, Ghi, MG, Sanguineti, G, Temam, S, Cheugoua-Zanetsie, M, O'Sullivan, B, Posner, MR, Vokes, EE, Cruz Hernandez, JJ, Szutkowski, Z, Lartigau, E, Budach, V, Suwiński, R, Poulsen, M, Kumar, S, Ghosh Laskar, S, Mazeron, JJ, Jeremic, B, Simes, J, Zhong, LP, Overgaard, J, Fortpied, C, Torres-Saavedra, P, Bourhis, J, Aupérin, A, Blanchard, P, MACH-NC and MARCH Collaborative Groups & Johansen, J 2021, 'Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis', The Lancet Oncology, bind 22, nr. 5, s. 727-736. https://doi.org/10.1016/S1470-2045(21)00076-0

TY - JOUR

T1 - Chemotherapy and radiotherapy in locally advanced head and neck cancer

T2 - an individual patient data network meta-analysis

AU - Petit, Claire

AU - Lacas, Benjamin

AU - Pignon, Jean Pierre

AU - Le, Quynh Thu

AU - Grégoire, Vincent

AU - Grau, Cai

AU - Hackshaw, Allan

AU - Zackrisson, Björn

AU - Parmar, Mahesh K.B.

AU - Lee, Ju Whei

AU - Ghi, Maria Grazia

AU - Sanguineti, Giuseppe

AU - Temam, Stéphane

AU - Cheugoua-Zanetsie, Maurice

AU - O'Sullivan, Brian

AU - Posner, Marshall R.

AU - Vokes, Everett E.

AU - Cruz Hernandez, Juan J.

AU - Szutkowski, Zbigniew

AU - Lartigau, Eric

AU - Budach, Volker

AU - Suwiński, Rafal

AU - Poulsen, Michael

AU - Kumar, Shaleen

AU - Ghosh Laskar, Sarbani

AU - Mazeron, Jean Jacques

AU - Jeremic, Branislav

AU - Simes, John

AU - Zhong, Lai Ping

AU - Overgaard, Jens

AU - Fortpied, Catherine

AU - Torres-Saavedra, Pedro

AU - Bourhis, J.

AU - Aupérin, A.

AU - Blanchard, Pierre

AU - MACH-NC and MARCH Collaborative Groups

A2 - Johansen, J.

PY - 2021/5

Y1 - 2021/5

N2 - Background: Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. Methods: We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). Findings: 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0–9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51–0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95% CI 0·66–1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and ICTaxPF followed by CLRT (80%). Interpretation: The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. Fundings: French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.

AB - Background: Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. Methods: We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). Findings: 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0–9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51–0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95% CI 0·66–1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and ICTaxPF followed by CLRT (80%). Interpretation: The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. Fundings: French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.

KW - Chemoradiotherapy

KW - Dose Fractionation, Radiation

KW - Female

KW - Head and Neck Neoplasms/mortality

KW - Humans

KW - Male

KW - Network Meta-Analysis

U2 - 10.1016/S1470-2045(21)00076-0

DO - 10.1016/S1470-2045(21)00076-0

M3 - Journal article

C2 - 33862002

AN - SCOPUS:85105832610

SN - 1470-2045

VL - 22

SP - 727

EP - 736

JO - The Lancet Oncology

JF - The Lancet Oncology

IS - 5

ER -

Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis

Abstract

Bibliografisk note

Finansiering

Dokumenter og links

SDU link

Fingeraftryk

Citationsformater