Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group

Date

10 Oct 2016

Session

Head and neck cancers

Presenters

Jean Bourhis

Citation

Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376

Authors

J. Bourhis¹, P. Blanchard², C. Landais³, C. Petit³, Q. Zhang⁴, V. Grégoire⁵, J. Tobias⁶, B. Burtness⁷, M.G. Ghi⁸, F. Janot⁹, J. Overgaard¹⁰, G. Wolf¹¹, F. Lewin¹², R. Hitt¹³, R. Corvo¹⁴, V. Budach¹⁵, A. Trotti¹⁶, C. Fortpied¹⁷, A. Hackshaw¹⁸, J. Pignon¹⁹

Author affiliations

¹ Département D'oncologie, Centre Hospitalier Universitaire Vaudois - CHUV, CH-1011 - Lausanne/CH
² Department Of Radiation Therapy, Gustave Roussy Cancer Campus, FR-94805 - Villejuif/FR
³ Biostatistics, Institut Gustave Roussy, Villejuif/FR
⁴ Statistics And Data Management Center, NRG Oncology, Philadelphia/US
⁵ Dept. Radiation Oncology, Cliniques Universitaires St. Luc, Brussels/BE
⁶ Dept. Radiation Oncology, University College London Hospital UCLH NHS Foundation Trust, London/GB
⁷ Medical Oncology, Yale University School of Medicine Medical Oncology, New Haven/US
⁸ Medical Oncology, Ospedale dell'Angelo e Ospedale SS Giovanni e Paolo, Venezia/IT
⁹ Head And Neck Surgery, Institut Gustave Roussy, Villejuif/FR
¹⁰ Dept. Radiation Oncology, Aarhus University Hospital, Aarhus C/DK
¹¹ Head And Neck Surgery, University of Michigan, Ann Arbor/US
¹² Dept. Radiation Oncology, County Hospital Ryhov, Jönköping/SE
¹³ Medical Oncology, Hospital Universitario Severo Ochoa, Madrid/ES
¹⁴ Dept. Radiation Oncology, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, Genova/IT
¹⁵ Dept. Radiation Oncology, Charité, Campus Virchow Klinikum, Berlin/DE
¹⁶ Dept. Radiation Oncology, H. Lee Moffitt Cancer Center University of South Florida, Tampa/US
¹⁷ Biostatistics, EORTC Headquarters, Brussels/BE
¹⁸ Clinical Trials, Cancer Research UK & University College London Cancer Trials Centre, London/GB
¹⁹ Service De Biostatistique Et D’epidemiologie, Cesp, Inserm U1018, Univ. Paris Sud, Univ. Paris-saclay, Ligue Contre Le Cancer, Gustave Roussy Cancer Campus, FR-94805 - Villejuif/FR

Resources

Abstract 3065

Background

Our previous meta-analysis showed that concomitant chemotherapy (CT) improved overall survival (OS) in patients with non-metastatic head and neck squamous cell carcinoma (HNSCC). The study purpose was to update patient follow up, gather data on toxicity and include randomized trials conducted up to 2010.

Methods

This individual patient data meta-analysis included trials comparing loco-regional treatment (LRT) to LRT + CT or induction CT + radiotherapy (RT) to RT + concomitant (or alternating) CT in non-metastatic HNSCC patients and conducted between 1965 and 2010. A fixed effect model was used. The log-rank test, stratified by trial, was used to compare treatments. OS was the primary endpoint.

Results

15 new trials (2,574 patients) were included. Updated data were obtained for 11 additional trials. For the comparison of LRT vs. LRT + CT, 94 trials (18,394 patients) with median follow-up of 6.7 years were analyzed. The most frequent tumor site was oropharynx (35%). Stage III and IV tumors represented 29% and 63% of patients. The addition of CT improved OS with a hazard ratio (HR) [95% confidence interval] of 0.89 [0.86; 0.92], p

Conclusions

This update of the MACH-NC meta-analysis confirms the superiority of concomitant CT for locally advanced HNSCC with longer follow-up, when compared to induction treatment. Study of patterns of relapse and toxicity is ongoing.

Clinical trial identification

Not applicable.

Legal entity responsible for the study

N/A

Funding

French Ministry of Health (Programme d'actions integrees de recherche VADS) Ligue Nationale Contre le Cancer French National Cancer Institute (SHS 2014-141) National Cancer Institute, National Institutes of Health (CA180888 and CA180819) Hellenic Cooperative Oncology Group (HE R_5G)

Disclosure

All authors have declared no conflicts of interest.

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