In an updated individual patient data network meta-analysis reported in The Lancet Oncology, Petit et al found that the treatment approach with the highest overall survival benefit among patients with nonmetastatic nasopharyngeal carcinoma treated with radiotherapy was induction chemotherapy with taxanes followed by chemoradiotherapy.
The investigators stated: “The meta-analysis of chemotherapy for nasopharynx carcinoma (MAC-NPC) collaborative group previously showed that the addition of adjuvant chemotherapy to concomitant chemoradiotherapy had the highest survival benefit of the studied treatment regimens in nasopharyngeal carcinoma. Due to the publication of new trials on induction chemotherapy, we updated the network meta-analysis.”
Study Details
In the updated analysis, trials of radiotherapy with or without chemotherapy in patients with nonmetastatic nasopharyngeal carcinoma that completed accrual before end of December 2016 were identified and updated individual patient data were obtained. General databases (eg, PubMed and Web of Science) and Chinese medical literature databases were searched. The treatment approaches assessed were: radiotherapy alone; induction chemotherapy followed by radiotherapy; induction chemotherapy without taxanes followed by chemoradiotherapy; induction chemotherapy with taxanes followed by chemoradiotherapy; chemoradiotherapy; chemoradiotherapy followed by adjuvant chemotherapy; and radiotherapy followed by adjuvant chemotherapy.
The outcome of interest was overall survival. A p score was used to rank treatments, with higher scores indicating greater benefit.
Key Findings
The analysis included 28 trials with a total of 8,214 patients. Median follow-up was 7.6 years (interquartile range = 6.2–13.3 years).
Compared with chemoradiotherapy alone (p score = 46%), the three treatment strategies associated with the greatest benefit in overall survival were: induction chemotherapy with taxanes followed by chemoradiotherapy (hazard ratio [HR] = 0.75, 95% confidence interval [CI] = 0.59–0.96, p score = 92%); induction chemotherapy without taxanes followed by chemoradiotherapy (HR = 0.81, 95% CI = 0.69–0.95, p score = 87%); and chemoradiotherapy followed by adjuvant chemotherapy (HR = 0.88, 95% CI = 0.75–1.04; p score = 72%).
The investigators concluded, “The inclusion of new trials modified the conclusion of the previous network meta-analysis. In this updated network meta-analysis, the addition of either induction chemotherapy or adjuvant chemotherapy to chemoradiotherapy improved overall survival over chemoradiotherapy alone in nasopharyngeal carcinoma.”
Pierre Blanchard, MD, of the Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Institut National du Cancer and Ligue Nationale Contre le Cancer. For full disclosures of the study authors, visit thelancet.com.
