TY - JOUR
T1 - Meta-analysis of chemotherapy in head and neck cancer (MACH-NC)
T2 - An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group
AU - MACH-NC Collaborative Group
AU - Lacas, Benjamin
AU - Carmel, Alexandra
AU - Landais, Cécile
AU - Wong, Stuart J.
AU - Licitra, Lisa
AU - Tobias, Jeffrey S.
AU - Burtness, Barbara
AU - Ghi, Maria Grazia
AU - Cohen, Ezra E.W.
AU - Grau, Cai
AU - Wolf, Gregory
AU - Hitt, Ricardo
AU - Corvò, Renzo
AU - Budach, Volker
AU - Kumar, Shaleen
AU - Laskar, Sarbani Ghosh
AU - Mazeron, Jean Jacques
AU - Zhong, Lai Ping
AU - Dobrowsky, Werner
AU - Ghadjar, Pirus
AU - Fallai, Carlo
AU - Zakotnik, Branko
AU - Sharma, Atul
AU - Bensadoun, René Jean
AU - Ruo Redda, Maria Grazia
AU - Racadot, Séverine
AU - Fountzilas, George
AU - Brizel, David
AU - Rovea, Paolo
AU - Argiris, Athanassios
AU - Nagy, Zoltán Takácsi
AU - Lee, Ju Whei
AU - Fortpied, Catherine
AU - Harris, Jonathan
AU - Bourhis, Jean
AU - Aupérin, Anne
AU - Blanchard, Pierre
AU - Pignon, Jean Pierre
AU - Adelstein, D. J.
AU - Alfonsi, M.
AU - Belkacemi, Y.
AU - Bar-Ad, V.
AU - Bernier, J.
AU - Hansen, A.
AU - Langendijk, J. A.
AU - Le, Q. T.
AU - Lin, A.
AU - Moon, J.
AU - Simon, C.
AU - Widder, J.
N1 - Funding Information:
We thank the trialists and the 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. This research was funded by grants from Institut National du Cancer (Programme Hospitalier de Recherche Clinique) and Ligue Nationale Contre le Cancer .
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/3
Y1 - 2021/3
N2 - Background and purpose: The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results.Materials and methods: Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint.Results: For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005).Conclusion: The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
AB - Background and purpose: The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results.Materials and methods: Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint.Results: For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005).Conclusion: The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
KW - Chemotherapy
KW - Head and Neck Cancer
KW - Individual Patient Data
KW - Meta-analysis
KW - Radiotherapy
KW - Randomised Clinical Trials
U2 - 10.1016/j.radonc.2021.01.013
DO - 10.1016/j.radonc.2021.01.013
M3 - Article
C2 - 33515668
AN - SCOPUS:85102363781
SN - 0167-8140
VL - 156
SP - 281
EP - 293
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -