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Optimal induction chemotherapy regimen for locoregionally advanced nasopharyngeal carcinoma: an update Bayesian network meta-analysis

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Abstract

Background and purpose

Induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) has been established as standard of care for locoregionally advanced nasopharyngeal carcinoma (LANPC). No direct comparison between different IC regimens has been performed. We conducted Bayesian network meta-analysis to evaluate the efficacy and safety of IC regimens in LANPC.

Materials and methods

We systematically searched studies comparing different regimens of IC plus CCRT versus CCRT alone for LANPC. Pairwise meta-analysis and Bayesian network meta-analysis were conducted using Review Manger, Stata and R software.

Results

Eight eligible studies with a total of 2382 patients were involved. Compared with CCRT alone, IC + CCRT significantly improved PFS (HR = 0.68 [95% CI 0.59–0.79]) and OS (HR = 0.72 [95% CI 0.61–0.86]) in conventional meta-analysis. In Bayesian network meta-analysis, GP (gemcitabine and cisplatin) had advantage in prolonging PFS, OS and DMFS. GP had adverse but manageable impacts on hemoglobin and platelet. Meanwhile, treatment compliance of GP was higher than that of other regimens.

Conclusion

Based on existing evidences, GP could likely to be recommended as an optimal IC regimen for LANPC.

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Abbreviations

ASCO:

American Society for Radiation Oncology

ASTRO:

American Society for Radiation Oncology

CC:

Concurrent chemotherapy

CCRT:

Concurrent chemoradiotherapy

CEP:

Paclitaxel, epirubicin and cis-platinum

CI:

Confidence interval

CSCO:

Chinese Society of Clinical Oncology

CSTRO:

Chinese Society for Radiation Oncology

DMFS:

Distant metastasis free survival

ESMO:

European Society for Medical Oncology

ESTRO:

European Society for Radiotherapy & Oncology

GCP:

Paclitaxel, gemcitabine and carboplatin

GP:

Cisplatin plus gemcitabine

HR:

Hazard ratio

IC:

Induction chemotherapy

LANPC:

Locoregionally advanced nasopharyngeal carcinoma

LRFS:

Locoregional failure survival

MEPFL:

Mitomycin, epirubicin, cisplatin, fluorouracil and leucovorin

NPC:

Nasopharyngeal carcinoma

OR:

Odds ratio

OS:

Overall survival

PF:

Cisplatin plus 5-fluorouracil

PFS:

Progression-free survival

PX:

Cisplatin plus capecitabine

RCT:

Randomized clinical trial

TP:

Docetaxel plus cisplatin

TPF:

Cisplatin, fluorouracil plus docetaxel

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Funding

Funding was provided by Health and Family Planning Commission of Hubei Province (WJ2019H060), Science, Technology and Innovation Seed Fund of Zhongnan Hospital of Wuhan University (znpy2018123).

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Author notes

  1. Qiuji Wu and Shaojie Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China

    Qiuji Wu, Shaojie Li, Jia Liu & Yahua Zhong

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  1. Qiuji Wu
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  3. Jia Liu
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  4. Yahua Zhong
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Correspondence to Yahua Zhong.

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Supplementary Information

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Figure S1 Risk of bias graph according to Cochrane Risk of Bias tool. (PDF 308 kb)

405_2022_7435_MOESM2_ESM.pdf

Figure S2 Results of pairwise meta-analysis aiming to compare effectiveness of IC+CCRT to that of CCRT alone. (A) PFS; (B) OS; (C) DMFS; (D) LRFS. (PDF 1671 kb)

405_2022_7435_MOESM3_ESM.pdf

Figure S3 Results of pairwise meta-analysis aiming to compare treatment-related toxicities of IC+CCRT to that of CCRT alone. (A) Neutropenia; (B) Leukopenia; (C) Nausea and vomiting; (D) Anemia; (E) Thrombocytopenia; (F) Mucositis. (PDF 2556 kb)

Figure S4 Bayesian network plot of included studies based on PFS. (PDF 83 kb)

405_2022_7435_MOESM5_ESM.pdf

Figure S5 Bayesian network meta-analysis for treatment-related toxicities. (A) Leukopenia; (B) Neutropenia; (C) Anemia; (D) Thrombocytopenia; (E) Nausea and vomiting; (F) Mucositis. (PDF 277 kb)

Supplementary file6 (DOCX 34 kb)

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Wu, Q., Li, S., Liu, J. et al. Optimal induction chemotherapy regimen for locoregionally advanced nasopharyngeal carcinoma: an update Bayesian network meta-analysis. Eur Arch Otorhinolaryngol 279, 5057–5069 (2022). https://doi.org/10.1007/s00405-022-07435-2

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  • DOI: https://doi.org/10.1007/s00405-022-07435-2

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