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Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group.

Publication ,  Journal Article
Lacas, B; Carmel, A; Landais, C; Wong, SJ; Licitra, L; Tobias, JS; Burtness, B; Ghi, MG; Cohen, EEW; Grau, C; Wolf, G; Hitt, R; Corvò, R ...
Published in: Radiother Oncol
March 2021

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 MATERIALS AND METHODS: Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT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.

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Published In

Radiother Oncol

DOI

EISSN

1879-0887

Publication Date

March 2021

Volume

156

Start / End Page

281 / 293

Location

Ireland

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Oncology & Carcinogenesis
  • Induction Chemotherapy
  • Humans
  • Head and Neck Neoplasms
  • Chemotherapy, Adjuvant
  • Carcinoma, Squamous Cell
  • Antineoplastic Combined Chemotherapy Protocols
  • 5105 Medical and biological physics
  • 3211 Oncology and carcinogenesis
 

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Lacas, B., Carmel, A., Landais, C., Wong, S. J., Licitra, L., Tobias, J. S., … MACH-NC Collaborative Group. (2021). Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol, 156, 281–293. https://doi.org/10.1016/j.radonc.2021.01.013
Lacas, Benjamin, Alexandra Carmel, Cécile Landais, Stuart J. Wong, Lisa Licitra, Jeffrey S. Tobias, Barbara Burtness, et al. “Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group.Radiother Oncol 156 (March 2021): 281–93. https://doi.org/10.1016/j.radonc.2021.01.013.
Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol. 2021 Mar;156:281–93.
Lacas, Benjamin, et al. “Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group.Radiother Oncol, vol. 156, Mar. 2021, pp. 281–93. Pubmed, doi:10.1016/j.radonc.2021.01.013.
Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron J-J, Zhong L-P, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun R-J, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee J-W, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon J-P, MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol. 2021 Mar;156:281–293.
Journal cover image

Published In

Radiother Oncol

DOI

EISSN

1879-0887

Publication Date

March 2021

Volume

156

Start / End Page

281 / 293

Location

Ireland

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Oncology & Carcinogenesis
  • Induction Chemotherapy
  • Humans
  • Head and Neck Neoplasms
  • Chemotherapy, Adjuvant
  • Carcinoma, Squamous Cell
  • Antineoplastic Combined Chemotherapy Protocols
  • 5105 Medical and biological physics
  • 3211 Oncology and carcinogenesis