Induction chemotherapy plus concomitant chemoradiotherapy in nasopharyngeal carcinoma: An updated network meta-analysis

[Display omitted] •Induction chemotherapy (IC) is usually administered in locally advanced NPC.•Different IC regimens have been used but the best choice is still debatable.•Platinum-based doublet IC appears to have a benefit on overall survival.•The docetaxel-platinum-5-FU regimen improves local dis...

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Published in:Critical reviews in oncology/hematology 2021-04, Vol.160, p.103244-103244, Article 103244
Main Authors: Bongiovanni, Alberto, Vagheggini, Alessandro, Fausti, Valentina, Mercatali, Laura, Calpona, Sebastiano, Di Menna, Giandomenico, Miserocchi, Giacomo, Ibrahim, Toni
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chemoradiotherapy
Cisplatin
Cisplatin - therapeutic use
Docetaxel-cisplatin-5FU
Gemcitabine
Humans
Induction Chemotherapy
Nasopharyngeal carcinoma
Nasopharyngeal Carcinoma - drug therapy
Nasopharyngeal Neoplasms - drug therapy
Network Meta-Analysis
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Summary:[Display omitted] •Induction chemotherapy (IC) is usually administered in locally advanced NPC.•Different IC regimens have been used but the best choice is still debatable.•Platinum-based doublet IC appears to have a benefit on overall survival.•The docetaxel-platinum-5-FU regimen improves local disease control. Induction chemotherapy (IC) added to concurrent chemoradiotherapy (CCRT) appears to be superior to CCRT alone for locally-advanced nasopharyngeal carcinoma (NPC). The main objective of this network meta-analysis (NMA) was to assess the impact of different IC regimens on patient outcome. We systematically searched and extracted data from randomized, controlled trials involving stage III-IV NPC patients randomly assigned to receive IC + CCRT vs. CCRT alone. Overall survival (OS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) in the two arms were compared using hazard ratios (HRs). Eight clinical trials were identified including 2362 patients. OS-benefit from doublet IC regimens, in particular platinum-docetaxel and platinum-gemcitabine regimens, was seen. With regard to LRFS, docetaxel-platinum-5FU regimen showed a greater impact than the others. An indirect comparison between taxane- and gemcitabine-based IC regimens showed a benefit of the latter in terms of OS and DMFS. Although CCRT with cisplatin has been the gold standard of treatment in NPC for several years. Docetaxel + cisplatin-IC and cisplatin + gemcitabine-IC regimens have a positive impact on survival in locally-advanced NPC and should be considered the new standard option.
ISSN:1040-8428
1879-0461
DOI:10.1016/j.critrevonc.2021.103244