Yu Xiao, Su Xiaolei, Fang Ling, Zhang Honglei, Chen Xi, Pu Yu, Liu Hongyi, Guo Rui
Graduate School, Hebei North University, Zhangjiakou, 075000, China.
Otorhinolaryngology Head and Neck Surgery, Air Force Medical Center, Beijing, 100142, China.
Eur Arch Otorhinolaryngol. 2023 Mar;280(3):1391-1401. doi: 10.1007/s00405-022-07673-4. Epub 2022 Oct 1.
To evaluate the efficacy on overall survival (OS) and progression-free survival (PFS) of the first-line systemic therapy regimens on 6-, 12-, 18-, 24-, and 30 months in recurrent/metastatic head and neck squamous cell carcinoma (R/M-HNSCC) and figure out the best regimen.
PubMed, Embase, The Cochrane Library, Scopus, and Google Scholars were systematically searched for studies in regard to the first-line systemic regimens for R/M-HNSCC from inception to March 2022. Odds ratios (ORs) were generated for dichotomous variants by network meta-analysis. The primary endpoint was OS, and the second endpoint was PFS. The software implemented was STATA 17.0 MP.
Eventually, 18 studies with 5298 patients and 12 first-line systematic regimens were enrolled. immunotherapy + chemotherapy (OR = 2.30, 95% CI 1.60-3.31) and single immunotherapy (OR = 1.91, 95% CI 1.33-2.76) were significantly superior to the EXTREME on OS at 30th month. Meantime, immunotherapy + chemotherapy (SUCRA = 87.7%) has the highest ranking. TPEx (OR = 1.61, 95% CI 1.05-2.48) showed significantly better efficacy compared with EXTREME on PFS at 12th month. Simultaneously, TPEx (SUCRA = 87.1%) had the highest ranking and was the long-lasting first-echelon regimen both in OS and PFS from a longitudinal perspective. It should be noted that EXTREME included platinum-based chemotherapy + fluorouracil + cetuximab, TPEx included docetaxel + cisplatin + cetuximab.
Considering the efficacy, safety, compliance, and economic profiles collectively, one of the standard first-line regimens, literally TPEx should be recommended as the best choice for R/M-HNSCC. Furthermore, more head-to-head trials are needed to confirm those findings.
评估一线全身治疗方案对复发/转移性头颈部鳞状细胞癌（R/M-HNSCC）患者6个月、12个月、18个月、24个月和30个月总生存期（OS）和无进展生存期（PFS）的疗效，并找出最佳方案。
系统检索PubMed、Embase、Cochrane图书馆、Scopus和谷歌学术数据库中从建库至2022年3月关于R/M-HNSCC一线全身治疗方案的研究。通过网络荟萃分析生成二分变量的比值比（OR）。主要终点为OS，次要终点为PFS。使用的软件为STATA 17.0 MP。
最终纳入18项研究，共5298例患者和12种一线全身治疗方案。在第30个月时，免疫治疗+化疗（OR = 2.30，95% CI 1.60 - 3.31）和单纯免疫治疗（OR = 1.91，95% CI 1.33 - 2.76）在OS方面显著优于EXTREME方案。同时，免疫治疗+化疗（累积排序概率曲线下面积（SUCRA）= 87.7%）排名最高。TPEx方案（OR = 1.61，95% CI 1.05 - 2.48）在第12个月时在PFS方面显示出比EXTREME方案显著更好的疗效。同时，TPEx方案（SUCRA = 87.1%）排名最高，从纵向来看，在OS和PFS方面都是持久的一线方案。需要注意的是，EXTREME方案包括铂类化疗+氟尿嘧啶+西妥昔单抗，TPEx方案包括多西他赛+顺铂+西妥昔单抗。
综合疗效、安全性、依从性和经济性等因素，TPEx方案应作为R/M-HNSCC标准一线方案之一被推荐为最佳选择。此外，还需要更多的头对头试验来证实这些发现。
