Immune-checkpoint inhibitor plus chemotherapy versus conventional chemotherapy for treatment of recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and network meta-analysis.
Immune-checkpoint inhibitor plus chemotherapy versus conventional chemotherapy for treatment of recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and network meta-analysis.
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免疫检查点抑制剂联合化疗与传统化疗治疗复发性或转移性头颈鳞状细胞癌的比较：系统评价和网络荟萃分析
DOI：
10.1177/1758835920983717
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发表时间：
2020
影响因子：
4.9
通讯作者：
Zhang S
中科院分区：
文献类型：
--
作者：
Jin Z;Zhang B;Zhang L;Huang W;Mo X;Chen Q;Wang F;Chen Z;Li M;Zhang S
包括免疫检查点抑制剂在内的多种疗法正在成为复发性或转移性头颈部鳞状细胞癌（R/M HNSSC）患者的有效治疗方法。然而，最佳的一线和二线治疗仍然存在争议。我们系统地检索了数据库，并对比较两种或多种R/M HNSSC治疗方法的II/III期随机对照试验（RCT）进行了系统评价。提取无进展生存期（PFS）、总生存期（OS）和不良事件（AE），并基于频率主义网络荟萃分析进行合成。纳入了26项试验，涉及8908例患者。在一线治疗中，派姆单抗+顺铂+5-氟尿嘧啶与OS显著改善相关（P评分= 0.91），TPEx在延长PFS方面排名第一（0.91）。EXTREME+多西他赛（0.18）在≥ 3级AE中排名最低。在二线治疗中，nivolumab是延长OS的最高等级治疗（0.95），而buparlisib+紫杉醇是PFS的最高等级治疗（0.94）。亚组分析表明，nivolumab与PD-L1高表达患者的OS改善显著相关（HR 0.55，0.43-0.70），而其OS获益与PD-L1低表达患者的常规化疗相似。Buparlisib+紫杉醇在HPV阴性状态的患者亚组中显示出最佳的OS获益，并且口腔或喉为原发肿瘤部位。Pembrolizumab+顺铂+5-氟尿嘧啶可能是OS优先考虑时的最佳一线治疗。否则，TPEx应该是最佳的一线选择，因为其具有上级PFS延长疗效、最佳安全性特征，以及与帕博利珠单抗+顺铂+5-氟尿嘧啶相似的OS获益。纳武利尤单抗似乎是最佳二线选择，在总体人群中具有最佳OS延长疗效和突出的安全性特征。未来的随机对照试验需要对患者进行细致的分组和详细的报告，以实现个体化治疗。
Multiple therapies including immune-checkpoint inhibitors are emerging as effective treatment for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSSC). However, the optimal first-line and second-line treatments remains controversial. We systematically searched databases and conducted a systematic review of phase II/III randomized controlled trials (RCTs) that compared two or more treatments for R/M HNSSC. Progression-free survival (PFS), overall survival (OS) and adverse events (AEs) ⩾3 with hazard ratios (HRs) were extracted and synthesized based on a frequentist network meta-analysis. Twenty-six trials involving 8908 patients were included. Of first-line treatments, pembrolizumab plus cisplatin plus 5-fluorouracil is associated with significantly improved OS (P-score = 0.91) and TPEx ranked first for prolonging PFS (0.91). EXTREME plus docetaxel (0.18) ranked lowest for AEs ⩾3. Of second-line treatments, nivolumab was the highest-ranked treatment for prolonging OS (0.95), while buparlisib plus paclitaxel was the highest-ranked treatment for PFS (0.94). Subgroup analyses suggested that nivolumab was significantly associated with improvement of OS in patients with high PD-L1 expression (HR 0.55, 0.43–0.70), whereas its OS benefit is similar with conventional chemotherapy for those with low PD-L1 expression. Buparlisib plus paclitaxel showed the best OS benefit in subgroups of patients with HPV-negative status, and with oral cavity or larynx as primary tumor sites. Pembrolizumab plus cisplatin plus 5-fluorouracil is likely to be the best first-line treatment when OS is a priority. Otherwise, TPEx should be the optimal first-line option due to its superior PFS prolongation efficacy, best safety profile, and similar OS benefit with pembrolizumab plus cisplatin plus 5-fluorouracil. Nivolumab appears to be the best second-line option with best OS prolongation efficacy and outstanding safety profile in the overall population. Future RCTs with meticulous grouping of patients and detailed reporting are urgently needed for individualized treatment.
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影响因子：
28.4
作者：
Ferris, Robert L.;Saba, Nabil F.;Cohen, Ezra E. W.
通讯作者：
Cohen, Ezra E. W.
影响因子：
39.2
作者：
Hutton, Brian;Salanti, Georgia;Moher, David
通讯作者：
Moher, David
影响因子：
16.6
作者：
He C;Duan X;Guo N;Chan C;Poon C;Weichselbaum RR;Lin W
通讯作者：
Lin W
影响因子：
50.5
作者：
Bossi, P.;Miceli, R.;Licitra, L.
通讯作者：
Licitra, L.
影响因子：
50.5
作者：
Guo, Y.;Ahn, M-J;Tang, P. Z.
通讯作者：
Tang, P. Z.