PMID- 33488783
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220420
IS  - 1758-8340 (Print)
IS  - 1758-8359 (Electronic)
IS  - 1758-8340 (Linking)
VI  - 12
DP  - 2020
TI  - 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.
PG  - 1758835920983717
LID - 10.1177/1758835920983717 [doi]
LID - 1758835920983717
AB  - BACKGROUND: 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. METHODS: 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. RESULTS: 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. 
      CONCLUSIONS: 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.
CI  - (c) The Author(s), 2020.
FAU - Jin, Zhe
AU  - Jin Z
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Zhang, Bin
AU  - Zhang B
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Zhang, Lu
AU  - Zhang L
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Huang, Wenhui
AU  - Huang W
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Mo, Xiaokai
AU  - Mo X
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Chen, Qiuyin
AU  - Chen Q
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Wang, Fei
AU  - Wang F
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Chen, Zhuozhi
AU  - Chen Z
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Li, Minmin
AU  - Li M
AD  - The First Affiliated Hospital of Jinan University, Guangzhou, China.
FAU - Zhang, Shuixing
AU  - Zhang S
AUID- ORCID: 0000-0001-7377-382X
AD  - The First Affiliated Hospital of Jinan University, No. 613, West Huangpu Avenue, 
      Guangzhou, Guangdong Province 510630, PR China.
LA  - eng
PT  - Journal Article
DEP - 20201226
PL  - England
TA  - Ther Adv Med Oncol
JT  - Therapeutic advances in medical oncology
JID - 101510808
PMC - PMC7768319
OTO - NOTNLM
OT  - chemotherapy
OT  - immune-checkpoint inhibitor
OT  - network meta-analysis
OT  - recurrent or metastatic head and neck carcinoma
COIS- Conflict of interest statement: The authors declare that there is no conflict of 
      interest.
EDAT- 2021/01/26 06:00
MHDA- 2021/01/26 06:01
PMCR- 2020/12/26
CRDT- 2021/01/25 05:39
PHST- 2020/08/11 00:00 [received]
PHST- 2020/12/01 00:00 [accepted]
PHST- 2021/01/25 05:39 [entrez]
PHST- 2021/01/26 06:00 [pubmed]
PHST- 2021/01/26 06:01 [medline]
PHST- 2020/12/26 00:00 [pmc-release]
AID - 10.1177_1758835920983717 [pii]
AID - 10.1177/1758835920983717 [doi]
PST - epublish
SO  - Ther Adv Med Oncol. 2020 Dec 26;12:1758835920983717. doi: 
      10.1177/1758835920983717. eCollection 2020.