Induction Chemotherapy plus Concomitant Chemoradiotherapy in Nasopharyngeal Carcinoma: an Updated Network Meta-Analysis.

Abstract

BACKGROUND\nInduction 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.\n\n\nPATIENTS AND METHODS\nWe systematically searched and extracted data from randomized, controlled trials involving stage III-IV NPC patients randomly assigned to receive IC\u2009+\u2009CCRT 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).\n\n\nRESULTS\nEight 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.\n\n\nCONCLUSIONS\nAlthough CCRT with cisplatin has been the gold standard of treatment in NPC for several years. Docetaxel\u2009+\u2009cisplatin-IC and cisplatin\u2009+\u2009gemcitabine-IC regimens have a positive impact on survival in locally-advanced NPC and should be considered the new standard option.