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

Abstract

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.

PPT1 Reduction Contributes to Erianin-Induced Growth Inhibition in Oral Squamous Carcinoma Cells

“…Treatment of oral cancer includes surgery, chemotherapy, radiotherapy or their combination (Johnson et al, 2020). Recently, the application of immunotherapy, especially immune checkpoint inhibitors, has been introduced (Jin et al, 2020). Some patients showed great remission after this treatment regimen, however, over 50% patients relapsed.…”

Plasma cell-free circRNAs panel act as fingerprint predicts the occurrence of laryngeal squamous cell carcinoma

“…According to the results of current epidemiological studies, smoking, HPV infection, laryngeal re ux and environmental occupational exposure are considered to be high risk factors for laryngeal cancer. [3,4]. However, the molecular mechanism of the pathogenesis of LSCC remains unclear.…”

Plasma Cell-free circRNAs Panel Act as Fingerprint Predicts the Occurrence of Laryngeal Squamous Cell Carcinoma

“…Laryngeal squamous cell carcinoma (LSCC) is the most common tumor of the head and neck [1,2]. The main risk factors for laryngeal cancer include tobacco, human papillomavirus infection, laryngopharyngeal re ux, environmental and occupational exposure, and alcohol [3,4]. However, the molecular mechanism of the pathogenesis of LSCC remains unclear.…”