Meta‐analysis of induction chemotherapy as a selection marker for chemoradiation in the head and neck

Abstract

Objective Many trials incorporate induction chemotherapy (IC) in selecting for organ preservation in head and neck squamous cell carcinomas (HNSCC). However, few studies examine IC response in predicting for chemoradiation therapy (CRT) response. This meta‐analysis aims to determine the predictive accuracy of IC for subsequent response to CRT and overall survival (OS). Data sources Medline, EMBASE, Cochrane register. Methods A systematic search identified studies from database inception to October 2016 that used IC prior to CRT as definitive treatment for advanced HNSCC. The sensitivities and specificities of IC response predicting for complete CRT response were calculated, and the results were pooled in a summary receiver operating curve. One‐, 2‐ and 5‐year OS data were extracted. Results Seven studies (n = 423 patients) were analyzed for response and six (n = 439) for OS. Pooled median sensitivity and specificity of IC response predicting CRT response were 0.95 (95% confidence interval [CI]: 0.72–0.98) and 0.43 (95% CI: 0.00–0.61), respectively. Patients were more likely to respond to CRT given previous response to IC (positive likelihood ratio = 1.6; 95% CI: 1.21–2.11) and less likely to respond to CRT if they failed to respond to IC (negative likelihood ratio = 0.16; 95% CI: 0.07–0.38). At 2 years, good response to IC was a statistically significant prognostic marker with a risk ratio of 1.35 (95% CI: 1.12–1.64). Conclusion Our data suggests that patients with poor IC response will have poorer response to CRT and should be directed to other modalities. In contrast, good IC response does not guarantee a favorable outcome to CRT; however, because these patients are likely to have better prognoses, they should be offered salvage therapies of curative intent despite treatment failure. Level of Evidence NA. Laryngoscope, 128:1594–1601, 2018

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

“…Most induction chemotherapy studies were designed prior to the widespread incorporation of p16 testing and stratification into prospective studies of HNSCC. Given the improved prognosis related to HPV initiated HNSCC, interest in induction therapy has primarily been related to the idea of chemoselectionwith a goal toward treatment de-escalation [9]. ECOG 1308 demonstrated the feasibility of such a schema, but whether induction chemotherapy need be part of future deescalation regimens remains controversial and its use of cetuximab, which has been shown to be an inferior radiosensitizer to cisplatin, make this an unlikely platform to move forward [10,11].…”

Predictors of survival outcomes in sinonasal squamous cell carcinoma: an analysis of the National Cancer Database

“…Patients with at least a partial response to IC demonstrate improved survival, whereas patients with no response or progression during IC demonstrate poor prognoses. 10,21 Despite this utility, IC is not routinely utilized in the management of SNSCC. The purpose of this study was to analyze the National Cancer Database (NCDB), a nationwide cohort with a large number of SNSCC patients, to better understand which management strategies are being used.…”

Dose-dense TPF induction chemotherapy for locally advanced head and neck cancer: a phase II study

“…ICT also was a predictor of survival for locally advanced SCCHN. A recent meta-analysis study showed the ICT responders had better survival than nonresponders [28]. Moreover, a phase II study demonstrated that responders after one cycle of split-dose TPF ICT were a survival predictor for oral and oropharyngeal squamous cell carcinoma (OPSCC) [29].…”