Predictor of effectiveness of treatment intensification on overall survival in head and neck cancer (HNC)

Selection of Head and Neck Cancer Patients for Intensive Therapy

“…Individual u scores were calculated using a previously described nomogram, which was developed in the Meta-Analyses of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) data set and validated in the Meta-analysis of chemotherapy in HNC (MACH-NC) data set. 17 This nomogram predicts risk for cancer progression relative to competing mortality, which in turn is correlated with the effect of intensive therapy. The nomogram is available at www.comogram.org, and the formula is provided in the appendix (available at https://doi.org/10.1016/ j.ijrobp.2019.09.011).…”

“…9,10 Multiple theoretical, population-based, and trial-based studies have indicated that the ratio of risk for cancer events versus competing mortality events (u ratio), rather than absolute OS or PFS, is likely to be a more critical determinant of the benefit of intensive therapy. [11][12][13][14][15][16][17] The u ratio represents the proportion of the overall event hazard that is attributable to cancer. 14,15,[17][18][19] Heuristically, the u ratio can be thought of as quantifying "the degree to which cancer is the patient's problem."…”

“…[11][12][13][14][15][16][17] The u ratio represents the proportion of the overall event hazard that is attributable to cancer. 14,15,[17][18][19] Heuristically, the u ratio can be thought of as quantifying "the degree to which cancer is the patient's problem." It also has a direct clinical interpretation: an u ratio of 0.50 means a patient has an equal risk for a primary event as for a competing event.…”

“…20 Nomograms to predict u ratios for individual patients (ie, u score) have been developed using supervised classification models based on generalized competing event (GCE) regression. 14,15,17,18 In particular, recent studies of Radiation Therapy Oncology Group trial data and 2 large meta-analyses have found that patients with HNC with a higher u score (0.8) selectively benefit from intensive therapy. 15,17 This scoring method is being used prospectively to define eligibility for the ongoing NRG HN004 trial.…”

“…14,15,17,18 In particular, recent studies of Radiation Therapy Oncology Group trial data and 2 large meta-analyses have found that patients with HNC with a higher u score (0.8) selectively benefit from intensive therapy. 15,17 This scoring method is being used prospectively to define eligibility for the ongoing NRG HN004 trial. 21,22 However, trial and meta-analysis samples do not represent the general population and often lack critical prognostic variables such as comorbidity.…”