Yan He1, Tao Guo2, Jingjing Wang1, Yu Sun1, Hui Guan1, Shaoyong Wu1, Xingchen Peng1. 1. Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China. 2. Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China.
Abstract
BACKGROUND: Which induction chemotherapy (IC) regimen followed by cisplatin-based concurrent chemoradiotherapy (CCRT) is the best choice among PF (cisplatin and 5-fluorouracil), TP (docetaxel and cisplatin) and TPF (docetaxel, cisplatin, and 5-fluorouracil) remains controversial in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). This Bayesian network meta-analysis investigated the efficacy and toxicity of these three common IC regimens and attempted to find the optimal chemotherapy regimen. METHODS: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) up to December, 2017. Then, we screened studies for eligibility, extracted data, assessed their quality, tested consistency, and used Bayesian network meta-analysis to combine direct and indirect evidence. RESULTS: Ten records were identified involving 7 eligible RCTs with 1,570 patients. Results of the Bayesian network meta-analysis shows that TPF [hazard ratios (HRs) 0.68; 95% credibility interval (CrI), 0.42-1.1], TP (HRs 0.70; 95% CrI, 0.22-2.2) and PF (HRs 1.0; 95% CrI, 0.71-1.5) have the probability of 49.61%, 47.45% and 1.57% respectively to be the optimal induction regimen. Docetaxel-based regimens, including TP [risk ratios (RRs) 5.9; 95% CrI, 1.4-26.0) and TPF (RRs 4.5; 95% CrI, 1.1-18.0), significantly increase the incidence of hematological toxicity. As for ≥ grade 3 mucositis, 5-fluorouracil-based regimens, including PF (RRs 2.1; 95% CrI, 0.91-5.8) and TPF (RRs 1.4; 95% CrI, 0.48-4. 6), are higher than TP (RRs 1.1; 95% CrI, 0.30-4.6). CONCLUSIONS: Only considering overall survival (OS), TPF has the highest probability to be the optimal choice in LA-NPC and TP also shows encouraging anti-tumor effects. However, we also noticed that TPF induced worse adverse events, especially in ≥ grade 3 hematological toxicity and oral mucositis.
BACKGROUND: Which induction chemotherapy (IC) regimen followed by cisplatin-based concurrent chemoradiotherapy (CCRT) is the best choice among PF (cisplatin and 5-fluorouracil), TP (docetaxel and cisplatin) and TPF (docetaxel, cisplatin, and 5-fluorouracil) remains controversial in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). This Bayesian network meta-analysis investigated the efficacy and toxicity of these three common IC regimens and attempted to find the optimal chemotherapy regimen. METHODS: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) up to December, 2017. Then, we screened studies for eligibility, extracted data, assessed their quality, tested consistency, and used Bayesian network meta-analysis to combine direct and indirect evidence. RESULTS: Ten records were identified involving 7 eligible RCTs with 1,570 patients. Results of the Bayesian network meta-analysis shows that TPF [hazard ratios (HRs) 0.68; 95% credibility interval (CrI), 0.42-1.1], TP (HRs 0.70; 95% CrI, 0.22-2.2) and PF (HRs 1.0; 95% CrI, 0.71-1.5) have the probability of 49.61%, 47.45% and 1.57% respectively to be the optimal induction regimen. Docetaxel-based regimens, including TP [risk ratios (RRs) 5.9; 95% CrI, 1.4-26.0) and TPF (RRs 4.5; 95% CrI, 1.1-18.0), significantly increase the incidence of hematological toxicity. As for ≥ grade 3 mucositis, 5-fluorouracil-based regimens, including PF (RRs 2.1; 95% CrI, 0.91-5.8) and TPF (RRs 1.4; 95% CrI, 0.48-4. 6), are higher than TP (RRs 1.1; 95% CrI, 0.30-4.6). CONCLUSIONS: Only considering overall survival (OS), TPF has the highest probability to be the optimal choice in LA-NPC and TP also shows encouraging anti-tumor effects. However, we also noticed that TPF induced worse adverse events, especially in ≥ grade 3 hematological toxicity and oral mucositis.
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