Comparison of Second-Line Treatments for Patients with Platinum-Resistant Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Systematic Review and Bayesian Network Meta-Analysis
by
Yan He
1,†, 
Junsong Zeng
1,†,
Zhigong Wei
1,
Yan Huang
1,
Lianlian Yang
1,
Xiaolin Hu
2,
Yonglin Su
3,* and
Xingchen Peng
1,*
1
Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610017, China
2
Department of Nursing, West China Hospital, Sichuan University, Chengdu 610017, China
3
Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu 610017, China
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2022, 14(18), 4472; https://doi.org/10.3390/cancers14184472
Submission received: 30 July 2022
/
Revised: 3 September 2022
/
Accepted: 12 September 2022
/
Published: 15 September 2022
(This article belongs to the Section Cancer Therapy)
Simple Summary
Which second-line treatment is the optimal choice for patients with platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma remains unclear. To inform clinical decisions, we performed a network meta-analysis and systematic review to assess the relative efficacy and safety of second-line treatments for patients with platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma. By synthesizing all available controlled trial evidence, PD-1 inhibitors significantly improved the overall survival, objective response rate, and treatment tolerance compared to the standard of care (docetaxel, methotrexate, or cetuximab). Afatinib presented a better progression-free survival and objective response rate than the standard of care. Compared with afatinib, PD-1 inhibitors had a better overall survival but a worse progress-free survival.
Abstract
Several new drugs and combination strategies can be used to treat patients with recurrent or metastatic head and neck squamous cell carcinoma in the second-line treatment. Questions regarding the relative efficacy and safety of any two of the multiple second-line treatment strategies have emerged. This study aims to compare second-line treatments for patients with platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma. Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched to identify relevant articles. Direct and indirect evidence in terms of the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events grade ≥ 3 (grade ≥ 3 trAE) were analyzed in this Bayesian network meta-analysis. A total of twenty-three trials involving 5039 patients were included. These studies compared 20 different treatments, including the standard of care (SOC: docetaxel, methotrexate, or cetuximab), PD-1 inhibitors (nivolumab or pembrolizumab), durvalumab, tremelimumab, durvalumab + tremelimumab, palbociclib + SOC, tivantinib + SOC, sorafenib + SOC, EMD1201081 + SOC, vandetanib + SOC, PX-866 + SOC, 5-fluorouracil + SOC, cixutumumab + SOC, gefitinib + SOC, cabazitaxel, nolatrexed, duligotuzumab, zalutumumab, gefitinib, and afatinib. Among the currently available treatment options, compared to the standard of care (SOC: docetaxel, methotrexate, or cetuximab), the PD inhibitor significantly improved OS, ORR, and grade ≥ 3 trAE. Afatinib presented a better PFS and ORR than the SOC. Compared with afatinib, the PD-1 inhibitor had a better OS but a worse PFS. In conclusion, compared to the SOC, the PD-1 inhibitor significantly improved the OS, ORR, and grade ≥ 3 trAE. Afatinib presented a better PFS and ORR than the SOC. Compared with afatinib, the PD-1 inhibitor had a better OS but a worse PFS.
