The Most Optimal Induction Chemotherapy Regimen For Loco-Regionally Advanced Nasopharyngeal Carcinoma: A Network Meta-Analysis

Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in the treatment of locally advanced nasopharyngeal carcinoma (NPC) has gained increasing popularity. However, the optimal regimens for IC remain undefined. We performed a network meta-analysis to compare the survival benefits of all available IC regimens followed by CCRT. All randomized trials of CCRT with or without IC in non-metastatic NPC were included. Overall, 10 trials and 3,116 patients were included. IC regimens were grouped into eight categories: docetaxel + cisplatin (DC), cisplatin + epirubicin + paclitaxel (PET), gemcitabine + carboplatin + paclitaxel (GCP), docetaxel + cisplatin + fluorouracil (TPF), mitomycin + epirubicin + cisplatin + fluorouracil + leucovorin (MEPFL), cisplatin + fluorouracil (PF), cisplatin + capecitabine (PX) and gemcitabine + cisplatin (GP). Inverse variance heterogeneity model was applied for network meta-analysis. The three IC regimens with the highest significant benefit on overall survival (OS) were DC, followed by PX and GP, with respective hazard ratios (HRs [95% CIs]) compared with CCRT alone of 0.24 (0.08 to 0.73), 0.38 (0.19 to 0.77) and 0.43 (0.24 to 0.77). PX, GP and TPF were the top three regimens showing significant improved progression-free survival (PFS) with their corresponding HRs of 0.39 (0.21 to 0.72), 0.51 (0.34 to 0.77) and 0.60 (0.42 to 0.86); and the only regimens which significantly improved both OS and PFS. PX achieved the highest survival benefit and consistent improvement for all end points among all regimens. Induction PX followed by CCRT should be the most effective regimen for loco-regionally advanced NPC.