(0689) Neoadjuvant Chemotherapy for Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-analysis

Introduction: This study assesses the impact of platinum-based neoadjuvant chemotherapy (NACT) on response rates (RR), overall survival (OS), disease-free survival (DFS), and adverse events (AE) in head and neck squamous cell carcinoma (HNSCC) to guide treatment strategies.

Methods: A comprehensive literature search performed in October 2023, including PubMed, Embase, and Cochrane databases, identified randomized controlled trials (RCTs) comparing NACT and upfront surgery. Search terms including variations of ‘head and neck squamous cell carcinoma’, ‘neoadjuvant therapy’, and ‘randomized controlled trial’, were combined. Eligible RCTs underwent meta-analysis using a random-effects model.

Results: Out of 6,104 screened studies, 12 studies describing nine unique RCTs (n = 1,601) were included. The pooled RR with NACT was 63% (95% CI: 46-78%). Meta-analysis revealed no significant differences in OS (HR 0.95, 95% CI 0.82-1.11), or DFS (HR 0.87, 95% CI 0.7-1.08) in the NACT group. Trials with NACT consisting of a platinum and fluorouracil +/- taxane (TPF/PF) exhibited significant DFS improvement (HR 0.76, 95% CI 0.61-0.94) but not in OS (HR 0.86, 95% CI 0.7-1.06). Grade 3-5 AEs after NACT was estimated to be 31% (95% CI: 21-43%).

Conclusions: NACT did not significantly improve OS or DFS among all studies but studies using TPF/PF NACT demonstrated significant improvement in DFS but not OS. These results suggest potential survival benefit of NACT with TPF/PF regimens for patients with HNSCC.