Network meta-analysis of pembrolizumab as monotherapy and in combination with chemotherapy for first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma

Authors

  • Ali Mojebi Evidence Synthesis, PRECISIONheor, Vancouver, BC, Canada.
  • Karthik Ramakrishnan Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA.
  • Dieter Ayers Evidence Synthesis, PRECISIONheor, Vancouver, BC, Canada.
  • Sam Keeping Evidence Synthesis, PRECISIONheor, Vancouver, BC, Canada.
  • Rebekah Borse Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA.
  • Diana Chirovsky Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA.

DOI:

https://doi.org/10.21115/JBES.v16.n1.p25-64

Keywords:

head and neck squamous cell carcinoma, first-line, pembrolizumab, KEYNOTE-048, immuno-oncology, network meta-analysis

Abstract

Pembrolizumab monotherapy or in combination with chemotherapy is approved as first-line treatment in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) based on improved overall survival (OS) versus EXTREME regimen in the KEYNOTE-048 trial. The clinical outcomes of pembrolizumab were compared with other recommended first-line treatments in R/M HNSCC in this study through a Bayesian network meta-analysis. A systematic literature review was conducted in July 2022, from which six trials that matched the KEYNOTE-048 patient eligibility criteria were included in the network. The OS and progression-free survival (PFS) outcomes were compared in the approved pembrolizumab indication (i.e., total population for pembrolizumab in combination with chemotherapy and combined positive score [CPS] ≥ 1 population for pembrolizumab monotherapy). A significant OS improvement was observed for pembrolizumab in combination with chemotherapy and pembrolizumab monotherapy versus EXTREME regimen (hazard ratio, 95% credible interval: 0.72, 0.60-0.86; 0.73, 0.60-0.88), platinum+5- FU (0.58, 0.43-0.76; 0.58, 0.44-0.78), and platinum+paclitaxel (0.53, 0.35-0.79; 0.53, 0.35-0.81), respectively. A non-significant numeric trend in OS improvement was observed versus the TPEx regimen. PFS was comparable with most first-line treatments and was improved versus platinum+5-FU (0.48, 0.36-0.64; 0.59, 0.45-0.79). Additional analyses in higher CPS subgroups also showed consistent results. Overall, our study results showed an improvement in OS outcomes versus alternative first-line treatments, consistent with the findings of the KEYNOTE-048 trial. These data support using pembrolizumab as a suitable firstline treatment option in R/M HNSCC.

Downloads

Download data is not yet available.

Downloads

Published

2024-05-06

How to Cite

Mojebi, A., Ramakrishnan, K., Ayers, D., Keeping, S., Borse, R., & Chirovsky, D. (2024). Network meta-analysis of pembrolizumab as monotherapy and in combination with chemotherapy for first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma. Jornal Brasileiro De Economia Da Saúde, 16(1), 25–64. https://doi.org/10.21115/JBES.v16.n1.p25-64

Issue

Section

Artigos