The Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) Study

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC):
    • Is an individual patient data analysis intended to evaluate the role of chemotherapy in head and neck cancers
    • It is known for its rigorous process for quality data collection and its large ongoing data- base
    • Results of indirect comparisons were not limited to evaluation of survival advantage:
      • But an estimate of the interaction between the treatment effects and the timing of chemotherapy as adjuvant, concurrent, neoadjuvant, or induction was made possible (Pignon and Bourhis, 1995 Oct)
    • Since the first reports of MACH-NC:
      • Results demonstrated an:
        • 8.6% benefit of cause-specific survival (CSS) at 5 years, hazard ratio, 0.81; 95% CI, 0.78–0.86; P = 0.001):
          • For concurrent chemoradiation (CCRT):
            • While systemic chemotherapy in the setting of induction or adjuvant did not show OS advantage
        • Nevertheless, the magnitude of the overall response rate of induction chemotherapy (IC) with the PF regimen (cisplatin 100 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2 daily for 5 days):
          • Was high and ranged from 57% to 80%, with a complete response rate of 19% to 48%
        • Analyses on the subset of 15 trials who received PF:
          • Showed a modest improvement in OS compared to CCRT (HR, 0.90; 95% CI, 0.82–0.99):
            • Which is a survival gain equal to 5% at 5 years
        • In the MACH-NC a subset analysis of 16 IC trials with non-PF combinations:
          • Did not show survival benefit with these IC regimens:
            • Which is attributed to the low dose of ineffective regimens that were administered for a duration not long enough:
              • Here, PF showed more adequate responses in comparison with non-PF trials:
                • Which reflects the nature of PF as a more potent drug combination for the most common administered schedules (Pignon et al., 2009; Monnerat et al., 2002):
                  • So, in particular PF became the dominant induction regimen for years
#Arrangoiz #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSCM #Miami #Mexico #HeadandNeckCancer
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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