Abstract 4098: Comparison of frontline therapeutic modalities in stages I/IE extranodal NK/T-cell lymphoma-nasal type (ENKTL-N): A network meta-analysis

Abstract

Abstract Introduction: Despite many studies reporting on the optimal therapies for early stage ENKTL-N in the front-line setting, this area continues to be subject to significant controversy regarding single modalities versus combination or sequential approaches. All these comparative studies were small non-randomized studies that combined stages I & II. The results were often inconclusive and occasionally conflicting. In the absence of direct head-to-head randomized controlled trials in this clinical setting, a network meta-analysis was conducted to compare these therapeutic approaches and their respective impact on 5-year survival in stage I/IE ENKTL-N. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language, diagnosis of stage I/IE ENKTL-N, treatment with chemotherapy (CT), radiation (RT), sequential CT and RT (SEQ), and chemoradiotherapy (CRT), comparative studies that reported predominantly I/IE 5-year survival and disease-free survival rates. Studies that reported on mixed samples of early and advanced ENKTL were excluded. A frequentist network meta-analysis was conducted using the netmeta package and random-effects model. Results: Seven studies comprising a total of 377 participants were included. Our network meta-analysis revealed that upfront RT tended to have better 5-year OS and DFS than CRT and SEQ, though it did not reach statistical significance. However, RT demonstrated significant 5-year OS and DFS when compare to CT alone in the frontline setting. Based on the pairwise and network meta-analyses, RT was ranked as the most effective first-line treatment approach followed by CRT, SEQ, and CT in decreasing order. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusions: This is the first network meta-analysis to compare all commonly utilized upfront treatment modalities in stages I/IE ENKTL-N. It indicates that upfront RT alone may be sufficient as there was no signal that chemotherapy added any OS or DFS advantages. Adequately powered randomized trials are warranted. Citation Format: Philip A. Haddad, Kevin Gallagher, Dalia Hammoud. Comparison of frontline therapeutic modalities in stages I/IE extranodal NK/T-cell lymphoma-nasal type (ENKTL-N): A network meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4098.