Abstract
OBJECTIVES: Checkpoint inhibitors have significantly improved outcomes in a number of malignancies. To determine the most effective course of treatment for head and neck squamous cell carcinoma (HNSCC), this systematic review evaluated the efficacy of several therapeutic approaches based on immune checkpoint inhibitors (ICIs). METHODS: A comprehensive evaluation of the literature was conducted, looking at randomized controlled trials (RCTs) that were published in Embase, PubMed, and the Cochrane Central Register of Controlled Trials since database establishment. The risk of bias of the enrolled studies was analyzed using The Review Manager (RevMan) 5.4. Using network meta-analyses (NMA), the relative treatment effects on overall survival (OS) and progression-free survival (PFS) from qualifying randomized controlled trials were synthesized and evaluated. RESULTS: Regarding OS, compared with nivolumab plus chemotherapy, chemotherapy (Hazard ratio (HR) = 2.1, 95% Confidence interval (CI): 1.2, 3.4) showed a treatment disadvantage. Meanwhile, nivolumab plus chemotherapy may represent the most efficient (57.89%) and has a lower cost among all the treatments enrolled in this study for advanced HNSCC. Regarding PFS, compared with nivolumab plus ipilimumab, nivolumab plus chemotherapy (HR = 0.4, 95% CI: 0.2, 0.8) showed treatment superiority. Additionally, nivolumab plus chemotherapy (77.18%) has the longest PFS among all interventions. CONCLUSION: Taking into account OS and PFS, the combination of nivolumab plus chemotherapy may appear to be the most effective option and is associated with a comparatively lower cost among all treatments included in this network meta-analysis, thereby recommending its use as a first-line therapy for HNSCC. REGISTRATION: INPLASY (2024070073).