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head and neck cancer squamous cell cancer (HNSCC), pembrolizumab based treatment , meta-analysis of study results

Outcome Relative effect 95%CI LoD Trt. better when I2 k (RCT/OBS) Bayesian probability Overall ROB Publication bias Degree of certainty Endpoint importance Published MA

efficacy endpoints 00

deaths (OS) 0.80 [0.72, 0.89]< 10%3 studies (3/-)100.0 %some concernnot evaluable moderatecrucial-
deaths (OS) (extension) 0.73 [0.64, 0.83]< 10%2 studies (2/-)100.0 %some concernnot evaluable moderateimportant-
progression or deaths (PFS) 1.06 [0.83, 1.35]< 181%3 studies (3/-)31.7 %some concernnot evaluable moderateimportant-
objective responses (ORR) 0.80 [0.36, 1.78]> 191%3 studies (3/-)29.3 %some concernnot evaluable moderatenon important-

safety endpoints 00

AE (any grade) 0.31 [0.22, 0.44]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
AE (grade 3-4) 1.00 [0.69, 1.46]< 10%1 study (1/-)49.7 %NAnot evaluable non important-
AE leading to death (grade 5) 1.02 [0.69, 1.50]< 10%2 studies (2/-)46.1 %some concernnot evaluable moderatenon important-
AE leading to treatment discontinuation (any grade) 0.68 [0.20, 2.35]< 195%2 studies (2/-)72.8 %some concernnot evaluable moderatenon important-
TRAE (any grade) 0.22 [0.05, 0.93]< 193%3 studies (3/-)98.0 %some concernnot evaluable moderatenon important-
TRAE (grade 3-4) 0.29 [0.06, 1.37]< 198%3 studies (3/-)94.0 %some concernnot evaluable moderatenon important-
TRAE leading to death (grade 5) 0.99 [0.37, 2.63]< 143%3 studies (3/-)50.9 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (any grade) 1.20 [0.55, 2.62]< 10%1 study (1/-)32.3 %NAnot evaluable non important-
TRAE leading to discontinuation (grade 3-4) 1.28 [0.53, 3.10]< 10%1 study (1/-)29.1 %NAnot evaluable non important-

TRAE (grade 3-4) endpoints 00

Acute kidney injury TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non important-
Adrenal insufficiency TRAE (grade 3-4) 1.29 [0.15, 11.09]< 10%3 studies (3/-)40.8 %some concernnot evaluable moderatenon important-
Alopecia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Anaemia TRAE (grade 3-4) 0.19 [0.01, 2.67]< 193%3 studies (3/-)88.9 %some concernnot evaluable moderatenon important-
Arthralgia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Asthenia TRAE (grade 3-4) 0.47 [0.12, 1.88]< 147%3 studies (3/-)85.8 %some concernnot evaluable moderatenon important-
Blood and lymphatic system disorders TRAE (grade 3-4) 0.12 [0.01, 2.59]< 197%3 studies (3/-)91.0 %some concernnot evaluable moderatenon important-
Blood creatinine increased TRAE (grade 3-4) 1.30 [0.15, 11.18]< 10%3 studies (3/-)40.5 %some concernnot evaluable moderatenon important-
Cardiac disorders TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Chills TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Colitis TRAE (grade 3-4) 0.99 [0.27, 3.68]< 10%3 studies (3/-)50.5 %some concernnot evaluable moderatenon important-
Constipation TRAE (grade 3-4) 0.74 [0.09, 6.36]< 10%3 studies (3/-)60.7 %some concernnot evaluable moderatenon important-
Cough TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Decreased appetite TRAE (grade 3-4) 0.71 [0.11, 4.40]< 161%3 studies (3/-)64.4 %some concernnot evaluable moderatenon important-
Diarrhoea TRAE (grade 3-4) 0.74 [0.16, 3.32]< 147%3 studies (3/-)65.5 %some concernnot evaluable moderatenon important-
Dyspepsia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Dyspnoea TRAE (grade 3-4) 3.83 [0.17, 85.33]< 10%1 study (1/-)20.1 %NAnot evaluable non important-
Endocrine disorders TRAE (grade 3-4) 3.02 [0.46, 19.73]< 10%3 studies (3/-)12.5 %some concernnot evaluable moderatenon important-
Epistaxis TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Eye disorders TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 0.98 [0.26, 3.68]< 172%3 studies (3/-)51.4 %some concernnot evaluable moderatenon important-
Febrile neutropenia TRAE (grade 3-4) 0.05 [0.00, 0.79]< 10%1 study (1/-)98.2 %NAnot evaluable non important-
Gastritis TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Gastrointestinal disorders TRAE (grade 3-4) 0.17 [0.03, 0.80]< 178%2 studies (2/-)98.7 %some concernnot evaluable moderatenon important-
General disorders and administration site conditions TRAE (grade 3-4) 0.61 [0.15, 2.52]< 190%3 studies (3/-)75.2 %some concernnot evaluable moderatenon important-
Guillain-Barré syndrome TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non important-
Headache TRAE (grade 3-4) 0.47 [0.02, 14.21]< 10%1 study (1/-)66.4 %NAnot evaluable non important-
Hepatitis TRAE (grade 3-4) 2.59 [0.39, 17.34]< 10%3 studies (3/-)16.4 %some concernnot evaluable moderatenon important-
Hepatobiliary disorders TRAE (grade 3-4) 0.95 [0.06, 15.29]< 10%1 study (1/-)51.4 %NAnot evaluable non important-
Hypersensitivity TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Hypertension TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Hyperthyroidism TRAE (grade 3-4) 1.29 [0.15, 11.09]< 10%3 studies (3/-)40.8 %some concernnot evaluable moderatenon important-
Hypophysitis TRAE (grade 3-4) 2.00 [0.18, 22.10]< 10%2 studies (2/-)28.8 %some concernnot evaluable moderatenon important-
Hypothyroidism TRAE (grade 3-4) 1.47 [0.11, 19.19]< 10%2 studies (2/-)38.5 %some concernnot evaluable moderatenon important-
Increase AST TRAE (grade 3-4) 0.31 [0.03, 3.04]< 10%1 study (1/-)84.0 %NAnot evaluable non important-
Increased ALT TRAE (grade 3-4) 0.16 [0.01, 3.15]< 10%1 study (1/-)88.4 %NAnot evaluable non important-
Infusion-related reactions TRAE (grade 3-4) 0.36 [0.12, 1.06]< 10%3 studies (3/-)96.8 %some concernnot evaluable moderatenon important-
Leucopenia TRAE (grade 3-4) 0.15 [0.02, 1.03]< 160%3 studies (3/-)97.3 %some concernnot evaluable moderatenon important-
Maculopapular rash TRAE (grade 3-4) 0.47 [0.02, 14.21]< 10%1 study (1/-)66.4 %NAnot evaluable non important-
Metabolism and nutrition disorders TRAE (grade 3-4) 0.47 [0.19, 1.17]< 179%3 studies (3/-)94.8 %some concernnot evaluable moderatenon important-
Mucosal inflammation TRAE (grade 3-4) 0.42 [0.05, 3.31]< 185%3 studies (3/-)79.5 %some concernnot evaluable moderatenon important-
Musculoskeletal and connective tissue disorders TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non important-
Myalgia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Myocarditis TRAE (grade 3-4) 1.49 [0.11, 19.48]< 10%2 studies (2/-)38.1 %some concernnot evaluable moderatenon important-
Myositis TRAE (grade 3-4) 0.50 [0.05, 5.51]< 10%2 studies (2/-)71.4 %some concernnot evaluable moderatenon important-
Nausea TRAE (grade 3-4) 0.31 [0.03, 2.80]< 165%3 studies (3/-)85.1 %some concernnot evaluable moderatenon important-
Nephritis TRAE (grade 3-4) 2.32 [0.20, 26.51]< 10%2 studies (2/-)25.0 %some concernnot evaluable moderatenon important-
Nervous system disorders TRAE (grade 3-4) 0.47 [0.04, 5.26]< 10%1 study (1/-)72.7 %NAnot evaluable non important-
Neutropenia TRAE (grade 3-4) 0.08 [0.00, 1.60]< 189%3 studies (3/-)94.9 %some concernnot evaluable moderatenon important-
Palmar-plantar erythrodysaesthesia syndrome TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Pancreatitis TRAE (grade 3-4) 1.49 [0.11, 19.48]< 10%2 studies (2/-)38.1 %some concernnot evaluable moderatenon important-
Pancytopenia TRAE (grade 3-4) 0.16 [0.01, 3.15]< 10%1 study (1/-)88.4 %NAnot evaluable non important-
Paraesthesia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Peripheral oedema TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non important-
Pneumonitis TRAE (grade 3-4) 2.18 [0.74, 6.38]< 10%3 studies (3/-)7.8 %some concernnot evaluable moderatenon important-
Pruritic rash TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Pruritus generalised TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Pruritus TRAE (grade 3-4) 0.24 [0.01, 5.27]< 10%1 study (1/-)81.6 %NAnot evaluable non important-
Pyrexia TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Rash TRAE (grade 3-4) 0.13 [0.04, 0.50]< 125%3 studies (3/-)99.9 %some concernnot evaluable moderatenon important-
Renal and urinary disorders TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 1.44 [0.40, 5.16]< 10%1 study (1/-)28.9 %NAnot evaluable non important-
Sepsis TRAE (grade 3-4) 0.24 [0.01, 5.27]< 10%1 study (1/-)81.6 %NAnot evaluable non important-
Severe skin reaction TRAE (grade 3-4) 0.27 [0.12, 0.61]< 130%3 studies (3/-)99.9 %some concernnot evaluable moderatenon important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 0.17 [0.06, 0.50]< 127%2 studies (2/-)99.9 %some concernnot evaluable moderatenon important-
Skin exfoliation TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Stevens-Johnson syndrome TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Stomatitis TRAE (grade 3-4) 0.26 [0.02, 4.41]< 186%3 studies (3/-)82.3 %some concernnot evaluable moderatenon important-
Thrombocytopenia TRAE (grade 3-4) 0.18 [0.02, 2.20]< 183%3 studies (3/-)90.8 %some concernnot evaluable moderatenon important-
Thyroiditis TRAE (grade 3-4) 1.00 [0.06, 15.99]< 10%2 studies (2/-)50.1 %some concernnot evaluable moderatenon important-
Uveitis TRAE (grade 3-4) 1.00 [0.06, 15.99]< 10%2 studies (2/-)50.1 %some concernnot evaluable moderatenon important-
Vascular disorders TRAE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Vomiting TRAE (grade 3-4) 0.52 [0.04, 7.08]< 166%2 studies (2/-)68.6 %some concernnot evaluable moderatenon important-
Weight decreased TRAE (grade 3-4) 1.38 [0.26, 7.18]< 10%3 studies (3/-)35.2 %some concernnot evaluable moderatenon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 0.31 [0.08, 1.14]< 10%2 studies (2/-)96.1 %some concernnot evaluable moderatenon important-
Acute kidney injury AE (grade 3-4) 2.26 [0.69, 7.40]< 10%2 studies (2/-)8.9 %some concernnot evaluable moderatenon important-
Anaemia AE (grade 3-4) 0.64 [0.10, 4.24]< 196%2 studies (2/-)67.9 %some concernnot evaluable moderatenon important-
Asthenia AE (grade 3-4) 0.62 [0.19, 2.01]< 153%2 studies (2/-)78.5 %some concernnot evaluable moderatenon important-
Back pain AE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Blood and lymphatic system disorders AE (grade 3-4) 0.38 [0.03, 4.87]< 199%2 studies (2/-)76.8 %some concernnot evaluable moderatenon important-
Decreased appetite AE (grade 3-4) 0.67 [0.14, 3.15]< 175%2 studies (2/-)69.3 %some concernnot evaluable moderatenon important-
Diarrhoea AE (grade 3-4) 0.56 [0.13, 2.37]< 160%2 studies (2/-)78.4 %some concernnot evaluable moderatenon important-
Dizziness AE (grade 3-4) 0.95 [0.02, 48.13]< 10%1 study (1/-)51.0 %NAnot evaluable non important-
Dyspnoea AE (grade 3-4) 1.82 [0.66, 4.99]< 10%2 studies (2/-)12.3 %some concernnot evaluable moderatenon important-
Fatigue AE (grade 3-4) 0.99 [0.40, 2.45]< 163%2 studies (2/-)50.8 %some concernnot evaluable moderatenon important-
Febrile neutropenia AE (grade 3-4) 0.27 [0.01, 13.91]< 187%2 studies (2/-)73.8 %some concernnot evaluable moderatenon important-

LoD: level of statistical demonstration: Statistically conclusive: statistically significant with a strict control of overall risk of type 1 error (statistically demonstrated), does not take into account the risk of bias; suggested: nominally statistically significant but without a strict control of overall risk of type 1 error; inconclusive: not nominally statistically significant; safety concerns;
Bayesian probability: Bayesian posterior probability of treatment effect (computed with a noninformative prior); ROB: risk of bias; k: number of studies; published MA: number of published meta-analysis on the same topic; degree of certainty adapted from GRADE. Trt. better when: indicates when the relative treatment effect shows that the studied treatment is better than control.