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metastatic-recurrent HNSCC (mHNSCC), pembrolizumab alone , 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) 0.82 [0.72, 0.93]< 10%2 studies (2/-)99.9 %some concernnot evaluable moderatecrucial-
deaths (OS) (extension) 0.74 [0.61, 0.90]< 10%1 study (1/-)99.9 %NAnot evaluable important-
progression or deaths (PFS) 1.14 [0.82, 1.58]< 185%2 studies (2/-)22.0 %some concernnot evaluable moderateimportant-
objective responses (ORR) 0.73 [0.18, 2.99]> 194%2 studies (2/-)33.3 %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 leading to death (grade 5) 0.84 [0.48, 1.48]< 10%1 study (1/-)72.6 %NAnot evaluable non important-
AE leading to treatment discontinuation (any grade) 0.36 [0.23, 0.55]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
TRAE (any grade) 0.12 [0.02, 0.87]< 196%2 studies (2/-)98.2 %some concernnot evaluable moderatenon important-
TRAE (grade 3-4) 0.15 [0.06, 0.39]< 190%2 studies (2/-)100.0 %some concernnot evaluable moderatenon important-
TRAE leading to death (grade 5) 0.75 [0.14, 3.93]< 157%2 studies (2/-)63.1 %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) 1.42 [0.11, 18.53]< 10%2 studies (2/-)39.6 %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) 0.05 [0.02, 0.17]< 10%2 studies (2/-)100.0 %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) 0.19 [0.04, 0.88]< 10%2 studies (2/-)98.3 %some concernnot evaluable moderatenon important-
Blood and lymphatic system disorders TRAE (grade 3-4) 0.03 [0.01, 0.07]< 10%2 studies (2/-)100.0 %some concernnot evaluable moderatenon important-
Blood creatinine increased TRAE (grade 3-4) 0.95 [0.06, 15.29]< 10%2 studies (2/-)51.3 %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) 0.96 [0.16, 5.54]< 10%2 studies (2/-)52.0 %some concernnot evaluable moderatenon important-
Constipation TRAE (grade 3-4) 0.64 [0.05, 8.37]< 10%2 studies (2/-)63.2 %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) 0.34 [0.02, 4.81]< 147%2 studies (2/-)78.7 %some concernnot evaluable moderatenon important-
Diarrhoea TRAE (grade 3-4) 0.85 [0.04, 16.24]< 173%2 studies (2/-)54.4 %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) 3.56 [0.38, 33.73]< 10%2 studies (2/-)13.6 %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) 0.64 [0.09, 4.64]< 171%2 studies (2/-)66.8 %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) 0.33 [0.11, 0.97]< 166%2 studies (2/-)97.8 %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) 2.86 [0.29, 28.34]< 10%2 studies (2/-)18.6 %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) 1.42 [0.11, 18.53]< 10%2 studies (2/-)39.6 %some concernnot evaluable moderatenon important-
Hypophysitis TRAE (grade 3-4) 1.92 [0.06, 57.35]< 10%1 study (1/-)35.6 %NAnot evaluable non important-
Hypothyroidism TRAE (grade 3-4) 1.91 [0.06, 57.09]< 10%1 study (1/-)35.7 %NAnot evaluable non 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) 0.37 [0.08, 1.63]< 10%2 studies (2/-)90.5 %some concernnot evaluable moderatenon important-
Leucopenia TRAE (grade 3-4) 0.04 [0.01, 0.32]< 10%2 studies (2/-)99.9 %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) 0.28 [0.16, 0.50]< 10%2 studies (2/-)100.0 %some concernnot evaluable moderatenon important-
Mucosal inflammation TRAE (grade 3-4) 0.15 [0.04, 0.50]< 10%2 studies (2/-)99.9 %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) 0.96 [0.02, 48.37]< 10%1 study (1/-)50.9 %NAnot evaluable non important-
Myositis TRAE (grade 3-4) 0.48 [0.02, 14.29]< 10%1 study (1/-)66.3 %NAnot evaluable non important-
Nausea TRAE (grade 3-4) 0.10 [0.01, 1.53]< 136%2 studies (2/-)95.0 %some concernnot evaluable moderatenon important-
Nephritis TRAE (grade 3-4) 3.85 [0.17, 85.65]< 10%1 study (1/-)20.0 %NAnot evaluable non 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) 0.02 [0.00, 0.13]< 114%2 studies (2/-)100.0 %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) 0.96 [0.02, 48.37]< 10%1 study (1/-)50.9 %NAnot evaluable non 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) 1.89 [0.46, 7.82]< 10%2 studies (2/-)18.9 %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) 0.23 [0.03, 1.77]< 146%2 studies (2/-)92.0 %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) 0.36 [0.17, 0.76]< 10%2 studies (2/-)99.6 %some concernnot evaluable moderatenon important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 0.31 [0.08, 1.15]< 10%1 study (1/-)95.9 %NAnot evaluable non 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) 0.07 [0.01, 0.36]< 10%2 studies (2/-)99.9 %some concernnot evaluable moderatenon important-
Thrombocytopenia TRAE (grade 3-4) 0.05 [0.01, 0.26]< 10%2 studies (2/-)100.0 %some concernnot evaluable moderatenon important-
Thyroiditis TRAE (grade 3-4) 0.96 [0.02, 48.37]< 10%1 study (1/-)50.9 %NAnot evaluable non important-
Uveitis TRAE (grade 3-4) 0.96 [0.02, 48.37]< 10%1 study (1/-)50.9 %NAnot evaluable non 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) 0.09 [0.01, 1.73]< 10%1 study (1/-)94.2 %NAnot evaluable non important-
Weight decreased TRAE (grade 3-4) 0.95 [0.10, 9.21]< 10%2 studies (2/-)51.6 %some concernnot evaluable moderatenon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 0.19 [0.02, 1.62]< 10%1 study (1/-)93.4 %NAnot evaluable non important-
Acute kidney injury AE (grade 3-4) 1.93 [0.35, 10.60]< 10%1 study (1/-)22.7 %NAnot evaluable non important-
Anaemia AE (grade 3-4) 0.24 [0.13, 0.44]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Asthenia AE (grade 3-4) 0.31 [0.08, 1.16]< 10%1 study (1/-)95.8 %NAnot evaluable non 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) 0.10 [0.06, 0.18]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Decreased appetite AE (grade 3-4) 0.28 [0.08, 1.03]< 10%1 study (1/-)97.2 %NAnot evaluable non important-
Diarrhoea AE (grade 3-4) 0.23 [0.05, 1.11]< 10%1 study (1/-)96.6 %NAnot evaluable non 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) 2.26 [0.58, 8.83]< 10%1 study (1/-)12.1 %NAnot evaluable non important-
Fatigue AE (grade 3-4) 0.60 [0.26, 1.42]< 10%1 study (1/-)87.7 %NAnot evaluable non important-
Febrile neutropenia AE (grade 3-4) 0.03 [0.00, 0.47]< 10%1 study (1/-)99.3 %NAnot evaluable non important-
Gastrointestinal disorders AE (grade 3-4) 0.33 [0.20, 0.56]< 10%1 study (1/-)100.0 %NAnot evaluable non 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.