Metastatic melanoma: Cochrane review compares systemic therapies

  • Pasquali S & al.
  • Cochrane Database Syst Rev
  • 6 Feb 2018

  • from Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • A Cochrane review of randomized controlled trials (RCTs) concludes that several systemic treatments for metastatic melanoma offer better efficacy than chemotherapy.

Why this matters

  • Review addresses the many new therapeutic options for metastatic melanoma.

Key results

  • Compared with chemotherapy alone, anti-PD1 antibodies (HR, 0.42; 95% CI, 0.37-0.48), BRAF inhibitors (HR, 0.40; 95% CI, 0.28-0.57), and antiangiogenic drugs plus chemotherapy (HR, 0.60; 95% CI, 0.45-0.81) were associated with improved OS.
  • Compared with chemotherapy alone, biochemotherapy (HR, 0.90; 95% CI, 0.83-0.99), anti-CTLA4 antibodies (HR, 0.76; 95% CI, 0.63-0.92), anti-PD1 antibodies (HR, 0.49; 95% CI, 0.39-0.61), BRAF inhibitors (HR, 0.27; 95% CI, 0.21-0.34), MEK inhibitors (HR, 0.5; 95% CI, 0.42-0.80), and antiangiogenic drugs plus chemotherapy (HR, 0.69; 95% CI, 0.52-0.92) were associated with improved PFS.
  • Polychemotherapy was not associated with improved OS (HR, 0.99; 95% CI, 0.85-1.16) or PFS (HR, 1.07; 95% CI, 0.91-1.25) compared with chemotherapy.
  • Network meta-analysis-based ranking suggested that BRAF plus MEK inhibitors is the most effective strategy for PFS. 

Study design

  • 28,561 participants from 122 RCTs were included, with 83 RCTs subjected to meta-analysis to rank treatments according to effectiveness and safety.
  • Funding: National Institute for Health Research.

Limitations

  • Some imprecision, between-study heterogeneity, and substandard reporting in trials.