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. 2012;17(11):1376-85.
doi: 10.1634/theoncologist.2011-0427. Epub 2012 Sep 28.

Systematic review and network meta-analysis of overall survival comparing 3 mg/kg ipilimumab with alternative therapies in the management of pretreated patients with unresectable stage III or IV melanoma

Pascale Dequen  1 , Paul Lorigan, Jeroen P Jansen, Marc van Baardewijk, Mario J N M Ouwens, Srividya Kotapati
Affiliations

Systematic review and network meta-analysis of overall survival comparing 3 mg/kg ipilimumab with alternative therapies in the management of pretreated patients with unresectable stage III or IV melanoma

Pascale Dequen et al. Oncologist. 2012.

Abstract

Objective: To compare the overall survival (OS) of patients treated with 3 mg/kg ipilimumab versus alternative systemic therapies in pretreated unresectable stage III or IV melanoma patients.

Methods: A systematic literature search was performed to identify relevant randomized clinical trials. From these trials, Kaplan-Meier survival curves for each intervention were digitized and combined by means of a Bayesian network meta-analysis (NMA) to compare different drug classes.

Results: Of 38 trials identified, 15 formed one interlinked network by drug class to allow for an NMA. Ipilimumab, at a dose of 3 mg/kg, was associated with a greater mean OS time (18.8 months; 95% credible interval [CrI], 15.5-23.0 months) than single-agent chemotherapy (12.3 months; 95% CrI, 6.3-28.0 months), chemotherapy combinations (12.2 months; 95% CrI, 7.1-23.3 months), biochemotherapies (11.9 months; 95% CrI, 7.0-22.0 months), single-agent immunotherapy (11.1 months; 95% CrI, 8.5-16.2 months), and immunotherapy combinations (14.1 months; 95% CrI, 9.0-23.8 months).

Conclusion: Results of this NMA were in line with previous findings and suggest that OS with ipilimumab is expected to be greater than with alternative systemic therapies, alone or in combination, for the management of pretreated patients with unresectable stage III or IV melanoma.

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Conflict of interest statement

Disclosures: Pascale Dequen: Bristol-Myers Squibb (C/A); Mapi Group (E); Paul Lorigan: Bristol-Myers Squibb, Roche, GlaxoSmithKline (C/A); Bristol-Myers Squibb, Roche (H, Expert Testimony); Jeroen P. Jansen: Bristol-Myers Squibb (C/A); Mapi Group (E); Marc van Baardewijk: Bristol-Myers Squibb (E, OI); Mario J.N.M. Ouwens: Bristol-Myers Squibb (C/A); Mapi Group (E); Srividya Kotapati: Bristol-Myers Squibb (E).

Figures

Figure 1.
Figure 1.
Network of 15 studies included in network meta-analysis based on treatment class.
Figure 2.
Figure 2.
Hazard ratio of 3 mg/kg ipilimumab (IPI 3) versus other drug classes, fixed effects Gompertz network meta-analysis model. Dotted lines reflect the 95% credible limits (low and high) of the same colored solid hazard ratio curves.
Figure 3.
Figure 3.
Survival probability over time as obtained with fixed-effects Gompertz network meta-analysis model. Dotted black lines reflect the 95% credible limits (low and high) of the 3 mg/kg ipilimumab (IPI 3) solid black survival curve. High and low estimates for Kaplan–Meier curves are only included for IPI 3 to ensure readability of the figure.
Figure 4.
Figure 4.
Probability of greatest survival benefit over time with each treatment as obtained with fixed effects Gompertz network meta-analysis model. Abbreviation: IPI, ipilimumab.
See this image and copyright information in PMC

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