Treatment of melanoma brain metastases with radiation and immunotherapy or targeted therapy: A systematic review with meta-analysis

Abstract

Background: Patients with melanoma brain metastases are now frequently treated with immunotherapy (IMT) or targeted therapy (TT). The aim of this systematic review was to determine relative survival outcomes after combining radiotherapy (RT) with IMT or TT.

Methods: 126 studies were identified by searching Medline, Embase and Cochrane CENTRAL (to 7Aug 2023).

Results: Multivariable analyses showed that the risk of death was reduced by 30 % for combined stereotactic radiosurgery (SRS)+IMT compared to IMT alone, by 65 % for patients treated with SRS+anti-PD1 and by 59 % for patients treated with SRS+anti-CTLA4 and/or anti-PD1 (HR 0.41, 95 %CI 0.31-0.54) compared to SRS alone. Four studies compared SRS+anti-CTLA4 with SRS+anti-PD1, showing a 42 % reduction in risk of death with SRS+anti-PD1 treatment. Combined treatment with SRS+TT showed a 59 % reduction in risk compared to SRS alone.

Conclusion: The systematic review suggests a substantial survival benefit for combining SRS with IMT or TT for patients with melanoma brain metastases.

Keywords: Brain metastases; Immunotherapy; Melanoma; Radiation therapy; Stereotactic radiosurgery.