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Meta-Analysis
. 2024 Oct:202:104462.
doi: 10.1016/j.critrevonc.2024.104462. Epub 2024 Aug 2.

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

Gabrielle J Williams  1 , Angela M Hong  2 , John F Thompson  3
Affiliations
Free article
Meta-Analysis

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

Gabrielle J Williams et al. Crit Rev Oncol Hematol. 2024 Oct.
Free article

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.

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Conflict of interest statement

Declaration of Competing Interest GJW has nothing to disclose. AMH has received honoraria for advisory board participation from Bayer, Oncobeta and Telix. JFT has received honoraria for advisory board participation from BMS Australia, MSD Australia, GSK and Provectus Biopharmaceuticals, and travel and conference support from GSK, Provectus Biopharmaceuticals and Novartis.

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