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

IF 5.5 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2024-08-02 DOI:10.1016/j.critrevonc.2024.104462

Gabrielle J. Williams , Angela M. Hong , John F. Thompson

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引用次数: 0

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.

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用放射线和免疫疗法或靶向疗法治疗黑色素瘤脑转移：系统综述与荟萃分析。

背景：目前，黑色素瘤脑转移患者经常接受免疫疗法（IMT）或靶向疗法（TT）治疗。方法：通过检索Medline、Embase和Cochrane CENTRAL（至2023年8月7日），确定了126项研究：多变量分析显示，与单纯IMT相比，联合立体定向放射手术（SRS）+IMT的死亡风险降低了30%；与单纯SRS相比，SRS+抗PD1治疗的患者死亡风险降低了65%；与单纯SRS相比，SRS+抗CTLA4和/或抗PD1治疗的患者死亡风险降低了59%（HR 0.41，95%CI 0.31-0.54）。四项研究比较了SRS+抗-CTLA4与SRS+抗-PD1，结果显示SRS+抗-PD1治疗的死亡风险降低了42%。与单纯SRS相比，SRS+TT联合治疗的风险降低了59%：系统综述表明，对黑色素瘤脑转移患者而言，将SRS与IMT或TT联合治疗可大大提高生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.