Kristine E Mayer, Lydia Warburton, Anne Zaremba, Sarah Preis, Yannick Foerster, Tilo Biedermann, Oana-Diana Persa
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引用次数: 0
Abstract
Background: Immune-checkpoint inhibitor (ICI) therapy elicits durable responses in a subset of patients with advanced melanoma. However, the appropriate timing for treatment cessation remains an unresolved issue. Moreover, some patients are required to discontinue therapy due to the occurrence of severe adverse events. Upon treatment cessation, a subset of patients maintains a durable response, while some patients relapse and require rechallenge with ICI. Criteria for a safe stop of ICI have not been established.
Objectives: The aim of this systematic review and meta-analysis was to evaluate the durability of response in melanoma patients who discontinued ICI therapy. Furthermore, the outcome of patients who electively stopped therapy was compared to that of patients who discontinued therapy due to adverse events.
Methods: MEDLINE/PubMed, Embase and the Cochrane Library were searched for studies reporting outcomes after ICI discontinuation in patients with advanced melanoma. Pooled 1- to 3-year progression-free survival (PFS) and overall survival (OS) rates were estimated using random-effects models. The impact of the reason for treatment discontinuation, therapy regime and treatment duration on relapse-free survival was evaluated.
Results: Twenty studies including 1832 patients were analysed. The pooled 1- and 3-year PFS rates after therapy stop were 86% (95% CI 80%-91%) and 71% (95% CI 64%-77%). A significantly higher 1-year PFS rate was observed in patients who electively discontinued treatment in contrast to toxicity-related therapy cessation (91% vs. 79%). Longer ICI treatment was associated with a higher PFS rate. 1- and 3-year OS rates post ICI treatment discontinuation were 96% (95% CI 91%-99%) and 86% (95% CI 79%-92%).
Conclusions: Most patients remained relapse-free after ICI treatment. Patients with a treatment duration of at least 2 years are ideal candidates for treatment cessation, while treatment discontinuation may be considered after at least 1 year of ICI. PROSPERO number: CRD42024543781.
背景：免疫检查点抑制剂（ICI）治疗在晚期黑色素瘤患者中引起持久的反应。然而，停止治疗的适当时机仍然是一个未解决的问题。此外，一些患者因发生严重不良事件而需要停止治疗。在停止治疗后，一部分患者保持持久的反应，而一些患者复发并需要再次使用ICI。ICI安全停止的标准尚未建立。目的：本系统综述和荟萃分析的目的是评估停止ICI治疗的黑色素瘤患者反应的持久性。此外，选择性停止治疗的患者的结果与因不良事件而停止治疗的患者的结果进行了比较。方法：检索MEDLINE/PubMed、Embase和Cochrane图书馆中报告晚期黑色素瘤患者停药后结果的研究。使用随机效应模型估计1- 3年无进展生存期（PFS）和总生存期（OS）。评估停药原因、治疗方案和治疗时间对无复发生存期的影响。结果：共分析了20项研究，包括1832例患者。停药后1年和3年的总PFS率分别为86% （95% CI 80%-91%）和71% （95% CI 64%-77%）。选择性停止治疗的患者1年PFS率明显高于毒性相关停止治疗的患者（91%对79%）。较长的ICI治疗与较高的PFS率相关。ICI治疗停止后1年和3年的OS率分别为96% （95% CI 91%-99%）和86% （95% CI 79%-92%）。结论：大多数患者在ICI治疗后仍无复发。治疗持续时间至少2年的患者是停止治疗的理想人选，而ICI至少1年后可能会考虑停止治疗。普洛斯彼罗号码：CRD42024543781。
期刊介绍：
The Journal of the European Academy of Dermatology and Venereology (JEADV) is a publication that focuses on dermatology and venereology. It covers various topics within these fields, including both clinical and basic science subjects. The journal publishes articles in different formats, such as editorials, review articles, practice articles, original papers, short reports, letters to the editor, features, and announcements from the European Academy of Dermatology and Venereology (EADV).
The journal covers a wide range of keywords, including allergy, cancer, clinical medicine, cytokines, dermatology, drug reactions, hair disease, laser therapy, nail disease, oncology, skin cancer, skin disease, therapeutics, tumors, virus infections, and venereology.
The JEADV is indexed and abstracted by various databases and resources, including Abstracts on Hygiene & Communicable Diseases, Academic Search, AgBiotech News & Information, Botanical Pesticides, CAB Abstracts®, Embase, Global Health, InfoTrac, Ingenta Select, MEDLINE/PubMed, Science Citation Index Expanded, and others.
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