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内容記述 |
Objective
To compare the efficacy and toxicity of four treatment strategies in patients with melanoma brain metastases (MBMs).
Methods
A systematic literature search of the Cochrane, PubMed, Embase, Web of Science, and OVID Medline databases was performed until July 24, 2024. A total of four therapeutic modalities for MBM, including immune checkpoint inhibitor (ICI) monotherapy, radiotherapy (RT) alone, ICI combined with RT (ICI + RT), and dual ICI therapy (ICI + ICI) were evaluated by the overall survival (OS), intracranial progression-free survival (iPFS), and adverse effect (AE). The Meta-analysis was performed using R language and registered in PROSPERO (registration no. CRD42023480912).
Results
This study included 33 studies comprising 2,496 patients with MBM. Our results indicated that ICI combined with RT and dual ICI therapy improved the 6-month and 12-month OS rates compared with ICI monotherapy and RT alone. Similar results were observed for iPFS, with the combination treatment group showing a significant difference compared with the treatment group alone, whereas no significant difference was observed in OS or iPFS between the RT + ICI group and the ICI + ICI group. Furthermore, the survival advantages of combination therapy gradually decreased with increasing duration of treatment. Additionally, compared with ICI monotherapy, dual ICI therapy significantly increased the incidence of AEs over grade 3 (ICI + ICI: 57% vs. ICI: 11%, P < 0.0001), whereas ICI combined with RT did not significantly differ (ICI + RT: 19% vs. ICI: 11%, P = 0.21).
Conclusion
Compared with the other three treatment strategies, the combination of ICI with RT offers superior survival benefits without increasing toxicity in patients with MBM. However, this survival benefit decreases over time, and further optimizing the treatment strategy is essential for improving the outcomes of patients with MBM. |
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