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Immune Checkpoint Inhibitor with or without Radiotherapy in Melanoma Patients with Brain Metastases: A Systematic Review and Meta-Analysis

Korean Journal of Radiology 2021년 22권 4호 p.584 ~ 595
김평화, 서종현, 김호성, 김경원, 김동영, Lee Eudocia Q., Aizer Ayal A., Guenette Jeffrey P., Huang Raymond Y.,
소속 상세정보
김평화 ( Kim Pyeong-Hwa ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
서종현 ( Suh Chong-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김호성 ( Kim Ho-Sung ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김경원 ( Kim Kyung-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김동영 ( Kim Dong-Yeong ) - Incheon Airport National Quarantine Station
 ( Lee Eudocia Q. ) - Harvard Medical School Dana-Farber Cancer Institute Center for Neuro-Oncology
 ( Aizer Ayal A. ) - Harvard Medical School Brigham and Women’s Hospital Department of Radiation Oncology
 ( Guenette Jeffrey P. ) - Harvard Medical School Brigham and Women’s Hospital Department of Radiology
 ( Huang Raymond Y. ) - Harvard Medical School Brigham and Women’s Hospital Department of Radiology

Abstract


Objective: Immune checkpoint inhibitor (ICI) therapy has shown activity against melanoma brain metastases. Recently, promising results have also been reported for ICI combination therapy and ICI combined with radiotherapy. We aimed to evaluate radiologic response and adverse event rates of these therapeutic options by a systematic review and meta-analysis.

Materials and Methods: A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to October 12, 2019 and included studies evaluating the intracranial objective response rates (ORRs) and/or disease control rates (DCRs) of ICI with or without radiotherapy for treating melanoma brain metastases. We also evaluated safety-associated outcomes.

Results: Eleven studies with 14 cohorts (3 with ICI combination therapy; 5 with ICI combined with radiotherapy; 6 with ICI monotherapy) were included. ICI combination therapy {pooled ORR, 53% (95% confidence interval [CI], 44?61%); DCR, 57% (95% CI, 49?66%)} and ICI combined with radiotherapy (pooled ORR, 42% [95% CI, 31?54%]; DCR, 85% [95% CI, 63?95%]) showed higher local efficacy compared to ICI monotherapy (pooled ORR, 15% [95% CI, 11?20%]; DCR, 26% [95% CI, 21?32%]). The grade 3 or 4 adverse event rate was significantly higher with ICI combination therapy (60%; 95% CI, 52?67%) compared to ICI monotherapy (11%; 95% CI, 8?17%) and ICI combined with radiotherapy (4%; 95% CI, 1?19%). Grade 3 or 4 central nervous system (CNS)-related adverse event rates were not different (9% in ICI combination therapy; 8% in ICI combined with radiotherapy; 5% in ICI monotherapy).

Conclusion: ICI combination therapy or ICI combined with radiotherapy showed better local efficacy than ICI monotherapy for treating melanoma brain metastasis. The grade 3 or 4 adverse event rate was highest with ICI combination therapy, and the CNS-related grade 3 or 4 event rate was similar. Prospective trials will be necessary to compare the efficacy of ICI combination therapy and ICI combined with radiotherapy.

키워드

Immune checkpoint inhibitor; Immunotherapy; Radiation; Radiotherapy; Meta-analysis

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