Overall survival (OS) in treatment (tmt) naive patients with unresectable stage III/IV (USIII/IV) melanoma: A systematic literature review and network meta-analysis (NMA)

Background: Tmt with ipilimumab (IPI) & dacarbazine (DTIC) resulted in greater OS than DTIC alone (Robert et al., 2011) in tmt naïve patients with USIII/IV melanoma. Direct comparisons vs. other systemic therapies in first line are lacking. The objective was to compare OS of patients receiving systemic therapies, including IPI, for naïve USIII/IV melanoma based on randomized controlled trials (RCTs). Methods: A systematic literature search was performed to identify RCTs. Kaplan-Meier OS curves for each intervention (ITV) were digitized, survival proportions over time were obtained from these images, and data were combined with a NMA using the best fit survival distribution resulting in pooled survival proportions (SPs) and expected OS (mean OS). Results: 16 studies provided OS curves and allowed for a NMA of the ITV groups listed in the table. Populations were comparable across trials other than in the vemurafenib study that selected patients with a BRAF mutation. IPI with DTIC showed greater mean OS than other ITVs (Table). The short follow-up for vemurafenib (median 3.8 months, max 12 months) did not allow for valid comparisons. Conclusions: Results of this NMA suggests that mean OS is expected to be greater with IPI & DTIC than with other ITVs for the management of tmt naïve patients with USIII/IV melanoma. (Table Presented).