Page 23 - ARNM-2-2

Advances in Radiotherapy
& Nuclear Medicine Melanoma brain metastatic treatment

Table 1. Main published meta-analyses addressing radiotherapy combined with immunotherapy to treat brain metastases
Author (year) Number Number Strategies Treatment Main results Main conclusions
of studies of patients included in the arms
included included analyses
Petrelli et al. 25 33 studies 1520 RT (WBRT/SRS) RT versus Median OS for melanoma Prolonged OS with
(32 (87 % ICI (ipilimumab/ RT+ICI BMs was 14.4 months combined RT+ ICI versus
retrospective melanoma prembrolizumab) (95% CI: 12.4 – 16.8) RT alone.
studies and patients) 1-year OS rate (melanoma RT given before or
1 phase BM): 54.2 % concurrently with ICI
I study) (95% CI: 48 – 60.4) administration provided
2-year OS rate (melanoma the best effect on outcome
BM): 52.3% (HR=0.54;
(95% CI: 39.1 – 65.2) 95% CI: 0.44 – 0.67)
1-year LC: 48% (13 studies,
n=523 patients)
2-year LC: 31.6% (6 studies,
n=281 patients)
Kim et al. 29 11 studies 577 (all RT (WBRT/SRS) ICI Intracranial ORR with ICI combination therapy
(6 melanoma) ICI (ipilimumab/ monotherapy ICI+RT 42% (95 % CI: or ICI+RT showed better
retrospective prembrolizumab/ versus 31 – 54), ICI combination local efficacy than ICI
and 5 phase nivolumab) ICI+RT therapy 53% (95 % CI: 44 monotherapy.
2 studies) versus ICI – 61) and ICI monotherapy Grade 3 or 4 CNS-related
combination 15% (95% CI: 11 – 20) adverse event rates were
therapy No significant difference not significantly different
between ICI+RT and ICI between the three arms.
combination therapy
Intracranial DCR with
ICI+RT 85% (95% CI:
63 – 95), ICI combination
therapy 57% (95% CI: 49 –
66) and ICI monotherapy
26% (95% CI: 21 – 32)
Significantly better
outcomes when using
ICI+RT compared to ICI
combination therapy (OR
1.41, 95% CI: 1.20 – 1.67,
P < 0.01)
Najafi et al. 27 28 studies (all 1465 (87 % RT (WBRT/SRS) RT+ICI OS for ICI+RT versus RT RT+ICI prolonged OS
retrospective) melanoma ICI (ipilimumab/ alone (HR =0.39; and reduced mortality
patients) prembrolizumab/ 95% CI 0.34 – 0.44) rates, with acceptable
nivolumab) For 1-year OS, the overall toxicity.
TT (BRAF or HR was 0.56
MEK inhibitors) (95% CI: 0.51 – 0.61)
For 2-year OSl, the overall
HR was 0.36
(95% CI: 0.31 – 0.42)
5 – 41% cognitive changes
(predominantly in WBRT)
18 28% bleeding 4 – 26%
headache
Radionecrosis was
described in 15 of 33 studies
(1 – 27.6%)
Anvari et al. 43 44 studies 2498 (all RT (WBRT or RT+ICI OS for ICI+RT versus ICI Better survival outcomes
(41 melanoma) SRS) versus ICI alone (HR=0.693, in ICI+RT versus RT
retrospective ICI (ipilimumab/ 95% CI: 0.526 – 0.913, alone and
studies, prembrolizumab/ P<0.001) ICI alone arms.
2 prospective nivolumab) OS for ICI+RT versus RT ICI+RT did not
(Cont’d...)

Volume 2 Issue 2 (2024) 3 doi: 10.36922/arnm.3499