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Updated: Apr 25, 2026
A 3D Organotypic Melanoma Spheroid Skin Model
Published on: May 18, 2018
Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: a meta-analysis
Daniel E Spratt1, Elizabeth A Gordon Spratt1, Shenhong Wu1
1Daniel E. Spratt, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacoutre, and Christopher A. Barker, Memorial Sloan-Kettering Cancer Center; Elizabeth A. Gordon Spratt, New York University Langone Medical Center, New York; and Shenhong Wu, Stony Brook University Cancer Center, Stony Brook, NY.
Purpose:
To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases.
Methods:
MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I(2) tests.
Results:
After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade ≥ 3 toxicity was reported in less than 6% of patients.
Conclusion:
Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed.
Insights
Skin-directed therapies show high response rates for cutaneous metastases, with objective response rates around 60%. Recurrence rates are low post-treatment, and therapies are generally well-tolerated.
Area of Science:
- Oncology
- Dermatology
- Clinical Research
Background:
- Cutaneous metastases represent a significant challenge in cancer care.
- Skin-directed therapies offer localized treatment options for these metastases.
Purpose of the Study:
- To conduct the first meta-analysis evaluating the efficacy of various skin-directed therapies for cutaneous metastases.
- To synthesize evidence on response rates, recurrence, and toxicity.
Main Methods:
- A systematic search of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for prospective studies (1960-2013).
- 47 studies involving 4,313 cases of cutaneous metastases were included.
- Meta-analyses used random-effect modeling to assess complete and objective response rates, and recurrence rates.
Main Results:
- The overall objective response rate was 60.2% (95% CI, 50.6% to 69.0%), with a complete response rate of 35.5%.
- Melanoma and breast carcinoma showed similar objective response rates.
- The overall recurrence rate was 9.2%, and severe toxicity (Grade ≥ 3) was reported in less than 6% of patients.
Conclusions:
- Skin-directed therapies demonstrate high efficacy for cutaneous metastases, though response varies by modality.
- These treatments are generally well-tolerated and improve quality of life.
- Standardized response criteria and treatment algorithms are needed to optimize therapy selection.
