Adjuvant therapy for cutaneous melanoma: a systematic review and network meta-analysis of new therapies

Area of Science:

• Oncology
• Pharmacology
• Biostatistics

Background:

• Adjuvant therapy is crucial for melanoma treatment post-surgery.
• Recent approvals include novel targeted and immune therapies for melanoma.
• Comparing these new agents is essential for optimal patient outcomes.

Purpose of the Study:

• To conduct a Bayesian network meta-analysis comparing new adjuvant therapies for melanoma.
• To assess efficacy in terms of recurrence-free survival (RFS) and overall survival (OS).
• To evaluate safety profiles by analyzing adverse events (AEs).

Main Methods:

• Systematic literature search of PubMed, Embase, Cochrane Library, and ASCO databases.
• Bayesian network meta-analysis including six randomized controlled trials with 4244 patients.
• Estimation of hazard ratios (HRs) for survival and odds ratios (ORs) for AEs, with Surface Under the Cumulative Ranking (SUCRA) probabilities.

Main Results:

• Nivolumab had the highest probability (75.1%) for superior RFS, followed by dabrafenib+trametinib, pembrolizumab, ipilimumab, and vemurafenib.
• Overall survival (OS) data was not estimable across all therapies.
• Pembrolizumab and nivolumab showed the highest probability for fewer any-grade (83.1%) and grade 3-4 (64.4%) AEs, respectively.

Conclusions:

• All evaluated new adjuvant therapies demonstrate high efficacy in melanoma treatment.
• Nivolumab appears most promising for RFS, while pembrolizumab and nivolumab offer favorable safety profiles.
• The optimal therapeutic choice should be individualized based on patient-specific factors and risk tolerance.