采用放疗和免疫治疗或靶向治疗治疗黑色素瘤脑转移瘤：一项系统评价和荟萃分析。
Treatment of melanoma brain metastases with radiation and immunotherapy or targeted therapy: A systematic review with meta-analysis.
机构信息
Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Sydney, NSW, Australia; The Mater Hospital, North Sydney, NSW, Australia.
出版信息
Crit Rev Oncol Hematol. 2024 Oct;202:104462. doi: 10.1016/j.critrevonc.2024.104462. Epub 2024 Aug 2.
BACKGROUND
Patients with melanoma brain metastases are now frequently treated with immunotherapy (IMT) or targeted therapy (TT). The aim of this systematic review was to determine relative survival outcomes after combining radiotherapy (RT) with IMT or TT.
METHODS
126 studies were identified by searching Medline, Embase and Cochrane CENTRAL (to 7Aug 2023).
RESULTS
Multivariable analyses showed that the risk of death was reduced by 30 % for combined stereotactic radiosurgery (SRS)+IMT compared to IMT alone, by 65 % for patients treated with SRS+anti-PD1 and by 59 % for patients treated with SRS+anti-CTLA4 and/or anti-PD1 (HR 0.41, 95 %CI 0.31-0.54) compared to SRS alone. Four studies compared SRS+anti-CTLA4 with SRS+anti-PD1, showing a 42 % reduction in risk of death with SRS+anti-PD1 treatment. Combined treatment with SRS+TT showed a 59 % reduction in risk compared to SRS alone.
CONCLUSION
The systematic review suggests a substantial survival benefit for combining SRS with IMT or TT for patients with melanoma brain metastases.
背景
现在，经常对患有黑色素瘤脑转移的患者采用免疫疗法（IMT）或靶向治疗（TT）进行治疗。本系统评价的目的是确定在联合放疗（RT）与 IMT 或 TT 治疗后相对生存结果。
方法
通过检索 Medline、Embase 和 Cochrane CENTRAL（截至 2023 年 8 月 7 日）共确定了 126 项研究。
结果
多变量分析显示，与单独 IMT 相比，立体定向放射外科手术（SRS）+IMT 联合治疗使死亡风险降低了 30%，SRS+抗 PD1 治疗降低了 65%，SRS+抗 CTLA4 和/或抗 PD1 治疗降低了 59%（HR 0.41，95%CI 0.31-0.54），与单独 SRS 相比。四项研究比较了 SRS+抗 CTLA4 与 SRS+抗 PD1，SRS+抗 PD1 治疗的死亡风险降低了 42%。与单独 SRS 相比，SRS+TT 联合治疗使风险降低了 59%。
结论
系统评价表明，对于患有黑色素瘤脑转移的患者，SRS 联合 IMT 或 TT 治疗可显著提高生存率。
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