Chemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients

2.50
Hdl Handle:
http://hdl.handle.net/10541/70318
Title:
Chemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients
Authors:
Ives, Natalie J; Stowe, Rebecca L; Lorigan, Paul C ( 0000-0002-8875-2164 ) ; Wheatley, Keith
Abstract:
PURPOSE: To assess the effect of adding interferon-alpha (IFN) +/- interleukin-2 (IL-2) to chemotherapy in patients with metastatic melanoma. METHODS A published data meta-analysis of trials of biochemotherapy versus chemotherapy in patients with metastatic melanoma was undertaken. End points evaluated were rates of partial response (PR), complete response (CR) and overall (partial + complete) response (OR); response duration; progression-free survival; overall survival (OS); and toxicity. The only subgroup analysis performed was by type of immunotherapy, with trials divided according to whether IFN only or IFN and IL-2 were administered in the biochemotherapy arm. RESULTS: Eighteen randomized trials were identified: 11 trials of chemotherapy +/- IFN and seven trials of chemotherapy +/- IFN and IL-2. More than 2,600 patients were entered onto the trials, with 555 responses and 2,039 deaths. There was a clear benefit for biochemotherapy for PR (odds ratio = 0.66; 95% CI, 0.53 to 0.82; P = .0001), CR (odds ratio = 0.50; 95% CI, 0.35 to 0.73; P = .0003) and OR (odds ratio = 0.59; 95% CI, 0.49 to 0.72; P < .00001). For OR, these benefits were significant for both the IFN (odds ratio = 0.60; 95% CI, 0.46 to 0.79; P = .0002) and IFN + IL-2 (odds ratio = 0.58; 95% CI, 0.44 to 0.77; P = .0001) subgroups. In contrast, there was no benefit overall in OS (odds ratio = 0.99; 95% CI, 0.91 to 1.08; P = .9), but there was evidence of heterogeneity of treatment effect between the individual trials (P = .006). CONCLUSION: This meta-analysis provides a comprehensive summary of all the data currently available, and shows that although biochemotherapy clearly improves response rates, this does not appear to translate into a survival benefit.
Affiliation:
Birmingham Clinical Trials Unit, Division of Medical Sciences, Robert Aitken Institute, University of Birmingham, Edgbaston, Birmingham, United Kingdom. n.j.ives@bham.ac.uk
Citation:
Chemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients. 2007, 25 (34):5426-34 J. Clin. Oncol.
Journal:
Journal of Clinical Oncology
Issue Date:
1-Dec-2007
URI:
http://hdl.handle.net/10541/70318
DOI:
10.1200/JCO.2007.12.0253
PubMed ID:
18048825
Type:
Article
Language:
en
ISSN:
1527-7755
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorIves, Natalie J-
dc.contributor.authorStowe, Rebecca L-
dc.contributor.authorLorigan, Paul C-
dc.contributor.authorWheatley, Keith-
dc.date.accessioned2009-06-12T12:17:43Z-
dc.date.available2009-06-12T12:17:43Z-
dc.date.issued2007-12-01-
dc.identifier.citationChemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients. 2007, 25 (34):5426-34 J. Clin. Oncol.en
dc.identifier.issn1527-7755-
dc.identifier.pmid18048825-
dc.identifier.doi10.1200/JCO.2007.12.0253-
dc.identifier.urihttp://hdl.handle.net/10541/70318-
dc.description.abstractPURPOSE: To assess the effect of adding interferon-alpha (IFN) +/- interleukin-2 (IL-2) to chemotherapy in patients with metastatic melanoma. METHODS A published data meta-analysis of trials of biochemotherapy versus chemotherapy in patients with metastatic melanoma was undertaken. End points evaluated were rates of partial response (PR), complete response (CR) and overall (partial + complete) response (OR); response duration; progression-free survival; overall survival (OS); and toxicity. The only subgroup analysis performed was by type of immunotherapy, with trials divided according to whether IFN only or IFN and IL-2 were administered in the biochemotherapy arm. RESULTS: Eighteen randomized trials were identified: 11 trials of chemotherapy +/- IFN and seven trials of chemotherapy +/- IFN and IL-2. More than 2,600 patients were entered onto the trials, with 555 responses and 2,039 deaths. There was a clear benefit for biochemotherapy for PR (odds ratio = 0.66; 95% CI, 0.53 to 0.82; P = .0001), CR (odds ratio = 0.50; 95% CI, 0.35 to 0.73; P = .0003) and OR (odds ratio = 0.59; 95% CI, 0.49 to 0.72; P < .00001). For OR, these benefits were significant for both the IFN (odds ratio = 0.60; 95% CI, 0.46 to 0.79; P = .0002) and IFN + IL-2 (odds ratio = 0.58; 95% CI, 0.44 to 0.77; P = .0001) subgroups. In contrast, there was no benefit overall in OS (odds ratio = 0.99; 95% CI, 0.91 to 1.08; P = .9), but there was evidence of heterogeneity of treatment effect between the individual trials (P = .006). CONCLUSION: This meta-analysis provides a comprehensive summary of all the data currently available, and shows that although biochemotherapy clearly improves response rates, this does not appear to translate into a survival benefit.en
dc.language.isoenen
dc.subject.meshAntineoplastic Agents-
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols-
dc.subject.meshHumans-
dc.subject.meshInterferon-alpha-
dc.subject.meshInterleukin-2-
dc.subject.meshMelanoma-
dc.subject.meshRandomized Controlled Trials as Topic-
dc.titleChemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patientsen
dc.typeArticleen
dc.contributor.departmentBirmingham Clinical Trials Unit, Division of Medical Sciences, Robert Aitken Institute, University of Birmingham, Edgbaston, Birmingham, United Kingdom. n.j.ives@bham.ac.uken
dc.identifier.journalJournal of Clinical Oncologyen

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