Cochrane · systematic review · CD011123
Systemic treatments for metastatic cutaneous melanoma
Pasquali, S, Hadjinicolaou, AV, Chiarion Sileni, V, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
40
current version
GRADE rated
39
No studies
1
Included studies
NR
No studies 1 · 2.5%Ungraded 0 · 0%Very low 0 · 0%Low 7 · 17.5%Moderate 13 · 32.5%High 19 · 47.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Anti‐PD1 monoclonal antibodies versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Anti‐PD1 monoclonal antibodies vs chemotherapy | HR 0.42 [0.37, 0.48] | 418 participants | High |
Progression‐free survival† Anti‐PD1 monoclonal antibodies vs chemotherapy | HR 0.49 [0.39, 0.61] | 957 participants | Moderate Downgraded: imprecision, inconsistency |
Tumour response Anti‐PD1 monoclonal antibodies vs chemotherapy | RR 3.42 [2.38, 4.92] | 1367 participants | High |
Toxicity (≥ G3) Anti‐PD1 monoclonal antibodies vs chemotherapy | 0.55 [0.31, 0.97] | 1360 participants | Low Downgraded: imprecision, inconsistency |
Anti‐PD1 monoclonal antibodies versus anti‐CTLA4 monoclonal antibodies
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Anti‐PD1 monoclonal antibodies vs anti‐CTLA4 monoclonal antibodies | HR 0.63 [0.6, 0.66] | 764 participants | High |
Progression‐free survival† Anti‐PD1 monoclonal antibodies vs anti‐CTLA4 monoclonal antibodies | HR 0.54 [0.5, 0.6] | 1465 participants | High |
Tumour response Anti‐PD1 monoclonal antibodies vs anti‐CTLA4 monoclonal antibodies | RR 2.47 [2.01, 3.04] | 1465 participants | High |
Toxicity (≥ G3) Anti‐PD1 monoclonal antibodies vs anti‐CTLA4 monoclonal antibodies | RR 0.7 [0.54, 0.91] | 1465 participants | Low Downgraded: imprecision, inconsistency |
Anti‐CTLA4 monoclonal antibodies plus chemotherapy versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Anti‐CTLA4 monoclonal antibodies plus chemotherapy vs chemotherapy | HR 0.81 [0.65, 1.01] | 1157 participants | Low Downgraded: imprecision, inconsistency |
Progression‐free survival† Anti‐CTLA4 monoclonal antibodies plus chemotherapy vs chemotherapy | HR 0.76 [0.63, 0.92] | 502 participants | Moderate Downgraded: imprecision, inconsistency |
Tumour response Anti‐CTLA4 monoclonal antibodies plus chemotherapy vs chemotherapy | RR 1.28 [0.92, 1.77] | 1157 participants | Moderate Downgraded: imprecision, inconsistency |
Toxicity (≥ G3) Anti‐CTLA4 monoclonal antibodies plus chemotherapy vs chemotherapy | RR 1.69 [1.19, 2.42] | 1142 participants | Moderate Downgraded: imprecision, inconsistency |
Anti‐CTLA4 monoclonal antibodies with versus without anti‐PD1 monoclonal antibodies
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Anti‐CTLA4 monoclonal antibodies with vs without anti‐PD1 monoclonal antibodies | no estimate extracted | NR | No studies |
Progression‐free survival† Anti‐CTLA4 monoclonal antibodies with vs without anti‐PD1 monoclonal antibodies | HR 0.4 [0.35, 0.46] | 738 participants | High |
Tumour response Anti‐CTLA4 monoclonal antibodies with vs without anti‐PD1 monoclonal antibodies | RR 3.5 [2.07, 5.92] | 738 participants | High |
Toxicity (≥ G3) Anti‐CTLA4 monoclonal antibodies with vs without anti‐PD1 monoclonal antibodies | RR 1.57 [0.85, 2.92] | 764 participants | Low Downgraded: imprecision, inconsistency |
BRAF inhibitors versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† BRAF inhibitors vs chemotherapy | HR 0.4 [0.28, 0.57] | 925 participants | High |
Progression‐free survival† BRAF inhibitors vs chemotherapy | HR 0.27 [0.21, 0.34] | 925 participants | High |
Tumour response BRAF inhibitors vs chemotherapy | RR 6.78 [4.84, 9.49] | 925 participants | High |
Toxicity (≥ G3) BRAF inhibitors vs chemotherapy | RR 1.27 [0.48, 3.33] | 408 participants | Low Downgraded: imprecision, inconsistency |
MEK inhibitors versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† MEK inhibitors vs chemotherapy | HR 0.85 [0.58, 1.25] | 496 participants | Low Downgraded: imprecision, inconsistency |
Progression‐free survival† MEK inhibitors vs chemotherapy | HR 0.58 [0.42, 0.8] | 496 participants | Moderate Downgraded: imprecision, inconsistency |
Tumour response MEK inhibitors vs chemotherapy | RR 2.01 [1.35, 2.99] | 496 participants | High |
Toxicity (≥ G3) MEK inhibitors vs chemotherapy | RR 1.61 [1.08, 2.41] | 91 participants | Moderate Downgraded: imprecision, inconsistency |
BRAF plus MEK inhibitors versus BRAF inhibitors
Population: people cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† BRAF plus MEK inhibitors vs BRAF inhibitors | HR 0.7 [0.59, 0.82] | 1784 participants | High |
Progression‐free survival† BRAF plus MEK inhibitors vs BRAF inhibitors | HR 0.56 [0.44, 0.71] | 1784 participants | Moderate Downgraded: inconsistency |
Tumour response BRAF plus MEK inhibitors vs BRAF inhibitors | RR 1.32 [1.2, 1.46] | 1784 participants | High |
Toxicity (≥ G3) BRAF plus MEK inhibitors vs BRAF inhibitors | RR 1.01 [0.85, 1.2] | 1774 participants | Moderate Downgraded: inconsistency |
Anti‐angiogenic drugs plus chemotherapy versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Anti‐angiogenic drugs plus chemotherapy vs chemotherapy | HR 0.6 [0.45, 0.81] | 324 participants | Moderate Downgraded: imprecision, inconsistency |
Progression‐free survival† Anti‐angiogenic drugs plus chemotherapy vs chemotherapy | HR 0.69 [0.52, 0.92] | 324 participants | Moderate Downgraded: imprecision, inconsistency |
Tumour response Anti‐angiogenic drugs plus chemotherapy vs chemotherapy | RR 1.71 [0.96, 3.03] | 324 participants | Moderate Downgraded: imprecision, inconsistency |
Toxicity (≥ G3) Anti‐angiogenic drugs plus chemotherapy vs chemotherapy | RR 0.68 [0.09, 5.32] | 324 participants | Low Downgraded: imprecision, inconsistency |
Biochemotherapy versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Biochemotherapy vs chemotherapy | HR 0.94 [0.84, 1.06] | 1317 participants | High |
Progression‐free survival† Biochemotherapy vs chemotherapy | HR 0.9 [0.83, 0.99] | 964 participants | High |
Tumour response Biochemotherapy vs chemotherapy | RR 1.36 [1.12, 1.66] | 770 participants | High |
Toxicity (≥ G3) Biochemotherapy vs chemotherapy | RR 1.35 [1.14, 1.61] | 631 participants | High |
Polychemotherapy versus chemotherapy
Population: people with cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival† Polychemotherapy vs chemotherapy | HR 0.99 [0.85, 1.16] | 594 participants | High |
Progression‐freesurvival† Polychemotherapy vs chemotherapy | HR 1.07 [0.91, 1.25] | 398 participants | High |
Tumour response Polychemotherapy vs chemotherapy | RR 1.27 [1.02, 1.58] | 1885 participants | Moderate Downgraded: imprecision |
Toxicity (≥ G3) Polychemotherapy vs chemotherapy | RR 1.97 [1.44, 2.71] | 390 participants | Moderate Downgraded: imprecision |