Cochrane · systematic review · CD012974
Neoadjuvant treatment for stage III and IV cutaneous melanoma
Gorry, C, McCullagh, L, O'Donnell, H, et al. · Cochrane Database of Systematic Reviews · 2023 · 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
35
current version
GRADE rated
20
No studies
15
Included studies
NR
No studies 15 · 42.9%Ungraded 0 · 0%Very low 12 · 34.3%Low 7 · 20%Moderate 1 · 2.9%High 0 · 0%
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
Neoadjuvant treatment compared to no neoadjuvant treatment
Population: stage III or IV cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS), measured by the number of deaths over time Median Neoadjuvant treatment vs no neoadjuvant treatment | HR 0.43 [0.15, 1.21] | 2 studies · 171 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Adverse events, Neoadjuvant treatment vs no neoadjuvant treatment | RR 1.58 | 2 studies · 162 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Overall response rate (ORR), Neoadjuvant treatment vs no neoadjuvant treatment | no estimate extracted | NR | No studies |
Time to recurrence (TTR),measured by the number of disease recurrence events over time. Neoadjuvant treatment vs no neoadjuvant treatment | HR 0.51 [0.22, 1.17] | 2 studies · 171 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Quality of life ‐ not measured Neoadjuvant treatment vs no neoadjuvant treatment | no estimate extracted | NR | No studies |
Neoadjuvant targeted treatment (BRAF/MEK inhibition) compared to no neoadjuvant treatment
Population: stage III or IV cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS), measured by number of deaths over time,Median Neoadjuvant targeted treatment (BRAF/MEK inhibition) vs no neoadjuvant treatment | HR 0.28 [0.03, 2.25] | 1 study · 21 participants | Very low Downgraded: risk of bias |
Adverse events, Neoadjuvant targeted treatment (BRAF/MEK inhibition) vs no neoadjuvant treatment | no estimate extracted | 1 study · 14 participants | Low Downgraded: risk of bias, imprecision |
Overall response rate (ORR), Neoadjuvant targeted treatment (BRAF/MEK inhibition) vs no neoadjuvant treatment | no estimate extracted | 1 study · 13 participants | Low Downgraded: risk of bias, imprecision |
Time to recurrence (TTR), measured by the number of disease recurrence events over time, Neoadjuvant targeted treatment (BRAF/MEK inhibition) vs no neoadjuvant treatment | HR 0.02 [0, 0.22] | 1 study · 21 participants | Very low Downgraded: risk of bias |
Quality of Life ‐ not measured Neoadjuvant targeted treatment (BRAF/MEK inhibition) vs no neoadjuvant treatment | no estimate extracted | NR | No studies |
Neoadjuvant immunotherapy (talimogene laherparepvec) compared to no neoadjuvant treatment
Population: stage III and IV cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS), measured by the number of deaths over time, Neoadjuvant immunotherapy (talimogene laherparepvec) vs no neoadjuvant treatment | HR 0.49 [0.15, 1.64] | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Adverse Events, Neoadjuvant immunotherapy (talimogene laherparepvec) vs no neoadjuvant treatment | RR 2.84 [0.96, 8.37] | 1 study · 142 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Overall response rate (ORR), Neoadjuvant immunotherapy (talimogene laherparepvec) vs no neoadjuvant treatment | no estimate extracted | 1 study · 76 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Time to recurrence (TTR), measured by the number of disease recurrence events over time, Neoadjuvant immunotherapy (talimogene laherparepvec) vs no neoadjuvant treatment | HR 0.75 [0.31, 1.79] | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Quality of Life ‐ not measured Neoadjuvant immunotherapy (talimogene laherparepvec) vs no neoadjuvant treatment | no estimate extracted | NR | No studies |
Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) compared to adjuvant immunotherapy (combined ipilimumab and nivolumab)
Population: stage III cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS) Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs adjuvant immunotherapy (combined ipilimumab and nivolumab) | no estimate extracted | NR | No studies |
Adverse events, Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs adjuvant immunotherapy (combined ipilimumab and nivolumab) | RR 1 [0.75, 1.34] | 1 study · 20 participants | Low Downgraded: risk of bias, imprecision |
Overall response rate (ORR), Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs adjuvant immunotherapy (combined ipilimumab and nivolumab) | no estimate extracted | 1 study · 10 participants | Low Downgraded: risk of bias, imprecision |
Time to recurrence ‐ not measured Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs adjuvant immunotherapy (combined ipilimumab and nivolumab) | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs adjuvant immunotherapy (combined ipilimumab and nivolumab) | no estimate extracted | NR | No studies |
Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) compared to neoadjuvant immunotherapy (nivolumab)
Population: stage III and IV cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS), measured by number of deaths over timeMedian Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (nivolumab) | no estimate extracted | 1 study · 23 participants | Moderate Downgraded: imprecision |
Adverse events, Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (nivolumab) | RR 8.73 [1.29, 59] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Overall response rate (ORR), Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (nivolumab) | RR 2.91 [1.02, 8.27] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Time to recurrence (TTR), measured by the number of disease recurrence events over time, Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (nivolumab) | no estimate extracted | 1 study · 23 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not measured Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (nivolumab) | no estimate extracted | NR | No studies |
Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) compared to neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab)
Population: stage III cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS) Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab) | no estimate extracted | NR | No studies |
Adverse events, Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab) | no estimate extracted | 1 study · 86 participants | Low Downgraded: risk of bias |
Overall response rate (ORR), Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab) | RR 1.42 [0.87, 2.32] | 1 study · 86 participants | Low Downgraded: risk of bias, imprecision |
Time to response ‐ not measured Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab) | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) vs neoadjuvant immunotherapy (sequential treatment with ipilimumab then nivolumab) | no estimate extracted | NR | No studies |
Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy compared to neoadjuvant chemotherapy
Population: stage III and IV cutaneous melanoma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS) Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy vs neoadjuvant chemotherapy | no estimate extracted | NR | No studies |
Adverse events Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy vs neoadjuvant chemotherapy | no estimate extracted | NR | No studies |
Overall response rate (ORR), measured after 8 weeks of treatment and prior to surgery. Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy vs neoadjuvant chemotherapy | RR 1.75 [0.62, 4.95] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Time to recurrence — not reported Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy vs neoadjuvant chemotherapy | no estimate extracted | NR | No studies |
Quality of life — not reported Neoadjuvant immunotherapy (high dose interferon) plus chemotherapy vs neoadjuvant chemotherapy | no estimate extracted | NR | No studies |