The following is a summary of “Efficacy of immune checkpoint inhibition in metastatic uveal melanoma: a systematic review and meta-analysis,” published in the August 2023 issue of Melanoma Research by Pham et al.
Historically, metastatic uveal melanoma (mUM) has been associated with limited survival and few effective treatments. Immune checkpoint inhibitors (ICIs) have been tested in patients with mUM; however, it is difficult to draw definitive conclusions regarding their efficacy due to small study sizes and heterogeneous patient populations. Patients’ demographics, objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) data were extracted from five databases using a combination of ‘ICI’ and ‘mUM’ subject headings.
The pooled ORR was computed using a random effects model and the inverse variance method. Using the available Kaplan–Meier OS and PFS curves, summary OS and PFS plots were constructed from which median values were derived. The aggregate ORR was 9.2% (95% CI: 7.2–11.2) [4.1% for anti-CTLA4 (95% CI: 2.1–7.7); 7.1% for anti-PD(L)1 (95% CI: 4.5–10.9); 13.5% for anti-CTLA4 plus anti-PD1 (95% CI: 10.0–18.0)]. Overall median OS was 11.5 months (95% CI: 9.5–13.8) [8.0 months for anti-CTLA4 (95% CI: 5.5–9.9), 11.7 months for anti-PD(L)1 (95% CI: 9.0–14.0), and 16.0 months for ipilimumab plus anti-PD1 (95% CI: 11.5–17.7) (P<0.001)].
The median PFS was 3.0 months (95% CI: 2.9–3.1). ICIs have limited efficacy in mUM, and a recommendation for their use must evaluate the benefit-to-risk ratio for individual patients without other treatment options. Additional biomarker profiling studies may help determine which patients will benefit from ICIs, especially adding ipilimumab to anti-PD1 therapy.