Adjuvant interferon-α for the treatment of high-risk melanoma: An individual patient data meta-analysis

the International Melanoma Meta-Analysis Collaborative Group (IMMCG), on behalf of, the International Melanoma Meta-Analysis Collaborative Group (IMMCG)

Research output: Contribution to journalReview article

66 Scopus citations

Abstract

Background Many randomised trials assessing interferon-α (IFN-α) as adjuvant therapy for high-risk malignant melanoma have been undertaken. To better assess the role of IFN-α, an individual patient data (IPD) meta-analysis of these trials was undertaken. Methods IPD was sought from all randomised trials of adjuvant IFN-α versus no IFN-α for high-risk melanoma. Primary outcomes were event-free survival (EFS) and overall survival (OS). Standard methods for quantitative IPD meta-analysis were used. Subgroup analyses by dose, duration of treatment and various patient and disease-specific parameters were performed. Findings Fifteen trials were included in the analysis (eleven with IPD). EFS was significantly improved with IFN-α (hazard ratio [HR] = 0.86, CI 0.81–0.91; P < 0.00001), as was OS (HR = 0.90, CI 0.85–0.97; P = 0.003). The absolute differences in EFS at 5 and 10 years were 3.5% and 2.7%, and for OS were 3.0% and 2.8% respectively in favour of IFN-α. There was no evidence that the benefit of IFN-α differed depending on dose or duration of treatment, or by age, gender, site of primary tumour, disease stage, Breslow thickness, or presence of clinical nodes. Only for ulceration was there evidence of an interaction (test for heterogeneity: P = 0.04 for EFS; P = 0.002 for OS); only patients with ulcerated tumours appeared to obtain benefit from IFN-α. Conclusion This meta-analysis provides clear evidence that adjuvant IFN-α significantly reduces the risk of relapse and improves survival and shows no benefit for higher doses compared to lower doses. The increased benefit in patients with ulcerated tumours, and lack of benefit in patients without ulceration, needs further investigation.

Original languageEnglish (US)
Pages (from-to)171-183
Number of pages13
JournalEuropean Journal of Cancer
Volume82
DOIs
StatePublished - Sep 2017

Keywords

  • Adjuvant interferon
  • Individual patient data meta-analysis
  • Melanoma
  • Randomised controlled trials

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    the International Melanoma Meta-Analysis Collaborative Group (IMMCG), on behalf of, & the International Melanoma Meta-Analysis Collaborative Group (IMMCG) (2017). Adjuvant interferon-α for the treatment of high-risk melanoma: An individual patient data meta-analysis. European Journal of Cancer, 82, 171-183. https://doi.org/10.1016/j.ejca.2017.06.006