Meta-Analysis in Metastatic Uveal Melanoma to Determine Progression-Free and Overall Survival Benchmarks: an International Rare Cancers Initiative (IRCI) Ocular Melanoma study

Khoja, L.; Atenafu, E.G.; Suciu, S.; Leyvraz, S.; Sato, T.; Marshall, E.; Keilholz, U.; Zimmer, L.; Patel, S.P.; Piperno-Neumann, S.; Piulats, J.; Kivel�, T.T.; Pfoehler, C.; Bhatia, S.; Huppert, P.; Van Iersel, L.B.J.; De Vries, I.J.M.; Penel, N.; Vogl, T.; Cheng, T.; Fiorentini, G.; Mouriaux, F.; Tarhini, A.; Patel, P.M.; Carvajal, R.; Joshua, A.M.

Abstract

Background: Despite the completion of numerous phase II studies, a standard of care treatment has yet to be defined for metastatic uveal melanoma (mUM). To determine benchmarks of progression free survival (PFS) and overall survival (OS), we carried out a meta-analysis using individual patient level trial data. Methods: Individual patient variables and survival outcomes were requested from 29 trials published from 2000 to 2016. Univariable and multivariable analysis were carried out for prognostic factors. The variability between trial arms and between therapeutic agents on PFS and OS was investigated. Results: OS data were available for 912 patients. The median PFS was 3.3 months (95% CI 2.9-3.6) and 6-month PFS rate was 27% (95% CI 24-30). Univariable analysis showed male sex, elevated (i.e. > versus ≤ upper limit of normal) lactate dehydrogenase (LDH), elevated alkaline phosphatase (ALP) and diameter of the largest liver metastasis (≥3 cm versus <3 cm) to be substantially associated with shorter PFS. Multivariable analysis showed male sex, elevated LDH and elevated ALP were substantially associated with shorter PFS. The most substantial factors associated with 6-month PFS rate, on both univariable and multivariable analysis were elevated LDH and ALP. The median OS was 10.2 months (95% CI 9.5-11.0) and 1 year OS was 43% (95% CI 40-47). The most substantial prognostic factors for shorter OS by univariable and multivariable analysis were elevated LDH and elevated ALP. Patients treated with liver directed treatments had statistically significant longer PFS and OS. Conclusion: Benchmarks of 6-month PFS and 1-year OS rates were determined accounting for prognostic factors. These may be used to facilitate future trial design and stratification in mUM.

• Journal Article Type: Article
• Acceptance Date: May 1, 2019
• Online Publication Date: May 31, 2019
• Publication Date: 2019-08
• Deposit Date: Jun 19, 2019
• Publicly Available Date: Jun 1, 2020
• Journal: Annals of Oncology
• Print ISSN: 0923-7534
• Electronic ISSN: 1569-8041
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: 8
• Pages: 1370-1380
• DOI: https://doi.org/10.1093/annonc/mdz176
• Keywords: meta-analysis, uveal melanoma, trial design, survival benchmarks
• Public URL: https://nottingham-repository.worktribe.com/output/2208937
• Publisher URL: https://academic.oup.com/annonc/advance-article/doi/10.1093/annonc/mdz176/5509502
• Additional Information: Date of acceptance is estimated.; ; This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Oncology following peer review. The version of record L Khoja, E G Atenafu, S Suciu, S Leyvraz, T Sato, E Marshall, U Keilholz, L Zimmer, S P Patel, S Piperno-Neumann, J Piulats, T T Kivelä, C Pfoehler, S Bhatia, P Huppert, L B J Van Iersel, I J M De Vries, N Penel, T Vogl, T Cheng, G Fiorentini, F Mouriaux, A Tarhini, P M Patel, R Carvajal, A M Joshua, Meta-analysis in metastatic uveal melanoma to determine progression free and overall survival benchmarks: an international rare cancers initiative (IRCI) ocular melanoma study, Annals of Oncology, Volume 30, Issue 8, August 2019, Pages 1370–1380 is available online at: https://doi.org/10.1093/annonc/mdz176