The First Line Treatment of Advanced or Metastatic BRAF Mutant Melanoma: A Network Meta-analysis

Abstract Purpose: The treatments for advanced or metastatic BRAF mutant melanoma are flourish, but the most effective treatment is unclear. Here, we conducted a network meta-analysis (NMA) in unresectable stage III or advanced (or metastatic) stage IV BRAF mutant melanoma patients to estimate the efficacy of various first line treatments.Methods: A comprehensive search for RCTs in PubMed and EMBASE was conducted to January 2021. Randomized control trials of unresectable stage III or advanced stage IV BRAF mutant melanoma were eligible if not receive previously treatment. By a Bayesian network meta-analysis, the effectiveness of each treatment was estimated and ranked based on the odds ratio (OR) for Object response rate (ORR) and hazard ratio (HR) for Overall survival (OS).Results: Eight trials enrolling 3272 patients were included. Combination dabrafenib and trametinib with pembrolizumab (HR: 0.37; 95% confidence interval [CI]: 0.21-0.66; compared with dacarbazine) ranked as the best effective treatment for OS.Conclusion: Combination pembrolizumab with trametinib and dabrafenib and combination atezolizumab with trametinib and dabrafenib appear more effective as first line treatments for unresectable stage III or advanced (or metastatic) stage IV BRAF mutant melanoma patients. Whereas, further RCTs are needed to complete the network.