Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: A meta-analysis Journal Article

Authors: Spratt, D. E.; Spratt, E. A. G.; Wu, S.; DeRosa, A.; Lee, N. Y.; Lacouture, M. E.; Barker, C. A.
Article Title: Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: A meta-analysis
Abstract: Results: After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade ≥ 3 toxicity was reported in less than 6% of patients. Methods: MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I2 tests. Conclusion: Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed. Purpose: To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases.
Keywords: treatment response; cancer surgery; excision; cancer recurrence; cisplatin; cytotoxic agent; advanced cancer; cancer radiotherapy; melanoma; quality of life; angiosarcoma; histology; sarcoma; systematic review; breast carcinoma; brachytherapy; bleomycin; immunomodulating agent; kaposi sarcoma; photodynamic therapy; visual analog scale; skin metastasis; meta analysis; metastatic melanoma; head and neck squamous cell carcinoma; randomized controlled trial (topic); human; article; electrochemotherapy
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 28
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-10-01
Start Page: 3144
End Page: 3155
Language: English
DOI: 10.1200/jco.2014.55.4634
PROVIDER: scopus
PUBMED: 25154827
PMCID: PMC4979225
Notes: Export Date: 3 November 2014 -- Source: Scopus
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MSK Authors
  1. Mario E Lacouture
    261 Lacouture
  2. Nancy Y. Lee
    547 Lee
  3. Christopher Barker
    113 Barker
  4. Daniel Eidelberg Spratt
    83 Spratt
  5. Antonio P DeRosa
    32 DeRosa