90P - Meta-analysis of hypophysitis incidence in melanoma patients treated with immune checkpoint inhibitors

Background

The objective of this meta-analysis is to evaluate the incidence and risk of hypophysitis in melanoma patients receiving immune checkpoint inhibitors (ICIs) by synthesizing data from multiple clinical studies. A search was conducted on PubMed for phase 2 and 3 randomized clinical trials (RCTs) focused on the treatment of advanced melanoma using various ICIs. The studies included were published between January 2014, and September 2024. Out of 506 identified articles, 11 RCTs were selected and evaluated for overall risk of bias.

Methods

The 11 selected RCTs, which examined 10 different ICIs regiments for advanced melanoma and included a total of 7529 patients, were compared using a Bayesian network meta-analysis. This analysis applied Markov chain Monte Carlo simulation with noninformative priors and random-effects generalized linear models. Pooled odds ratios (ORs) with 95% credible intervals (CrIs) were calculated to estimate the risk of hypophysitis. The ranking of the treatment regimens was determined using the surface under the cumulative ranking curve (SUCRA).

Results

Although statistically significant differences were not found between these treatments based on odds ratios (ORs) and 95% credible intervals (CrIs), in comparing commonly used ICI regimens for advanced melanoma — such as nivolumab (3 mg/kg every 2 weeks), pembrolizumab (200 mg every 3 weeks), and the combination of nivolumab (1 mg/kg) with ipilimumab (3 mg/kg every 3 weeks) — SUCRA rankings suggested a trend that nivolumab was linked to the lowest risk of severe, grade 3-5 treatment-related hypophysitis (SUCRA, 62%), followed by pembrolizumab (SUCRA, 44%), while the combination of nivolumab and ipilimumab was associated with the highest risk (SUCRA, 28%) between all treatments.

Conclusions

The SUCRA ranking trends indicate that for advanced melanoma patients at risk of developing hypophysitis, nivolumab may be the most suitable treatment option among the immune checkpoint inhibitor regimens compared.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.