Interferon alpha adjuvant therapy in patients with high-risk melanoma: A systematic review and meta-analysis

BackgroundBased on previous meta-analyses of randomized controlled trials (RCTs), the use of interferon alpha (IFN-α) in the adjuvant setting improves disease-free survival (DFS) in patients with high-risk cutaneous melanoma. However, RCTs have yielded conflicting data on the effect of IFN-α on overall survival (OS).MethodsWe conducted a systematic review and meta-analysis to examine the effect of IFN-α on DFS and OS in patients with high-risk cutaneous melanoma. The systematic review was performed by searching MEDLINE, EMBASE, Cancerlit, Cochrane, ISI Web of Science, and ASCO databases. The meta-analysis was performed using time-to-event data from which hazard ratios (HRs) and 95% confidence intervals (CIs) of DFS and OS were estimated. Subgroup and meta-regression analyses to investigate the effect of dose and treatment duration were also performed. Statistical tests were two-sided.ResultsThe meta-analysis included 14 RCTs, published between 1990 and 2008, and involved 8122 patients, of which 4362 patients were allocated to the IFN-α arm. IFN-α alone was compared with observation in 12 of the 14 trials, and 17 comparisons (IFN-α vs comparator) were generated in total. IFN-α treatment was associated with a statistically significant improvement in DFS in 10 of the 17 comparisons (HR for disease recurrence = 0.82, 95% CI = 0.77 to 0.87; P