title: Indirect Treatment Comparison of Talimogene Laherparepvec Compared with Ipilimumab and Vemurafenib for the Treatment of Patients with Metastatic Melanoma.
abstract: Few randomized controlled trials have compared new treatments for metastatic melanoma. We sought to examine the relative treatment effect of talimogene laherparepvec compared with ipilimumab and vemurafenib.
  
  
  
  A systematic literature review of treatments for metastatic melanoma was undertaken but a valid network of evidence could not be established because of a lack of comparative data or studies with sufficient common comparators. A conventional adjusted indirect treatment comparison via network meta-analysis was, therefore, not feasible. Instead, a meta-analysis of absolute efficacy was undertaken, adjusting overall survival (OS) data for differences in prognostic factors between studies using a published algorithm.
  
  
  
  Four trials were included in the final indirect treatment comparison: two of ipilimumab, one of vemurafenib, and one of talimogene laherparepvec. Median OS for ipilimumab and vemurafenib increased significantly when adjustment was applied, demonstrating that variation in disease and patient characteristics was biasing OS estimates; adjusting for this made the survival data more comparable. For both ipilimumab and vemurafenib, the adjustments improved Kaplan-Meier OS curves; the observed talimogene laherparepvec OS curve remained above the adjusted OS curves for ipilimumab and vemurafenib, showing that long-term survival could differ from the observed medians.
  
  
  
  Even with limited data, talimogene laherparepvec, ipilimumab, and vemurafenib could be compared following adjustments, thereby providing a more reliable understanding of the relative effect of treatment on survival in a more comparable patient population. The results of this analysis suggest that OS with talimogene laherparepvec is at least as good as with ipilimumab and vemurafenib and improvement was more pronounced in patients with no bone, brain, lung or other visceral metastases.
  
  
  
  Amgen Inc.
authors.affiliation: PRMA Consulting Ltd, Fleet, Hampshire, UK.
authors.forename: Casey
authors.initials: C
authors.lastname: Quinn
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Qiufei
authors.initials: Q
authors.lastname: Ma
authors.affiliation: PRMA Consulting Ltd, Fleet, Hampshire, UK.
authors.forename: Amber
authors.initials: A
authors.lastname: Kudlac
authors.affiliation: Centre for Health Economics, University of York, Heslington, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Barber
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA. Zhongyun@amgen.com.
authors.forename: Zhongyun
authors.initials: Z
authors.lastname: Zhao
mesh_terms: D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D057186:Comparative Effectiveness Research; D006801:Humans; D007211:Indoles / Q000494:pharmacology*; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D009362:Neoplasm Metastasis; D050130:Oncolytic Virotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000494:pharmacology*; D016019:Survival Analysis; D000077484:Vemurafenib
chemical_list: D000911:Antibodies, Monoclonal; D007211:Indoles; D000074324:Ipilimumab; D013449:Sulfonamides; D000077484:Vemurafenib
keywords: Efficacy; Ipilimumab; Meta-analysis; Metastatic melanoma; Oncology; Oncolytic immunotherapy; Talimogene laherparepvec; Vemurafenib