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metastatic/adv melanoma (mML), immune chekpoint inhibitors versus Standard of Care (SoC), meta-analysis of study results

Outcome Relative effect 95%CI LoD Trt. better when I2 k (RCT/OBS) Bayesian probability Overall ROB Publication bias Degree of certainty Endpoint importance Published MA

efficacy endpoints 00

deaths (OS) 0.81 [0.74, 0.89]< 10%6 studies (6/-)100.0 %some concernnot evaluable moderatecrucial-
deaths (OS) (extension) 0.69 [0.57, 0.84]< 10%1 study (1/-)100.0 %NAnot evaluable important-
progression or deaths (PFS) 0.65 [0.54, 0.78]< 162%5 studies (5/-)100.0 %lownot evaluable highimportant-
DCR 1.15 [0.79, 1.68]> 10%1 study (1/-)76.8 %NAnot evaluable non important-
DOR 0.41 [0.20, 0.83]< 10%1 study (1/-)99.3 %NAnot evaluable non important-
objective responses (ORR) 1.96 [1.03, 3.72]> 186%6 studies (6/-)98.0 %lownot evaluable highnon important-

safety endpoints 00

AE (any grade) 2.65 [1.48, 4.73]< 10%3 studies (3/-)0.1 %some concernnot evaluable moderatenon important-
AE (grade 3-4) 2.46 [1.59, 3.82]< 167%3 studies (3/-)0.0 %lownot evaluable highnon important-
AE leading to death (grade 5) 1.58 [0.89, 2.80]< 10%4 studies (4/-)5.7 %some concernnot evaluable moderatenon important-
AE leading to treatment discontinuation (any grade) 3.05 [0.63, 14.86]< 187%3 studies (3/-)8.4 %lownot evaluable highnon important-
SAE (any grade) 3.19 [2.19, 4.65]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
STRAE (any grade) 1.24 [0.85, 1.81]< 10%1 study (1/-)12.9 %NAnot evaluable non important-
TRAE (any grade) 1.26 [0.38, 4.14]< 194%5 studies (5/-)35.4 %lownot evaluable highnon important-
TRAE (grade 3-4) 1.66 [0.54, 5.14]< 195%5 studies (5/-)18.9 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 3.31 [0.76, 14.36]< 10%4 studies (4/-)5.6 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (any grade) 1.62 [0.86, 3.05]< 136%3 studies (3/-)6.8 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (grade 3-4) 2.06 [0.87, 4.87]< 10%2 studies (2/-)5.1 %some concernnot evaluable moderatenon important-

TRAE (grade 3-4) endpoints 00

Adrenal insufficiency TRAE (grade 3-4) 5.93 [0.30, 118.96]< 10%1 study (1/-)12.5 %NAnot evaluable non important-
Alopecia TRAE (grade 3-4) 0.96 [0.06, 15.38]< 10%2 studies (2/-)51.2 %some concernnot evaluable moderatenon important-
Anaemia TRAE (grade 3-4) 0.08 [0.01, 0.43]< 10%2 studies (2/-)99.8 %some concernnot evaluable moderatenon important-
Arthralgia TRAE (grade 3-4) 1.30 [0.50, 3.42]< 10%3 studies (3/-)29.4 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 1.64 [0.45, 5.96]< 10%3 studies (3/-)22.5 %lownot evaluable highnon important-
Blood creatinine increased TRAE (grade 3-4) 0.61 [0.02, 18.27]< 10%1 study (1/-)61.1 %NAnot evaluable non important-
Chorioretinopathy TRAE (grade 3-4) 0.61 [0.02, 18.27]< 10%1 study (1/-)61.1 %NAnot evaluable non important-
Colitis TRAE (grade 3-4) 2.86 [0.59, 13.95]< 10%3 studies (3/-)9.8 %some concernnot evaluable moderatenon important-
Constipation TRAE (grade 3-4) 0.96 [0.06, 15.38]< 10%2 studies (2/-)51.2 %some concernnot evaluable moderatenon important-
Decreased appetite TRAE (grade 3-4) 0.58 [0.07, 4.55]< 10%3 studies (3/-)69.9 %some concernnot evaluable moderatenon important-
Diarrhoea TRAE (grade 3-4) 1.08 [0.25, 4.71]< 157%4 studies (4/-)45.8 %lownot evaluable highnon important-
Dry skin TRAE (grade 3-4) 1.98 [0.25, 15.69]< 10%3 studies (3/-)26.0 %some concernnot evaluable moderatenon important-
Erythema TRAE (grade 3-4) 7.41 [0.37, 148.78]< 10%1 study (1/-)9.8 %NAnot evaluable non important-
Eye disorders TRAE (grade 3-4) 0.98 [0.02, 49.62]< 10%1 study (1/-)50.4 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 0.48 [0.10, 2.26]< 157%3 studies (3/-)82.4 %some concernnot evaluable moderatenon important-
Hepatitis TRAE (grade 3-4) 3.85 [0.77, 19.20]< 10%4 studies (4/-)5.0 %some concernnot evaluable moderatenon important-
Hyperthyroidism TRAE (grade 3-4) 1.71 [0.27, 10.69]< 10%4 studies (4/-)28.3 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 1.43 [0.11, 18.64]< 10%2 studies (2/-)39.4 %some concernnot evaluable moderatenon important-
Hypothyroidism TRAE (grade 3-4) 0.98 [0.10, 9.42]< 10%3 studies (3/-)50.8 %some concernnot evaluable moderatenon important-
Increase AST TRAE (grade 3-4) 52.70 [7.19, 385.99]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
Increased ALT TRAE (grade 3-4) 32.40 [7.79, 134.72]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
Increased lipase level TRAE (grade 3-4) 0.99 [0.64, 1.52]< 10%1 study (1/-)52.3 %NAnot evaluable non important-
Leucopenia TRAE (grade 3-4) 0.07 [0.01, 0.50]< 10%2 studies (2/-)99.5 %some concernnot evaluable moderatenon important-
Maculopapular rash TRAE (grade 3-4) 1.38 [0.80, 2.37]< 10%3 studies (3/-)12.1 %lownot evaluable highnon important-
Myalgia TRAE (grade 3-4) 1.61 [0.35, 7.36]< 10%3 studies (3/-)27.2 %some concernnot evaluable moderatenon important-
Nausea TRAE (grade 3-4) 0.18 [0.05, 0.69]< 10%3 studies (3/-)99.4 %some concernnot evaluable moderatenon important-
Neutropenia TRAE (grade 3-4) 0.08 [0.01, 0.60]< 10%2 studies (2/-)99.3 %some concernnot evaluable moderatenon important-
Pancreatitis TRAE (grade 3-4) 2.61 [0.37, 18.36]< 10%3 studies (3/-)16.9 %some concernnot evaluable moderatenon important-
Paraesthesia TRAE (grade 3-4) 0.96 [0.06, 15.38]< 10%2 studies (2/-)51.2 %some concernnot evaluable moderatenon important-
Peripheral neuropathy TRAE (grade 3-4) 0.24 [0.03, 2.13]< 10%2 studies (2/-)89.9 %some concernnot evaluable moderatenon important-
Peripheral oedema TRAE (grade 3-4) 1.22 [0.02, 61.84]< 10%1 study (1/-)46.1 %NAnot evaluable non important-
Pneumonitis TRAE (grade 3-4) 4.00 [0.65, 24.72]< 10%3 studies (3/-)6.9 %some concernnot evaluable moderatenon important-
Pruritus TRAE (grade 3-4) 2.75 [0.59, 12.86]< 10%4 studies (4/-)10.0 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 1.22 [0.24, 6.13]< 10%1 study (1/-)40.3 %NAnot evaluable non important-
Rash TRAE (grade 3-4) 1.05 [0.58, 1.89]< 10%4 studies (4/-)44.0 %lownot evaluable highnon important-
Thrombocytopenia TRAE (grade 3-4) 0.18 [0.03, 1.07]< 10%2 studies (2/-)97.0 %some concernnot evaluable moderatenon important-
Thyroiditis TRAE (grade 3-4) 1.02 [0.02, 51.42]< 10%1 study (1/-)49.7 %NAnot evaluable non important-
Uveitis TRAE (grade 3-4) 1.42 [0.11, 18.63]< 10%2 studies (2/-)39.4 %some concernnot evaluable moderatenon important-
Vitiligo TRAE (grade 3-4) 0.96 [0.06, 15.38]< 10%2 studies (2/-)51.2 %some concernnot evaluable moderatenon important-
Vomiting TRAE (grade 3-4) 0.33 [0.11, 1.03]< 10%3 studies (3/-)97.2 %some concernnot evaluable moderatenon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 1.33 [0.15, 12.01]< 182%2 studies (2/-)39.9 %some concernnot evaluable moderatenon important-
Asthenia AE (grade 3-4) 0.14 [0.02, 0.77]< 10%2 studies (2/-)98.8 %lownot evaluable highnon important-
Chills AE (grade 3-4) 1.02 [0.02, 51.42]< 10%1 study (1/-)49.7 %NAnot evaluable non important-
Constipation AE (grade 3-4) 0.99 [0.17, 5.73]< 10%2 studies (2/-)50.5 %some concernnot evaluable moderatenon important-
Cough AE (grade 3-4) 2.00 [0.18, 22.13]< 10%2 studies (2/-)28.7 %some concernnot evaluable moderatenon important-
Decreased appetite AE (grade 3-4) 3.03 [0.17, 53.71]< 181%2 studies (2/-)22.7 %lownot evaluable highnon important-
Diarrhoea AE (grade 3-4) 21.14 [1.23, 363.94]< 10%1 study (1/-)1.9 %NAnot evaluable non important-
Dyspnoea AE (grade 3-4) 5.55 [1.41, 21.79]< 10%2 studies (2/-)0.7 %some concernnot evaluable moderatenon important-
Fatigue AE (grade 3-4) 2.86 [1.61, 5.08]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
Headache AE (grade 3-4) 2.94 [0.58, 14.91]< 10%2 studies (2/-)9.7 %lownot evaluable highnon important-
Hypothyroidism AE (grade 3-4) 1.22 [0.02, 61.84]< 10%1 study (1/-)46.1 %NAnot evaluable non important-
Increase AST AE (grade 3-4) 18.42 [5.64, 60.14]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
Increased ALT AE (grade 3-4) 34.83 [8.39, 144.67]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
Nausea AE (grade 3-4) 1.38 [0.67, 2.86]< 10%2 studies (2/-)19.0 %some concernnot evaluable moderatenon important-
Neutropenia AE (grade 3-4) 0.03 [0.00, 0.19]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Peripheral oedema AE (grade 3-4) 4.97 [0.58, 42.77]< 10%1 study (1/-)7.3 %NAnot evaluable non important-
Pruritus AE (grade 3-4) 7.90 [0.98, 63.82]< 10%2 studies (2/-)2.7 %lownot evaluable highnon important-
Pyrexia AE (grade 3-4) 3.79 [0.36, 39.89]< 10%2 studies (2/-)13.6 %some concernnot evaluable moderatenon important-
Rash AE (grade 3-4) 6.71 [1.20, 37.51]< 10%2 studies (2/-)1.5 %some concernnot evaluable moderatenon important-
Thrombocytopenia AE (grade 3-4) 0.03 [0.00, 0.26]< 10%1 study (1/-)99.9 %NAnot evaluable non important-
Vomiting AE (grade 3-4) 1.70 [0.85, 3.42]< 10%2 studies (2/-)6.7 %some concernnot evaluable moderatenon important-
Weight decreased AE (grade 3-4) 1.00 [0.14, 7.12]< 10%2 studies (2/-)50.1 %some concernnot evaluable moderatenon important-

LoD: level of statistical demonstration: Statistically conclusive: statistically significant with a strict control of overall risk of type 1 error (statistically demonstrated), does not take into account the risk of bias; suggested: nominally statistically significant but without a strict control of overall risk of type 1 error; inconclusive: not nominally statistically significant; safety concerns;
Bayesian probability: Bayesian posterior probability of treatment effect (computed with a noninformative prior); ROB: risk of bias; k: number of studies; published MA: number of published meta-analysis on the same topic; degree of certainty adapted from GRADE. Trt. better when: indicates when the relative treatment effect shows that the studied treatment is better than control.