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黑色素瘤治疗领域的新进展
Recent Advances in the Treatment of Melanoma


Brendan D. Curti ... 肿瘤 • 2021.06.10
相关阅读
• 贝伐珠单抗对不同年龄黑色素瘤患者的不同疗效 • BRAF 突变型转移性黑色素瘤的靶向治疗与免疫治疗比较

黑色素瘤发病率持续增加,但晚期黑色素瘤病死率在过去10年间有所下降1。从黑色素瘤研究中获得的认识使我们更深入地理解了抗肿瘤免疫应答,并将免疫疗法确立为癌症的主要疗法之一。本刊2004年的一篇黑色素瘤综述文章很有预见性地指出检查点免疫疗法和BRAF靶向疗法代表了未来的治疗方向,而这两种疗法已经彻底改变了癌症治疗2。2004年时,黑色素瘤尚无任何全身性疗法被证明有生存获益。而现在已经至少有4种免疫治疗方案和3种靶向治疗方案可延长患者总生存期和无病生存期(图1)。本文着重介绍黑色素瘤治疗领域的新进展,包括分期的改变、手术治疗,以及高危和晚期黑色素瘤全身性疗法的进展。

 

图1. 已批准的黑色素瘤疗法和相关的2年总生存率

图A显示了美国食品药品管理局(FDA)批准各种全身性疗法的时间,其中包括用于晚期黑色素瘤的化疗及细胞因子、检查点和靶向疗法,以及切除术后的辅助治疗。图B显示了晚期黑色素瘤疗法关键临床试验中的2年总生存率。Atezo表示阿替利珠单抗,Bini表示贝美替尼(binimetinib),Cobi表示考比替尼(cobimetinib),CTLA-4表示细胞毒性T淋巴细胞抗原4,Dab表示达拉非尼(dabrafenib),Enco表示康奈非尼(encorafenib),Ipi表示伊匹木单抗(ipilimumab),Nivo表示纳武利尤单抗,PD-1表示程序性死亡受体1,PD-L1表示PD-1配体,Pembro表示帕博利珠单抗,Tram表示曲美替尼,TVEC表示talimogene laherparepvec,Vem表示维莫非尼。

 

黑色素瘤分期


在美国癌症联合委员会(American Joint Committee on Cancer)现行(第八版)癌症分期手册(AJCC-8)中,黑色素瘤分期系统是基于接受现代手术方法(包括前哨淋巴结活检)治疗的超过46,000例患者的数据3。该分期系统保留了传统的肿瘤-淋巴结-转移(TNM)分类,并结合了分类间的相互影响来确定最终分期。AJCC-8黑色素瘤分期系统纳入了前哨淋巴结状态,这样可以区分淋巴结阴性和淋巴结阳性黑色素瘤,因而大幅改进了预后信息3,4。原发黑色素瘤部位的特征(包括浸润深度、溃疡程度和有丝分裂率)可用于估计淋巴结转移风险5。目前正在设计无需完全淋巴结清扫术的未来分期系统,因为现行标准做法是尽量避免大多数患者的淋巴结清扫术6





作者信息

Brendan D. Curti, M.D., and Mark B. Faries, M.D.
From the Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR (B.D.C.); and Cedars–Sinai Medical Center and the Angeles Clinic and Research Institute, Los Angeles (M.B.F.). Address reprint requests to Dr. Curti at the Providence Cancer Institute, Providence Portland Medical Center, 4805 NE Glisan St., Suite 2N82, Portland, OR 97213, or at brendan.curti@providence.org.

 

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