Crosby T, Fish R, Coles B, Mason M D
Clinical Oncology, Velindre Hospital, Whitchurch, Cardiff, UK, CF4 7XL.
Cochrane Database Syst Rev. 2000(2):CD001215. doi: 10.1002/14651858.CD001215.
Systemic therapies for metastatic cutaneous melanoma, the most aggressive of all skin cancers, remain disappointing. Few lasting remissions are achieved and the therapeutic aim remains one of palliation. Many agents are used alone or in combination with varying degrees of toxicity and cost. It is unclear whether evidence exists to support these complex regimens over best supportive care / placebo.
To review the benefits from the use of systemic therapies in metastatic cutaneous melanoma compared to best supportive care/placebo, and to establish whether a 'standard' therapy exists which is superior to other treatments.
Randomised controlled trials were identified from the MEDLINE, EMBASE and CCTR/CENTRAL databases. References, conference proceedings, and Science Citation Index/Scisearch were also used to locate trials. Cancer registries and trialists were also contacted.
Randomised controlled trials of adults with histologically proven metastatic cutaneous melanoma in which systemic anti-cancer therapy was compared with placebo or supportive care.
Study selection was performed by two independent reviewers. Data extraction forms were used for studies which appeared to meet the selection criteria and, where appropriate, full text articles were retrieved and reviewed independently.
No randomised controlled trials were found comparing a systemic therapy with placebo or best supportive care in metastatic cutaneous melanoma.
REVIEWER'S CONCLUSIONS: There is no evidence from randomised controlled clinical trials to show superiority of systemic therapy over best supportive care / placebo in the treatment of malignant cutaneous melanoma. Given that patients with metastatic melanoma frequently receive systemic therapy, it is our pragmatic view that a future systematic review could compare any systemic treatment, or combination of treatments, to single agent dacarbazine.
转移性皮肤黑色素瘤是所有皮肤癌中侵袭性最强的一种，其全身治疗效果仍然令人失望。很少能实现持久缓解，治疗目的仍然是姑息治疗。许多药物单独使用或联合使用，毒性和成本各不相同。目前尚不清楚是否有证据支持这些复杂的治疗方案优于最佳支持治疗/安慰剂。
比较全身治疗与最佳支持治疗/安慰剂在转移性皮肤黑色素瘤治疗中的益处，并确定是否存在优于其他治疗方法的“标准”治疗方案。
从MEDLINE、EMBASE和CCTR/CENTRAL数据库中检索随机对照试验。还利用参考文献、会议论文集以及科学引文索引/科学搜索来查找试验。还联系了癌症登记处和试验研究者。
对组织学确诊为转移性皮肤黑色素瘤的成年人进行随机对照试验，其中将全身抗癌治疗与安慰剂或支持治疗进行比较。
由两名独立的评审员进行研究选择。对于似乎符合选择标准的研究，使用数据提取表，并在适当情况下检索全文文章并独立评审。
未发现将全身治疗与安慰剂或最佳支持治疗用于转移性皮肤黑色素瘤的随机对照试验。
随机对照临床试验没有证据表明全身治疗在恶性皮肤黑色素瘤治疗中优于最佳支持治疗/安慰剂。鉴于转移性黑色素瘤患者经常接受全身治疗，我们务实的观点是，未来的系统评价可以将任何全身治疗或治疗组合与单药达卡巴嗪进行比较。
