Sabel Michael S, Sondak Vernon K
University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA.
Oncologist. 2003;8(5):451-8. doi: 10.1634/theoncologist.8-5-451.
Should interferon alpha (IFN-alpha) be considered the standard of care for the adjuvant therapy of high-risk malignant melanoma? For 2003, it was estimated that 51,400 cases of invasive melanoma would be diagnosed. The risk of recurrence after surgery is reported to be approximately 60% for patients with thick primary lesions (T4N0M0, American Joint Committee on Cancer [AJCC] stage IIB) and 75% for patients with regional nodal metastases (T1-4N1M0, AJCC stage III). The observation that melanoma is susceptible to attack by the host's immune system has resulted in the testing of a remarkably broad spectrum of immunotherapies in the adjuvant setting. Many of these approaches failed to demonstrate a significant clinical impact, until the use of adjuvant IFN-alpha. Conflicting data from several large, randomized clinical trials resulted in a rapid rise and then decline in the use of IFN-alpha in the adjuvant setting. This roller coaster has left many clinicians still hesitant to strongly recommend it, and the use of adjuvant IFN-alpha in high-risk melanoma remains controversial. This manuscript reviews the leading arguments for and against its routine use and addresses questions regarding its role in the management of high-risk malignant melanoma.
α干扰素（IFN-α）是否应被视为高危恶性黑色素瘤辅助治疗的标准疗法？据估计，2003年有51400例侵袭性黑色素瘤将被确诊。据报道，原发性厚皮损患者（T4N0M0，美国癌症联合委员会[AJCC]IIB期）术后复发风险约为60%，区域淋巴结转移患者（T1 - 4N1M0，AJCC III期）术后复发风险为75%。黑色素瘤易受宿主免疫系统攻击这一发现促使人们在辅助治疗中对种类繁多的免疫疗法进行了测试。在使用辅助性IFN-α之前，这些方法大多未能显示出显著的临床效果。来自几项大型随机临床试验的相互矛盾的数据导致辅助性IFN-α的使用迅速增加，随后又减少。这种过山车式的情况让许多临床医生仍对强烈推荐它犹豫不决，高危黑色素瘤中辅助性IFN-α的使用仍然存在争议。本文综述了支持和反对其常规使用的主要论据，并探讨了其在高危恶性黑色素瘤治疗中的作用相关问题。
