Karg C, Garbe C, Orfanos C E
Universitäts-Hautklinik, Klinikum Steglitz der Freien Universität Berlin.
Hautarzt. 1990 Feb;41(2):56-65.
Curative treatment modalities for patients with malignant melanoma (MM) in advanced stages are limited. Temporary successes with chemotherapy have so far mainly been achieved after removal of all accessible tumor masses. Extensive experience with cytostatic measures has been gained over more than two decades both with therapeutic and with adjuvant schedules. Dacarbazine (DTIC), which is associated with a remission rate of approximately 20%, continues to be the most effective cytostatic drug in the treatment of MM. Systemic (poly) chemotherapeutic schedules with and without DTIC have improved the response rates in metastasizing MM in numerous phase II trials. However, these results have not been confirmed in randomized studies comparing these schedules with DTIC monochemotherapy. For the BOLD schedule (bleomycin, Oncovin, lomustine, dacarbazine), the BELD schedule (Eldisine instead of Oncovin), and the DVP combination (dacarbazine, vindesine, Platinex), initial response rates of 40-49% have been reported. However, lower response rates were recently described (DVP: 24%; BOLD: 22% and 4%). Therefore, there is still no definite evidence that polychemotherapy is superior to DTIC monotherapy in MM. In our opinion, expected response rates of 20-30% justify the use of chemotherapy in disseminated MM; in cases of further progression, therapy should be interrupted early - after 2-3 cycles. Systemic (poly) chemotherapy of metastasizing MM is indicated in patients whose general condition is good, mainly in those who have skin, soft tissue, or lung metastases. These metastases usually respond well to cytostatic treatment. In future, the combined use of cytostatics together with new antitumour molecules may reduce the general toxicity and improve the efficacy of systemic cytostatic therapy in MM. The benefits of adjuvant chemotherapy in the treatment of MM have still to be confirmed definitively. While adjuvant therapy with DTIC has proved to be ineffective in stage I, irrespective of the tumor thickness, some studies suggest that adjuvant therapy with DTIC, or combinations including DTIC, may improve the prognosis of patients in clinical stage II.
晚期恶性黑色素瘤（MM）患者的根治性治疗方法有限。迄今为止，化疗取得的暂时成功主要是在切除所有可触及的肿瘤块之后实现的。二十多年来，在治疗性和辅助性治疗方案方面都积累了丰富的细胞毒性治疗经验。达卡巴嗪（DTIC）的缓解率约为20%，仍然是治疗MM最有效的细胞毒性药物。在众多II期试验中，含或不含DTIC的全身（联合）化疗方案提高了转移性MM的缓解率。然而，在将这些方案与DTIC单药化疗进行比较的随机研究中，这些结果并未得到证实。对于BOLD方案（博来霉素、长春新碱、洛莫司汀、达卡巴嗪）、BELD方案（用长春地辛代替长春新碱）和DVP组合（达卡巴嗪、长春地辛、顺铂），已报道初始缓解率为40 - 49%。然而，最近报道的缓解率较低（DVP：24%；BOLD：22%和4%）。因此，仍然没有确凿的证据表明联合化疗在MM中优于DTIC单药治疗。我们认为，20 - 30%的预期缓解率证明在播散性MM中使用化疗是合理的；在病情进一步进展的情况下，应在2 - 3个周期后尽早中断治疗。转移性MM的全身（联合）化疗适用于一般状况良好的患者，主要是那些有皮肤、软组织或肺转移的患者。这些转移灶通常对细胞毒性治疗反应良好。未来，细胞毒性药物与新的抗肿瘤分子联合使用可能会降低全身毒性，并提高MM全身细胞毒性治疗的疗效。辅助化疗在MM治疗中的益处仍有待最终证实。虽然DTIC辅助治疗在I期已被证明无效，无论肿瘤厚度如何，但一些研究表明，DTIC或包括DTIC的联合辅助治疗可能会改善临床II期患者的预后。
