Department of Medicine, Melanoma and Sarcoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Clin Dermatol. 2013 May-Jun;31(3):290-7. doi: 10.1016/j.clindermatol.2012.08.016.
The recent past has witnessed unprecedented clinical progress in the treatment of advanced malignant melanoma through targeting of mutant BRAF in approximately 50% of patients and immune check point blockade in all patients. As has been well documented, responses to targeted therapy are of limited duration, and rates of clinical benefit to immunotherapy are modest. Given these factors, palliation of patients with chemotherapy remains an essential aspect of melanoma oncology. Many chemotherapeutics (and combinations with other agents, such as immunotherapy) have been evaluated in melanoma, although no chemotherapy regimen has been documented to provide an overall survival benefit in a prospective, randomized, well-controlled phase III study. We provide an overview of the development of the most common chemotherapy regimens for melanoma, discuss the clinical trial evidence supporting and contrasting them, and highlight appropriate clinical situations in which they might be used. We also discuss the future of chemotherapy for melanoma, noting the potential for combinations of chemotherapy with either targeted or immunotherapeutic agents.
近年来，通过针对大约 50%的患者的突变 BRAF 和所有患者的免疫检查点阻断，在治疗晚期恶性黑色素瘤方面取得了前所未有的临床进展。正如已有充分记录的那样，靶向治疗的反应持续时间有限，免疫治疗的临床获益率也较低。鉴于这些因素，化疗缓解患者的病情仍然是黑色素瘤肿瘤学的一个重要方面。已经评估了许多化疗药物（以及与其他药物的联合治疗，如免疫治疗）在黑色素瘤中的应用，尽管没有一种化疗方案在前瞻性、随机、对照的 III 期研究中被证明能提供总体生存获益。我们提供了黑色素瘤最常见化疗方案的发展概述，讨论了支持和对比它们的临床试验证据，并强调了在适当的临床情况下使用它们的情况。我们还讨论了化疗治疗黑色素瘤的未来，指出化疗与靶向或免疫治疗药物联合应用的潜力。
