Mc Clay E F, Mastrangelo M J
Division of Medical Oncology, Jefferson Medical College, Philadelphia.
Semin Oncol. 1988 Dec;15(6):569-77.
The treatment of patients with metastatic melanoma remains a difficult problem. It is clear that more effective agents need to be developed. No single agent in conventional doses has been shown to be more effective than DTIC alone. The results obtained with detrorubicin in untreated patients are encouraging, but need further confirmation. If confirmed, combination regimens incorporating detrorubicin should be studied. Further experience is needed with high-dose cisplatin before it can be recommended for broader clinical use. Recent experience with the 4 drug combination of DTIC, BCNU, cisplatin, and tamoxifen is encouraging. The objective response rate is approximately 50% and patients with visceral disease have demonstrated regressions. CRs are not uncommon with occasional patients exhibiting durable remissions for as long as 3 years. An added benefit is that this regimen is well tolerated by most patients making it technically easy to administer. Finally, the role of interferon needs further study. The response rate to interferon alfa-2a is reasonably well defined at about 20%. Combinations of chemotherapeutic agents and interferons have only begun to be evaluated but the preliminary data are interesting.
转移性黑色素瘤患者的治疗仍然是一个难题。显然，需要研发更有效的药物。常规剂量下，没有单一药物被证明比达卡巴嗪（DTIC）更有效。在未经治疗的患者中使用去甲柔红霉素所获得的结果令人鼓舞，但需要进一步证实。如果得到证实，应研究包含去甲柔红霉素的联合治疗方案。在高剂量顺铂被推荐用于更广泛的临床应用之前，还需要更多的经验。近期使用达卡巴嗪、卡莫司汀（BCNU）、顺铂和他莫昔芬的四联药物组合的经验令人鼓舞。客观缓解率约为50%，内脏疾病患者已出现病情缓解。完全缓解（CR）并不罕见，偶尔有患者可表现出长达3年的持久缓解。另一个好处是，大多数患者对该方案耐受性良好，使其在技术上易于给药。最后，干扰素的作用需要进一步研究。对α-2a干扰素的缓解率已得到较为明确的界定，约为20%。化疗药物与干扰素的联合应用才刚刚开始评估，但初步数据很有意思。
