Saraceni Megan M, Khushalani Nikhil I, Jarkowski Anthony
Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
J Pharm Pract. 2015 Apr;28(2):193-203. doi: 10.1177/0897190014527317. Epub 2014 Mar 27.
The incidence and mortality of melanoma are on the rise. Historically, patients diagnosed with metastatic melanoma were faced with a grim prognosis, with survival rates of 15% at 5 years. Prior to 2011, no drug or therapeutic regimen had been shown to improve overall survival (OS) in metastatic melanoma. Chemotherapeutic agents, such as dacarbazine or temozolomide, are often given to patients for palliative purposes; high-dose interleukin 2 and biochemotherapy are immunotherapeutic options that could be offered to patients with a good performance status at specialized centers. Neither has been shown to impact OS, but durable complete responses are seen in a minority of patients. Since 2011, 4 new drugs have been approved by the US Food and Drug Administration for the treatment of metastatic melanoma, all of which improve survival. Three of these agents (vemurafenib, dabrafenib, and trametinib) are targeted therapies, with ipilimumab being the only new immunotherapy. With a focus on immunotherapeutic agents, this review seeks to summarize the treatment options currently available for metastatic melanoma and to examine those on the near horizon.
黑色素瘤的发病率和死亡率正在上升。从历史上看，被诊断为转移性黑色素瘤的患者面临着严峻的预后，5年生存率为15%。在2011年之前，没有药物或治疗方案被证明能提高转移性黑色素瘤的总生存期（OS）。化疗药物，如达卡巴嗪或替莫唑胺，通常用于患者的姑息治疗；高剂量白细胞介素2和生物化疗是免疫治疗选择，可在专业中心提供给身体状况良好的患者。两者均未显示对总生存期有影响，但少数患者出现持久的完全缓解。自2011年以来，美国食品药品监督管理局已批准4种新药用于治疗转移性黑色素瘤，所有这些药物都能提高生存率。其中三种药物（维莫非尼、达拉非尼和曲美替尼）是靶向治疗药物，伊匹单抗是唯一的新型免疫治疗药物。本综述聚焦于免疫治疗药物，旨在总结目前可用于转移性黑色素瘤的治疗选择，并探讨近期即将出现的治疗方法。
