DePeralta Danielle K, Boland Genevieve M
Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2015 Oct;22(11):3451-8. doi: 10.1245/s10434-015-4702-1. Epub 2015 Jul 30.
In recent years, there have been dramatic improvements in the diagnosis and treatment of patients with melanoma. The development of molecular markers and associated targeted therapies have given new hope to subsets of patients with advanced disease. Here we discuss the most important advances in molecular targeted therapy and how these developments are likely to affect the practice of the clinical surgeon.
Germ-line and somatic mutations are common in melanoma and provide prognostic information that can now be harnessed to provide a more personalized approach to cancer treatment. BRAF mutation at the V600 position is the most commonly identified mutation in patients with melanoma. Treatment with targeted inhibitors in patients with BRAF-mutant melanoma has afforded dramatic responses in about half of selected patients. Unfortunately, disease control is not durable and recurrences are common. We predict an increasing role for the surgeon in the multidisciplinary treatment of patients with metastatic disease, as well as a role for molecular profiling in patients with high-risk early stage disease. Further, we are only beginning to understand the prognostic significance of various gene mutations in patients with melanoma.
近年来，黑色素瘤患者的诊断和治疗有了显著改善。分子标志物及相关靶向治疗的发展为晚期疾病患者亚群带来了新希望。在此，我们讨论分子靶向治疗的最重要进展以及这些进展可能如何影响临床外科医生的实践。
种系和体细胞突变在黑色素瘤中很常见，并提供预后信息，现在可利用这些信息为癌症治疗提供更个性化的方法。V600 位点的 BRAF 突变是黑色素瘤患者中最常发现的突变。BRAF 突变型黑色素瘤患者使用靶向抑制剂治疗，约半数选定患者有显著反应。不幸的是，疾病控制并不持久，复发很常见。我们预测外科医生在转移性疾病患者的多学科治疗中的作用将增加，以及分子谱分析在高危早期疾病患者中的作用。此外，我们才刚刚开始了解黑色素瘤患者各种基因突变的预后意义。
