Aix-Marseille University and APHM Hospital CHU Timone, Marseille, France.
Melanoma Institute Australia, University of Sydney, and Mater Hospital, Sydney, NSW, Australia.
Lancet Oncol. 2015 Oct;16(13):e522-6. doi: 10.1016/S1470-2045(15)00003-0.
In the past 5 years, the treatment of metastatic melanoma has changed from almost no effective treatment to the use of targeted and immune therapies with proven improvements in survival. The time has now come to define the optimal drug combinations, sequence of treatment, and drug regimens (intermittent vs continuous dosing) in the treatment of patients with metastatic melanoma. In view of the prevalence of advanced melanoma, finite resources, and the heterogeneity of disease characteristics, not all possibilities can be tested in therapeutic trials starting from an unselected population of patients with metastatic melanoma. In practice, clinicians rely on a few clinically derived signals, especially dynamic signals, to categorise patients into scenarios, from fast disease kinetics to slow disease kinetics, which drive clinicians' therapeutic decision making. The realistic goals of therapy are different in each scenario. We recommend that these scenarios are incorporated into clinical trials as either patient inclusion criteria or stratification factors. This approach is not only feasible but is also the only way to generate evidence for more effective and individualised treatment strategies for patients with metastatic melanoma.
在过去的 5 年中，转移性黑色素瘤的治疗已经从几乎没有有效治疗方法转变为使用靶向和免疫疗法，这些方法已被证明可以提高生存率。现在是时候确定转移性黑色素瘤患者治疗中的最佳药物组合、治疗顺序和药物方案（间歇性与连续性给药）了。鉴于晚期黑色素瘤的普遍性、有限的资源以及疾病特征的异质性，并非所有可能性都可以在从未经选择的转移性黑色素瘤患者开始的治疗试验中进行测试。在实践中，临床医生依赖于少数临床衍生的信号，特别是动态信号，将患者分类为不同的情况，从快速疾病动力学到缓慢疾病动力学，这些情况驱动着临床医生的治疗决策。每个情况下的治疗现实目标是不同的。我们建议将这些情况纳入临床试验作为患者纳入标准或分层因素。这种方法不仅可行，而且是为转移性黑色素瘤患者生成更有效和个体化治疗策略证据的唯一途径。
