Mangana Joanna, Cheng Phil F, Kaufmann Corina, Amann Valerie C, Frauchiger Anna L, Stögner Viola, Held Ulrike, von Moos Roger, Michielin Olivier, Braun Ralph P, Levesque Mitchell P, Goldinger Simone M, Dummer Reinhard
aDepartment of Dermatology, University Hospital Zurich bUniversity of Zurich cHorten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich dDepartment of Internal Medicine, Cantonal Hospital Aarau, Aarau eDepartment of Oncology, Cantonal Hospital Graubünden, Chur fService of Medical Oncology, Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland gUniversity of Vienna, Vienna, Austria.
Melanoma Res. 2017 Aug;27(4):358-368. doi: 10.1097/CMR.0000000000000359.
Metastatic melanoma is a highly aggressive disease. Recent progress in immunotherapy (IT) and targeted therapy (TT) has led to significant improvements in response and survival rates in metastatic melanoma patients. The current project aims to determine the benefit of the introduction of these new therapies in advanced melanoma across several regions of Switzerland. This is a retrospective multicenter analysis of 395 advanced melanoma patients treated with standard chemotherapy, checkpoint inhibitors, and kinase inhibitors from January 2008 until December 2014. The 1-year survival was 69% (n=121) in patients treated with checkpoint inhibitors (IT), 50% in patients treated with TTs (n=113), 85% in the IT+TT group (n=66), and 38% in patients treated with standard chemotherapy (n=95). The median overall survival (mOS) from first systemic treatment in the entire study cohort was 16.9 months. mOS of patients treated either with checkpoint or kinase inhibitors (n=300, 14.6 months) between 2008 and 2014 was significantly improved (P<0.0001) compared with patients treated with standard chemotherapy in 2008-2009 (n=95, 7.4 months). mOS of 61 patients with brain metastases at stage IV was 8.1 versus 12.5 months for patients without at stage IV (n=334), therefore being significantly different (P=0.00065). Furthermore, a significant reduction in hospitalization duration compared with chemotherapy was noted. Treatment with checkpoint and kinase inhibitors beyond clinical trials significantly improves the mOS in real life and the results are consistent with published prospective trial data.
转移性黑色素瘤是一种极具侵袭性的疾病。免疫疗法（IT）和靶向疗法（TT）的最新进展已使转移性黑色素瘤患者的缓解率和生存率得到显著提高。当前项目旨在确定在瑞士多个地区的晚期黑色素瘤中引入这些新疗法的益处。这是一项回顾性多中心分析，研究对象为2008年1月至2014年12月期间接受标准化疗、检查点抑制剂和激酶抑制剂治疗的395例晚期黑色素瘤患者。接受检查点抑制剂（IT）治疗的患者1年生存率为69%（n = 121），接受TTs治疗的患者为50%（n = 113），IT + TT组为85%（n = 66），接受标准化疗的患者为38%（n = 95）。整个研究队列中首次全身治疗后的中位总生存期（mOS）为16.9个月。2008年至2014年期间接受检查点或激酶抑制剂治疗的患者（n = 300，14.6个月）的mOS与2008 - 2009年接受标准化疗的患者（n = 95，7.4个月）相比有显著改善（P < 0.0001）。IV期有脑转移的61例患者的mOS为8.1个月，而IV期无脑转移的患者为12.5个月（n = 334），因此差异显著（P = 0.00065）。此外，与化疗相比，住院时间显著缩短。在现实生活中，超出临床试验范围使用检查点和激酶抑制剂进行治疗可显著改善mOS，结果与已发表的前瞻性试验数据一致。
