Department of Dermatology, University Hospital Zurich.
Kein Division, University of Zurich, Zurich, Switzerland.
Curr Opin Oncol. 2018 Mar;30(2):118-124. doi: 10.1097/CCO.0000000000000432.
We review the results from relevant clinical trials and discuss current strategies in the melanoma adjuvant setting.
The favorable therapeutic efficacy and the significant less toxicity of nivolumab compared with ipilimumab, fully substitutes today's approval of ipilimumab, regardless mutation status, whereas in BRAF-mutated patients, dabrafenib and trametinib seem to confirm their high efficacy also in adjuvant setting. The use of interferon is restricted to patients with ulcerated melanoma and countries with no access to the new drugs.
Systemic adjuvant treatment after complete disease resection in high-risk melanoma patients aims to increase relapse-free survival (RFS) and overall survival (OS). According to the eighth edition of melanoma classification of American Joint Committee on Cancer (AJCC), the prognosis in stage III patients is heterogeneous and depends not only on N (nodal) but also on T (tumor thickness) category criteria. Recent data from randomized, phase-3 clinical trials analyzing the use of adjuvant anti-programmed death-1 and targeted therapies ultimately affect the standard of care and change the landscape of the adjuvant treatment.
我们回顾了相关临床试验的结果，并讨论了黑色素瘤辅助治疗的现状策略。
与依匹单抗相比，纳武单抗具有更好的治疗效果和更小的毒性，目前已完全取代了依匹单抗的批准，而不论突变状态如何，而在 BRAF 突变患者中，达布拉非尼和曲美替尼似乎也证实了它们在辅助治疗中的高疗效。干扰素的使用仅限于溃疡型黑色素瘤患者和无法获得新药的国家。
在高危黑色素瘤患者完全切除疾病后进行全身辅助治疗旨在提高无复发生存率（RFS）和总生存率（OS）。根据美国癌症联合委员会（AJCC）第八版黑色素瘤分类，III 期患者的预后存在异质性，不仅取决于 N（淋巴结），还取决于 T（肿瘤厚度）分类标准。最近来自随机、III 期临床试验的数据，分析了辅助抗程序性死亡-1 和靶向治疗的应用，最终影响了标准治疗，并改变了辅助治疗的格局。
