Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, -1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Curr Treat Options Oncol. 2019 Jun 24;20(8):63. doi: 10.1007/s11864-019-0666-x.
In recent years, the number of patients with malignant melanoma has continued to increase globally; surgery remains the first treatment option for patients with resectable melanoma. Adjuvant therapy for patients with stage III and IV melanoma following surgical resection has gradually been approved. After complete resection, these patients can probably derive significant benefit from adjuvant therapy. New treatments that improve the long-term survival of patients with unresectable advanced or metastatic melanoma are currently under evaluation in adjuvant therapy to increase relapse-free survival and overall survival. We here review several relevant clinical trials of radiotherapy, systemic immune therapies, molecular-targeted therapies, and neoadjuvant therapies in order to shed light on most suitable adjuvant therapy. The findings of this review include the following: The use of interferon-α2b will be restricted for patients with ulcerated primary melanoma in countries with no access to new drugs in adjuvant therapy. Ipilimumab should not be considered as the first-line therapy due to its lower efficacy and severe toxicity. The use of anti-programmed death-1 antibody would be a relevant adjuvant therapy for patients without BRAF mutation. If the BRAF mutation status is positive, the combination of dabrafenib and trametinib is a plausible option. The establishment of appropriate therapeutic planning and clinical endpoints in adjuvant therapy should affect the standard of care. The choice of optimal adjuvant therapy for individual patients is an important issue.
近年来，全球恶性黑素瘤患者数量持续增加；手术仍然是可切除黑素瘤患者的首选治疗方法。手术切除后，III 期和 IV 期黑素瘤患者的辅助治疗逐渐得到批准。完全切除后，这些患者可能从辅助治疗中获得显著获益。目前，新的治疗方法正在评估中，以改善不可切除的晚期或转移性黑素瘤患者的长期生存，增加无复发生存期和总生存期。我们在此回顾了放疗、系统免疫治疗、分子靶向治疗和新辅助治疗的几项相关临床试验，以期阐明最适合的辅助治疗方法。该综述的结果包括以下内容：在没有新辅助治疗药物的国家，对于有溃疡原发性黑素瘤的患者，将限制使用干扰素-α2b。由于其疗效较低且毒性严重，不应将伊匹单抗视为一线治疗药物。抗程序性死亡-1 抗体的使用将是无 BRAF 突变患者的一种相关辅助治疗方法。如果 BRAF 突变状态为阳性，达布拉非尼和曲美替尼联合治疗是一种合理的选择。辅助治疗中适当治疗计划和临床终点的建立应影响护理标准。选择最佳的辅助治疗方案对于个体患者而言是一个重要问题。
