State University of New York Upstate Medical University, Syracuse, NY.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2020 Nov 20;38(33):3947-3970. doi: 10.1200/JCO.20.00198. Epub 2020 Mar 31.
To provide guidance to clinicians regarding the use of systemic therapy for melanoma.
ASCO convened an Expert Panel and conducted a systematic review of the literature.
A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma.
In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in -mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in -mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines.
为临床医生提供有关黑色素瘤系统治疗的使用指南。
ASCO 召集了一个专家小组并对文献进行了系统回顾。
系统回顾、一项荟萃分析和 34 项额外的随机试验被确定。已发表的研究包括皮肤和非皮肤黑色素瘤的广泛的系统治疗。
在辅助治疗环境下，对于已切除的 IIIA/B/C/D 期野生型皮肤黑色素瘤患者，应提供纳武利尤单抗或帕博利珠单抗；而在 - 突变疾病中，应提供这两种药物中的任何一种或达拉非尼联合曲美替尼。对于皮肤黑色素瘤的新辅助治疗，不能推荐或反对使用。在不可切除/转移性治疗环境下，对于野生型皮肤黑色素瘤患者，应提供伊匹单抗联合纳武利尤单抗、纳武利尤单抗单药或帕博利珠单抗单药；而对于 - 突变疾病，应提供这三种方案或联合 BRAF/MEK 抑制剂治疗（达拉非尼/曲美替尼、恩考芬尼/比美替尼或维莫非尼/考比替尼）。黏膜黑色素瘤患者可能会接受与皮肤黑色素瘤相同的治疗建议。对于葡萄膜黑色素瘤，不能推荐或反对特定的治疗。更多信息可在 www.asco.org/melanoma-guidelines 上获得。
