Faculty of Medicine and Health, The University of Sydney, North Sydney, NSW, Australia.
Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
Ann Surg Oncol. 2020 Jul;27(7):2188-2200. doi: 10.1245/s10434-020-08566-8. Epub 2020 May 14.
Since the advent of effective systemic therapy, quantum changes have occurred in the multidisciplinary management strategies used for patients with American Joint Committee on Cancer stages 3 and 4 melanoma. For high-risk stage 3 patients, neoadjuvant immune checkpoint blockade (ICB) and targeted therapies present a promising novel approach to improving survival outcomes. In particular, patients who respond to ICB have an excellent prognosis, and clinical trials are ongoing to investigate whether those with a pathologic complete response (pCR) or near-pCR in a single node may avoid therapeutic lymph node dissection and adjuvant therapy. Toxicities currently are acceptably low, but when toxic events occur, they can have an enduring impact on a patient's quality of life. To date, nearly all patients evaluated after treatment with neoadjuvant dabrafenib plus trametinib have some clinical and pathologic response. Patients who achieve pCR have improved prognosis, but pCR is not as reliable a predictor of improved outcome as pCR or near-pCR after neoadjuvant ICB. Ongoing studies should ideally be coordinated through the International Neoadjuvant Melanoma Consortium to ensure maximal efficiency at improving outcomes for melanoma patients.
自有效的全身治疗问世以来，用于治疗美国癌症联合委员会（AJCC）分期 3 期和 4 期黑色素瘤患者的多学科管理策略发生了重大变化。对于高危 3 期患者，新辅助免疫检查点阻断（ICB）和靶向治疗为改善生存结果提供了一种很有前途的新方法。特别是，对 ICB 有反应的患者预后极好，目前正在进行临床试验，以研究单一淋巴结中具有病理完全缓解（pCR）或接近 pCR 的患者是否可以避免治疗性淋巴结清扫和辅助治疗。目前毒性可接受程度较低，但当毒性事件发生时，它们会对患者的生活质量产生持久影响。迄今为止，几乎所有接受新辅助达拉非尼加曲美替尼治疗后的患者都有一定的临床和病理反应。达到 pCR 的患者预后改善，但 pCR 作为新辅助 ICB 后 pCR 或接近 pCR 的预测指标并不如后者可靠。理想情况下，正在进行的研究应通过国际新辅助黑色素瘤联盟协调进行，以确保最大程度地提高黑色素瘤患者的治疗效果。
