Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Am Soc Clin Oncol Educ Book. 2024 Jun;44(3):e438654. doi: 10.1200/EDBK_438654.
Little more than 10 years ago, metastatic melanoma was considered to have one of the poorest cancer outcomes, associated with a median overall survival of 6-8 months. Cytotoxic chemotherapy offered modest response rates of 20%-30%, but no clear survival benefit. Patients were routinely enrolled in clinical trials as their first-line therapy in the search for effective novel therapeutics. Remarkable developments in molecular biology, cancer genomics, immunology, and drug discovery have dominated the early part of the 21st century, and nowhere have the benefits been better realized than in the transformation of outcomes for patients with metastatic melanoma: since 2011, 14 new agents have been approved that significantly increase survival, with long-term remissions and, possibly now, potential for cure. Even so, there is still much work to be done, given that most treated patients still die of their disease. Although most survival gains have so far been realized for cutaneous melanoma, improving treatment options for those 10% of patients with rarer, noncutaneous melanomas is a high priority. Key novel therapeutic approaches aimed at improving outcomes with potential for curing patients with melanoma are considered.
仅仅 10 多年前，转移性黑色素瘤被认为是预后最差的癌症之一，中位总生存期为 6-8 个月。细胞毒性化疗的缓解率仅为 20%-30%，但无明显生存获益。由于迫切需要寻找有效的新型治疗药物，患者通常在临床试验中作为一线治疗方案入组。分子生物学、癌症基因组学、免疫学和药物发现方面的显著进展主导了 21 世纪的早期阶段，而转移性黑色素瘤患者的治疗效果得到了前所未有的改善：自 2011 年以来，已有 14 种新药物获得批准，这些药物显著提高了患者的生存率，带来了长期缓解，甚至现在可能有治愈的潜力。即便如此，鉴于大多数接受治疗的患者仍死于疾病，仍有许多工作要做。尽管迄今为止大多数生存获益都来自于皮肤黑色素瘤，但改善罕见的非皮肤黑色素瘤患者的治疗选择是当务之急。本文考虑了旨在改善黑色素瘤患者治疗效果并可能治愈患者的新型治疗方法。
