Dougherty Sean C, Flowers William L, Gaughan Elizabeth M
Division of Hematology/Oncology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; and.
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
J Nucl Med. 2024 Dec 3;65(12):1838-1845. doi: 10.2967/jnumed.124.267781.
Over the last 2 decades, significant progress has been made in our understanding of the genomics, tumor immune microenvironment, and immunogenicity of malignant melanoma. Historically, the prognosis for metastatic melanoma was poor because of limited treatment options. However, after multiple landmark clinical trials displaying the efficacy of combined inhibition for -mutant melanoma and the application of immune checkpoint inhibitors targeting the programmed death-1, cytotoxic T-lymphocyte antigen-4, and lymphocyte activation gene-3 molecules, overall survival rates have dramatically improved. The role of immune checkpoint inhibition has since expanded to the neoadjuvant and adjuvant settings with multiple regimens in routine use. Personalized therapies, including tumor-infiltrating lymphocytes that are extracted from a patient's melanoma and eventually reinfused into the patient, and messenger RNA vaccines used to target neoantigens unique to a patient's tumor, show promise. Improvements in accompanying imaging modalities, particularly within the field of nuclear medicine, have allowed for more accurate staging of disease and assessment of treatment response. Continued growth in the role of nuclear medicine in the evaluation of melanoma, including the incorporation of artificial intelligence into image interpretation and use of radiolabeled tracers allowing for intricate imaging of the tumor immune microenvironment, is expected in the coming years.
在过去20年里，我们对恶性黑色素瘤的基因组学、肿瘤免疫微环境和免疫原性的理解取得了重大进展。从历史上看，由于治疗选择有限，转移性黑色素瘤的预后很差。然而，在多项具有里程碑意义的临床试验展示了联合抑制对突变型黑色素瘤的疗效以及应用针对程序性死亡-1、细胞毒性T淋巴细胞抗原-4和淋巴细胞激活基因-3分子的免疫检查点抑制剂之后，总体生存率有了显著提高。此后，免疫检查点抑制的作用已扩展到新辅助和辅助治疗领域，多种方案在常规使用中。个性化疗法显示出前景，包括从患者的黑色素瘤中提取并最终回输到患者体内的肿瘤浸润淋巴细胞，以及用于靶向患者肿瘤特有的新抗原的信使RNA疫苗。伴随成像方式的改进，特别是在核医学领域，使得疾病分期和治疗反应评估更加准确。预计未来几年核医学在黑色素瘤评估中的作用将持续增长，包括将人工智能纳入图像解读以及使用放射性标记示踪剂对肿瘤免疫微环境进行精细成像。
