Aapro M S
Clinique de Genolier, Switzerland.
Eur J Cancer. 1993;29A(4):613-7. doi: 10.1016/s0959-8049(05)80164-9.
This paper reviews recent developments in the systemic treatment of advanced malignant melanoma. In the introduction emphasis is given to prevention and early detection of this disease. Metastatic malignant melanoma patients have a median survival of less than 1 year in the most favourable situation. Adjuvant chemotherapeutic treatment after initial surgery has not had an impact on prognosis, while immunological manipulations with interferon alfa or other agents may prove beneficial after primary surgery. In advanced disease which cannot be palliated by surgery, many approaches are under investigation. Modulation of the patient's immune response can be achieved with vaccines, monoclonal antibodies, interleukin-2 and interferons, as single agents or in combination between themselves or with peripheral blood mononuclear cells or with tumour infiltrating lymphocytes or even with chemotherapy. Immunological approaches yield a 20-30% response rate, with some possibly long-term responses. Chemotherapeutic agents have a 10-30% response rate, which is usually of short duration. Combinations of chemotherapeutic agents can increase the response rate to 50%, but an impact on ultimate survival seems unlikely. Randomised studies have shown that modulation of chemotherapy with interferon or tamoxifen improves response rates. Clinicians should be encouraged to enter their patients with malignant melanoma in therapeutic trials.
本文综述了晚期恶性黑色素瘤全身治疗的最新进展。在引言部分，重点强调了该疾病的预防和早期检测。转移性恶性黑色素瘤患者在最有利的情况下，中位生存期不到1年。初始手术后的辅助化疗对预后没有影响，而在初次手术后，使用α干扰素或其他药物进行免疫调节可能证明是有益的。对于无法通过手术缓解的晚期疾病，许多方法正在研究中。可以通过疫苗、单克隆抗体、白细胞介素-2和干扰素来调节患者的免疫反应，这些药物可单独使用，或相互联合使用，或与外周血单个核细胞、肿瘤浸润淋巴细胞联合使用，甚至与化疗联合使用。免疫治疗方法的有效率为20%-30%，有些可能是长期反应。化疗药物的有效率为10%-30%，通常持续时间较短。联合化疗药物可使有效率提高到50%，但对最终生存期的影响似乎不大。随机研究表明，用干扰素或他莫昔芬调节化疗可提高有效率。应鼓励临床医生让他们的恶性黑色素瘤患者参加治疗试验。
