Dickler M N, Coit D G, Meyers M L
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Surg Oncol Clin N Am. 1997 Oct;6(4):793-812.
The incidence of malignant melanoma continues to rise steadily in the United States, with approximately 40,300 new cases expected in 1997. A significant number of patients with deep primary lesions or regional lymph node metastases are at high risk for developing recurrent, metastatic disease despite adequate surgical intervention. Therefore, approaches to adjuvant therapy including immunotherapy, such as interferon, levamisole, and vaccines and chemotherapy and chemoimmunotherapy have been investigated in high-risk patients. The key adjuvant trials are reviewed, with emphasis placed on randomized trials. High-dose interferon-alpha has recently been shown to modestly improve disease-free and overall survival in a prospective randomized trial of high-risk patients and has been approved by the FDA for this indication. Vaccines, which currently remain experimental, may prove to be equally effective but less toxic options for adjuvant therapy. Also, the identification of more high-risk patients who might benefit from adjuvant therapy may be facilitated by sentinel lymph node biopsy and the reverse-transcriptase polymerase chain reaction for tyrosinase.
在美国，恶性黑色素瘤的发病率持续稳步上升，预计1997年将有大约40300例新发病例。尽管进行了充分的手术干预，但相当数量的原发性深部病变或区域淋巴结转移患者仍有发生复发性、转移性疾病的高风险。因此，已经在高危患者中研究了包括免疫疗法（如干扰素、左旋咪唑和疫苗）、化疗以及化疗免疫疗法在内的辅助治疗方法。本文回顾了关键的辅助治疗试验，重点是随机试验。最近在前瞻性随机试验中已证明，高剂量干扰素-α可适度改善高危患者的无病生存期和总生存期，并且已获美国食品药品监督管理局（FDA）批准用于这一适应症。目前仍处于试验阶段的疫苗可能被证明是同样有效的，但毒性较小的辅助治疗选择。此外，前哨淋巴结活检和酪氨酸酶逆转录聚合酶链反应可能有助于识别更多可能从辅助治疗中获益的高危患者。
