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治疗II期黑色素瘤的辅助疗法:需要进一步研究
Rebecca Lee1, Mario Mandala2, Georgina V Long3
1The Christie NHS Foundation Trust, Department of Medical Oncology, Manchester, UK; The University of Manchester, Division of Cancer Sciences, Manchester, UK.
概括
免疫疗法显著改善了晚期黑色素瘤的生存率. 对于高风险的早期疾病,辅助疗法可以改善结果,但个性化生物标志物选择至关重要,以避免过度治疗.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 皮肤病学 皮肤病学
背景情况:
- 检查点抑制剂免疫疗法改变了黑色素瘤治疗结果.
- 辅助性和新辅助性免疫疗法在切除的高危黑色素瘤和结节阳性黑色素瘤中显示出有前途.
- 目前用于IIB/C阶段黑色素瘤的辅助治疗提供了适度的绝对益处,并具有潜在的毒性.
研究的目的:
- 审查当前免疫疗法和向治疗在黑色素瘤治疗中的现状.
- 强调需要基于分子风险分层的个性化治疗策略.
- 强调对生物标志物的关键需求,以指导治疗选择,避免不必要的治疗.
主要方法:
- 对各种黑色素瘤阶段的免疫治疗和向治疗的临床试验数据的审查.
- 对生存结果的分析,包括无复发生存率 (RFS) 和无远程转移生存率 (DMFS).
- 讨论当前和正在进行的临床试验,评估新型治疗组合和向疗法.
主要成果:
- 用尼沃卢马布和伊皮利穆马布治疗的转移性黑色素瘤患者的5年生存率>50%.
- 辅助药物 pembrolizumab,nivolumab,或dabrafenib/trametinib 在III期黑色素瘤中改善RFS和DMFS.
- 辅助剂 pembrolizumab 和 nivolumab 在IIB/C阶段的疾病中也可以改善RFS和DMFS,尽管绝对益处很低.
结论:
- 免疫疗法已经彻底改变了黑色素瘤治疗的各个阶段,从转移到辅助设置.
- 虽然有效,目前用于早期黑色素瘤的辅助疗法在绝对益处和毒性方面存在局限性.
- 基于组织和血液的生物标志物的开发和验证对于个性化的黑色素瘤治疗选择至关重要.
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