Systemic Therapy for Melanoma: ASCO Guideline
Systemic Therapy for Melanoma: ASCO Guideline
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DOI：
10.1200/jco.20.00198
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发表时间：
2020-11-20
影响因子：
45.3
通讯作者：
Funchain, Pauline
中科院分区：
文献类型：
--
作者：
Seth, Rahul;Messersmith, Hans;Funchain, Pauline
目的：为临床医生对黑色素瘤进行全身治疗提供指导。方法ASCO召集了一个专家小组，对文献进行了系统的综述。结果：一项系统综述、一项荟萃分析和34项额外的随机试验被确定。发表的研究包括广泛的皮肤和非皮肤黑色素瘤的全身治疗。在辅助治疗中，对于切除的IIIA/B/C/D期BRAF野生型皮肤黑色素瘤患者，应给予纳武单抗或派姆单抗，而对于BRAF突变型疾病，应给予这两种药物中的任何一种或达非尼和曲美替尼的联合治疗。对于皮肤黑色素瘤的新辅助治疗，目前尚无支持或反对的建议。在不可切除/转移的情况下，易普利姆单抗联合纳武单抗、单独纳武单抗或单独派姆单抗应提供给BRAF野生型皮肤黑色素瘤患者，而这三种方案或BRAF/MEK抑制剂联合达非尼/曲美替尼、恩科非尼/比尼美替尼或vemurafenib/cobimetinib应提供给BRAF突变型疾病。粘膜黑色素瘤患者可采用与皮肤黑色素瘤相同的治疗方法。目前还没有针对葡萄膜黑色素瘤的特异性治疗的建议。更多信息请访问www.asco.org/melanoma-guidelines。
PURPOSETo provide guidance to clinicians regarding the use of systemic therapy for melanoma.METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature.RESULTS A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma.RECOMMENDATIONS In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines.