Metastatic melanoma.
Metastatic melanoma.
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DOI：
10.1007/s11864-001-0033-5
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发表时间：
2001-06-01
影响因子：
4.3
通讯作者：
Schuchter, L M
中科院分区：
文献类型：
--
作者：
Sun, W;Schuchter, L M
转移性黑色素瘤患者的总生存期为4.7至11个月，中位生存期为8.5个月。尚未定义针对转移性黑色素瘤患者的标准治疗。治疗方案的范围包括仔细观察，分离转移的手术切除，达卡巴嗪治疗，联合化疗以及参与临床试验。许多化学治疗剂显示在治疗恶性黑色素瘤方面的活性。 Dacarbazine（DTIC-DOME; BAYER CORPORATION，WEST HAVEN，CT）的缓解率为15％至20％，并且仍然是治疗转移性疾病的参考药物。具有单药活性的其他药物包括顺铂（Platinol-AQ； Bristol-Myers Myers肿瘤学，新泽西州普林斯顿）； Carmustine（Bicnu； Bristol-Myers肿瘤学，新泽西州普林斯顿）；紫杉醇（紫杉醇；新泽西州普林斯顿的布里斯托尔美犬squibb）；和多西他赛（Danotere； Rhone-Poulenc Rorer Pharmaceuticals，宾夕法尼亚州大学维尔）。 Temozolomide（Temodar; Schering-Plough，NJ Kenilworth，NJ）本质上是Dacarbazine的一种口服形式，但具有更大的中枢神经系统渗透性，与20％的反应率有关。在转移性黑色素瘤患者中，对有或没有他莫昔芬的联合化疗已经得到了广泛的评估。尽管达特茅斯方案（Dacarbazine，Cisplatin，carmustine和atamoxifen）的最初结果与单机构研究中的总体反应率为50％至55％有关，但较大的多中心研究的结果揭示了响应率率为10％至20％至20％至20 ％。根据几项临床试验的结果，没有证据表明他莫昔芬的添加可提高反应率。另一种组合方案是顺铂，长丁质和达卡巴嗪（CVD），与20％至25％有关。人们普遍存在开发针对转移性黑色素瘤的免疫疗法。干扰素（IFN）-Alfa和白介素（IL）-2作为单个药物的15％至20％范围内产生了响应率。生物化学疗法是免疫疗法和细胞毒性化学疗法的结合，已在转移性黑色素瘤患者中进行了研究。多个II期研究表明，对总体生存的影响很高，但对总体生存的影响不清。治疗与明显的毒性有关。正在进行的随机临床试验将阐明生物化学疗法在转移性黑色素瘤患者中的作用。正在进行的新方法包括单独使用疫苗或与细胞因子结合使用治疗。
The overall survival for patients with metastatic melanoma ranges from 4.7 to 11 months, with a median survival of 8.5 months. Standard treatment for patients with metastatic melanoma has not been defined. The range of treatment options includes close observation, surgical resection of isolated metastases, therapy with dacarbazine, combination chemotherapy, and participation in clinical trials. Numerous chemotherapeutic agents have shown activity in the treatment of malignant melanoma. Dacarbazine (DTIC-Dome; Bayer Corporation, West Haven, CT) has a response rate of 15% to 20% and remains the reference agent for the treatment of metastatic disease. Additional agents with single-agent activity include cisplatin, (Platinol-AQ; Bristol-Myers Oncology, Princeton, NJ); carmustine (BiCNU; Bristol-Myers Oncology, Princeton, NJ); paclitaxel (Taxol; Bristol-Myers Squibb, Princeton, NJ); and docetaxel (Taxotere; Rhone-Poulenc Rorer Pharmaceuticals, Collegeville, PA). Temozolomide (Temodar; Schering-Plough, Kenilworth, NJ), which is essentially an oral form of dacarbazine but with greater central nervous system penetrance, is associated with a response rate of 20%. Combination chemotherapy with or without tamoxifen has been extensively evaluated in patients with metastatic melanoma. Although the initial results with the Dartmouth regimen (dacarbazine, cisplatin, carmustine, and tamoxifen) were associated with overall response rates of 50% to 55% in single-institution studies, results from larger multicenter studies reveal responses rates ranging from 10% to 20%. Based on the results of several clinical trials, there is no evidence that the addition of tamoxifen improves the response rate. Another combination regimen is cisplatin, vinblastine, and dacarbazine (CVD), which is associated with a 20% to 25% response rate. There has been widespread interest in developing immunotherapies against metastatic melanoma. Interferon (IFN)-alfa and interleukin (IL)-2 as single agents have produced response rates in the 15% to 20% range. Biochemotherapy, which is a combination of immunotherapy and cytotoxic chemotherapy, has been studied in patients with metastatic melanoma. Multiple phase II studies have demonstrated high response rates but unclear impact on overall survival. Therapy is associated with significant toxicity. Ongoing randomized clinical trials will clarify the role of biochemotherapy in patients with metastatic melanoma. Ongoing new approaches to treatment include the therapeutic use of vaccines alone or in combination with cytokines.