European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019
European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019
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DOI：
10.1016/j.ejca.2019.11.015
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发表时间：
2020-02-01
影响因子：
8.4
通讯作者：
Eggermont, Alexander M. M.
中科院分区：
文献类型：
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作者：
Garbe, Claus;Amaral, Teresa;Eggermont, Alexander M. M.
来自欧洲皮肤病学论坛、欧洲皮肤肿瘤学协会和欧洲癌症研究与治疗组织 (EORTC) 的多学科专家组成了独特的合作关系，根据系统文献综述和专家的经验，就皮肤黑色素瘤的诊断和治疗提出建议。皮肤黑色素瘤的切除具有 1 至 2 厘米的安全边界。对于肿瘤厚度 >= 1.0 mm 或 >= 0.8 mm 且具有其他组织学危险因素的患者，应将前哨淋巴结清扫术作为分期程序进行，尽管这种方法尚无明显的生存益处。 III/IV 期患者的治疗决定应主要由跨学科肿瘤学团队（“肿瘤委员会”）做出。 III/IV 期患者的辅助治疗主要是抗 PD-1（与突变状态无关），或者针对 BRAF 突变患者的达拉非尼加曲美替尼（Trametinib）。对于远处转移，无论是否切除，都需要进行全身治疗。对于一线治疗，特别是BRAF野生型患者，应考虑单独使用PD-1抗体或与CTLA-4抗体联合进行免疫治疗。在 IV 期黑色素瘤和 BRAF-V600 E/K 突变患者的特殊情况下，可以提供 BRAF/MEK 抑制剂一线治疗作为免疫治疗的替代方案。对于免疫治疗原发性耐药且携带 BRAF-V600 E/K 突变的患者，应在二线提供该治疗。 III/IV 期黑色素瘤的全身治疗正在迅速变化，这些建议很可能在不久的将来发生变化。 (C) 2019 作者。由爱思唯尔有限公司出版
A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness >= 1.0 mm or >= 0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future. (C) 2019 The Author(s). Published by Elsevier Ltd.