[Treatment of metastatic melanoma: update 2025].

Deutsche medizinische Wochenschrift (1946) Pub Date : 2025-05-01 Epub Date: 2025-04-22 DOI:10.1055/a-2500-0927
Georg Lodde, Lea Jessica Albrecht, Dirk Schadendorf
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引用次数: 0

Abstract

Immune checkpoint inhibition and targeted therapy with BRAF/MEK inhibition for BRAF-mutated melanoma have significantly improved progression-free and overall survival in patients with metastatic melanoma. Current research focuses on novel treatment strategies for PD-1 resistance, neoadjuvant approaches, and cellular therapies. 10-year follow-up data of randomized clinical trials show that both combined CTLA-4 and PD-1 immune checkpoint inhibition and PD-1 immune checkpoint inhibition alone can achieve long-term survival in metastatic melanoma. Potential surrogate markers of long-term response include a progression-free survival at 3 years after start of treatment and a reduction in tumour burden of at least 80%. The management of PD-1 resistance remains a challenge. Advances in molecular pathology have led to the identification of new therapeutic targets. Several cellular therapies are currently being evaluated in clinical trials as alternatives for melanoma patients refractory to immune checkpoint inhibition or targeted BRAF/MEK inhibition. In BRAF-mutant melanoma, combined BRAF/MEK inhibition is an alternative to immune checkpoint inhibition. Real-world data and clinical trial results on treatment sequencing suggest that immune checkpoint inhibition may improve survival in the first line setting, particularly in the absence of prior adjuvant systemic therapy. Adjuvant treatment leads to improved progression-free survival in melanoma patients while overall survival data are still pending. Neoadjuvant treatment seems to be a promising alternative to conventional adjuvant therapy for specific subgroups of melanoma patients. Participation in clinical trials offers patients the best opportunity to benefit from the latest treatment options.

[转移性黑色素瘤的治疗:更新于2025年]。
免疫检查点抑制和BRAF/MEK抑制靶向治疗BRAF突变黑色素瘤可显著改善转移性黑色素瘤患者的无进展生存期和总生存期。目前的研究重点是PD-1耐药的新治疗策略、新辅助方法和细胞治疗。随机临床试验10年随访数据显示,CTLA-4联合PD-1免疫检查点抑制和单独PD-1免疫检查点抑制均可实现转移性黑色素瘤的长期生存。长期缓解的潜在替代指标包括治疗开始后3年的无进展生存期和肿瘤负担减少至少80%。PD-1耐药的管理仍然是一个挑战。分子病理学的进步导致了新的治疗靶点的确定。目前正在临床试验中评估几种细胞疗法作为免疫检查点抑制或靶向BRAF/MEK抑制难治性黑色素瘤患者的替代疗法。在BRAF突变型黑色素瘤中,BRAF/MEK联合抑制是免疫检查点抑制的替代方法。真实世界的数据和治疗顺序的临床试验结果表明,免疫检查点抑制可能提高一线患者的生存率,特别是在先前没有辅助全身治疗的情况下。辅助治疗提高了黑色素瘤患者的无进展生存期,但总体生存期数据仍未公布。新辅助治疗似乎是一个有希望的替代传统辅助治疗的黑色素瘤患者的特定亚群。参与临床试验为患者提供了从最新治疗方案中获益的最佳机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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