抗PD-1时代的局部黑色素瘤治疗。

IF 4.7 2区 医学 Q1 ONCOLOGY
Current Oncology Reports Pub Date : 2024-08-01 Epub Date: 2024-06-06 DOI:10.1007/s11912-024-01556-z
Elan Novis, Alexander C J van Akkooi
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引用次数: 0

摘要

综述的目的:在过去十年中,随着有效的全身疗法的引入,皮肤黑色素瘤的治疗取得了快速进展。鉴于最近的大量临床试验极大地改变了这些患者的治疗方法,因此有必要对有关局部黑色素瘤治疗的现有证据进行最新回顾:在早期(I-III期)黑色素瘤的辅助治疗和新辅助治疗中,有效的全身疗法正在迅速改变外科手术在皮肤黑色素瘤治疗中的作用,尤其是在广泛局部切除术(WLE)的手术安全边缘、前哨淋巴结活检(SLNB)的作用以及淋巴结清扫的范围等方面。随机 2 期 SWOG1801 试验表明,与仅辅助抗 PD-1 治疗相比,新辅助-辅助抗 PD1 治疗可将 2 年无事件生存率提高 23%。此外,PRADO 试验还表明,可以根据患者对初始新辅助免疫疗法的反应,采取更有针对性的方法,安全有效地进行手术和辅助治疗。这些结果还有待验证,预计 2024 年进行的三期 Nadina 试验(NCT04949113)将最终确定新辅助联合免疫疗法为新标准。这将进一步重新定义局部黑色素瘤的治疗。在未来十年中,有效全身疗法的使用将继续发展,加上新出现的诊断和监测技术,将有可能减少 I-III 期黑色素瘤的常规手术范围。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Management of Localized Melanoma in the Anti-PD-1 Era.

Management of Localized Melanoma in the Anti-PD-1 Era.

Purpose of review: The management of cutaneous melanoma has rapidly progressed over the past decade following the introduction of effective systemic therapies. Given the large number of recent clinical trials which have dramatically altered the management of these patients, an updated review of the current evidence regarding the management of localized melanoma is needed.

Recent findings: The role of effective systemic therapies in earlier stages (I-III) melanoma, both in adjuvant and neoadjuvant settings is rapidly changing the role of surgery in the management cutaneous melanoma, particularly regarding surgical safety margins for wide local excision (WLE), the role of sentinel lymph node biopsy (SLNB) and the extent of lymph node dissections. The randomized phase 2 SWOG1801 trial has demonstrated superiority of neoadjuvant-adjuvant anti-PD1 therapy in improving event-free survival by 23% at 2-years over adjuvant anti-PD-1 therapy only. Furthermore, the PRADO trial has suggested a more tailored approach both the extent of surgery as well as adjuvant therapy can safely and effectively be done, depending on the response to initial neoadjuvant immunotherapy. These results await validation and it is expected that in 2024 the phase 3 Nadina trial (NCT04949113) will definitively establish neo-adjuvant combination immunotherapy as the novel standard. This will further redefine the management of localized melanoma. The use of effective systemic therapies will continue to evolve in the next decade and, together with new emerging diagnostic and surveillance techniques, will likely reduce the extent of routine surgery for stage I-III melanoma.

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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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