Adjuvant treatments in melanoma
| Autor: | Simetić, Luka, Blažević, Krešimir, Herceg, Davorin |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Libri Oncologici, Vol 49, Iss 2-3, Pp 113-117 (2021) Libri Oncologici : Croatian Journal of Oncology Volume 49 Issue 2-3 |
| ISSN: | 2584-3826 0300-8142 |
| DOI: | 10.20471/lo.2021.49.02-03.16 |
| Popis: | For decades, interferon-alpha (IFN-α) has been the only option in the adjuvant treatment of high-risk melanoma. Despite numerous clinical trials and meta-analyzes, IFN-α is not yet a gold standard. It indeed showed benefit in progressionfree survival (PFS) and to a lesser extent in overall survival (OS) but at the cost of high toxicity. The emergence of new, revolutionary therapies in the treatment of metastatic melanoma, like immunotherapy (checkpoint inhibitors - CTLA4 and PD1 inhibitors) and targeted therapies (BRAF and MEK inhibitors), led to considering their potential effect in adjuvant/preventive use. A number of phase II and phase III trials analyzed the adjuvant application of targeted therapies and immunotherapies in completely resected stage III melanoma (IIIA, IIIB, IIIC) and stage IV melanoma (PD1 inhibitor nivolumab). They showed a clear benefit in relapse-free survival (RFS) and overall survival (OS). This led to a change in guidelines for adjuvant treatment of melanoma and approval of immunotherapy and targeted therapy by the FDA (Food and Drug Administration) and EMA (European medicines agency) in the indications mentioned above. Further trials are underway in other high-risk stages (like IIC) and in neoadjuvant treatment of stage III melanoma. Desetljećima je interferon alfa bio jedina opcija u adjuvatnoj terapiji visokorizičnog melanoma. Unatoč brojnim studijama i meta analizama, interferon nije zaživio kao zlatni standard liječenja visokorizičnog melanoma. Pokazao je svakako benefit u vremenu do progresije bolesti (PFS, progression free survival) te u manjem dijelu u ukupnom preživljenju (OS, overall survival) pod cijenu visoke toksičnosti. Pojavom revolucionarnih terapija u liječenju metastatskog melanoma; imunoterapije, anti CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) i anti PD-1 inhibitora (programmed cell death protein 1) te ciljane terapije (BRAF i MEK inhibitori) razmišljalo se o njihovom potencijalnom učinku u adjuvatnom/preventivnom smislu. Brojne studije faze II i III ispitivale su adjuvantnu primjenu ciljane terapije i imunoterapije u kompletno reseciranom stadiju III (IIIA, IIIB, IIIC) i stadiju IV (anti PD-1 inhibitor nivolumab). Pokazale su jasan benefit u vremenu do povratka bolesti (PFS) i ukupnom preživljenju (OS). Navedeni rezultati su promijenili smjernice za adjuvantnu terapiju kod melanoma u vidu registracije imunoterapije te ciljane terapije od strane FDA (Food and drug administration) i EMA (European medicines agency) za adjuvantnu primjenu. U tijeku su daljnja ispitivanja i u drugim visokorizičnim stadijima (npr. IIC) te neoadjuvantno liječenje stadija III. |
| Databáze: | OpenAIRE |
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