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黑素瘤的辅助免疫治疗

Author
Jeffrey A Sosman, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD
Translators
高天文, 主任医师，教授

引言

手术切除是早期皮肤黑素瘤的首选治疗，并且大多数病例可经此治愈。然而，部分患者术后会出现黑素瘤的播散性复发。根据原发肿瘤的高危特征和局部淋巴结转移的情况可识别出复发风险较高的患者群。

本文将总结辅助免疫疗法在高危黑素瘤中的应用。皮肤黑素瘤的初始治疗和黑素瘤转移患者的治疗将单独讨论。 (参见“皮肤和罕见部位黑色素瘤的初始外科治疗”和“晚期皮肤黑色素瘤处理的概述”)

辅助治疗的一般情况

分期和预后 — 对于已行皮肤黑素瘤完全切除术的患者，决定是否推荐辅助治疗取决于疾病复发风险(复发风险基于诊断分期)，以及对患者年龄、共存疾病和个人意愿的考虑。

根据原发肿瘤的病变程度、特点及局部淋巴结受累的情况，可将患者分为不同的风险类别。美国癌症联合会(American Joint Committee on Cancer, AJCC)(表 1A-B)的TNM(tumor node metastasis)分期系统包含了最重要的预后决定因素[1,2]。 (参见“皮肤黑色素瘤的TNM分期系统和其他预后因素”)

●对于原发肿瘤(T)，肿瘤厚度增加、有丝分裂率增加以及出现溃疡(即原发肿瘤上覆表皮层有缺失)均与复发风险高相关(图 1)。

               

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-06.
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References
Top
  1. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27:6199.
  2. Melanoma of the Skin. In: American Joint Committee on Cancer Staging Manual, 7th, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.325.
  3. Kaufman HL, Kirkwood JM, Hodi FS, et al. The Society for Immunotherapy of Cancer consensus statement on tumour immunotherapy for the treatment of cutaneous melanoma. Nat Rev Clin Oncol 2013; 10:588.
  4. Eggermont AM, Chiarion-Sileni V, Grob JJ, et al. Adjuvant ipilimumab versus placebo after complete resection of high-risk stage III melanoma (EORTC 18071): a randomised, double-blind, phase 3 trial. Lancet Oncol 2015; 16:522.
  5. Eggermont AM, Chiarion-Sileni V, Grob JJ, et al. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy. N Engl J Med 2016; 375:1845.
  6. Ascierto PA, Del Vecchio M, Robert C, et al. Overall survival and safety results from a phase 3 trial of ipilimumab at 3 mg/kg vs 10 mg/kg in patients with metastatic melanoma (abstract 11060). Presented at the European Society for Medical Oncology 2016 meeting.
  7. Kirkwood JM, Ibrahim JG, Sosman JA, et al. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol 2001; 19:2370.
  8. Kirkwood JM, Manola J, Ibrahim J, et al. A pooled analysis of eastern cooperative oncology group and intergroup trials of adjuvant high-dose interferon for melanoma. Clin Cancer Res 2004; 10:1670.
  9. Kirkwood JM, Strawderman MH, Ernstoff MS, et al. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol 1996; 14:7.
  10. Eggermont AM, Suciu S, Santinami M, et al. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomised phase III trial. Lancet 2008; 372:117.
  11. Flaherty LE, Othus M, Atkins MB, et al. Southwest Oncology Group S0008: a phase III trial of high-dose interferon Alfa-2b versus cisplatin, vinblastine, and dacarbazine, plus interleukin-2 and interferon in patients with high-risk melanoma--an intergroup study of cancer and leukemia Group B, Children's Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. J Clin Oncol 2014; 32:3771.
  12. Eggermont AM, Suciu S, MacKie R, et al. Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2b versus observation in patients with stage IIb/III melanoma (EORTC 18952): randomised controlled trial. Lancet 2005; 366:1189.
  13. Grob JJ, Dreno B, de la Salmonière P, et al. Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma. Lancet 1998; 351:1905.
  14. Hauschild A, Weichenthal M, Rass K, et al. Efficacy of low-dose interferon {alpha}2a 18 versus 60 months of treatment in patients with primary melanoma of >= 1.5 mm tumor thickness: results of a randomized phase III DeCOG trial. J Clin Oncol 2010; 28:841.
  15. Eggermont AM, Suciu S, Testori A, et al. Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma. J Clin Oncol 2012; 30:3810.
  16. Mocellin S, Pasquali S, Rossi CR, Nitti D. Interferon alpha adjuvant therapy in patients with high-risk melanoma: a systematic review and meta-analysis. J Natl Cancer Inst 2010; 102:493.
  17. Hauschild A, Gogas H, Tarhini A, et al. Practical guidelines for the management of interferon-alpha-2b side effects in patients receiving adjuvant treatment for melanoma: expert opinion. Cancer 2008; 112:982.
  18. Corrie PG, Marshall A, Dunn JA, et al. Adjuvant bevacizumab in patients with melanoma at high risk of recurrence (AVAST-M): preplanned interim results from a multicentre, open-label, randomised controlled phase 3 study. Lancet Oncol 2014; 15:620.
  19. Lawson DH, Lee S, Zhao F, et al. Randomized, Placebo-Controlled, Phase III Trial of Yeast-Derived Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) Versus Peptide Vaccination Versus GM-CSF Plus Peptide Vaccination Versus Placebo in Patients With No Evidence of Disease After Complete Surgical Resection of Locally Advanced and/or Stage IV Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E4697). J Clin Oncol 2015; 33:4066.