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转移性黑素瘤的细胞毒化疗

Author
Jeffrey A Sosman, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD
Translators
盛锡楠, 副主任医师

引言

虽然恶性黑素瘤的发病率日益增加，但大多数病例可在早期诊断。在此情况下，大多数病例可以通过手术切除而治愈，而转移风险高的患者则可能从干扰素α(interferon alpha, IFNa)的辅助治疗中获益[1]。 (参见“皮肤和罕见部位黑色素瘤的初始外科治疗”和“黑素瘤的辅助免疫治疗”)

大多数Ⅳ期患者需要全身治疗(表 1A-B)。对于颅外转移性黑素瘤患者，细胞毒化疗在历史上曾被广泛应用于那些不宜行大剂量白细胞介素-2(Interleukin-2, IL-2)治疗的患者，不过从未证明该治疗能够改善生存。然而，随着新型免疫治疗方案和对BRAF突变肿瘤的靶向治疗的出现，化疗目前基本上仅用作二线或三线治疗。

本文将总结细胞毒化疗用作单药治疗、联合化疗方案或与生物制剂(IL-2、IFNa)联合治疗的临床作用。晚期黑素瘤治疗的概述参见其他专题。 (参见“晚期皮肤黑色素瘤处理的概述”)

播散性黑素瘤的治疗选择

对于恰当选择的患者，有些治疗方法已被表明对播散性黑素瘤患者可提供有临床重要意义的益处，这些治疗包括大剂量IL-2免疫治疗、针对CTLA-4或PD1的检测点抑制剂免疫治疗，以及对BRAF基因V600突变的黑素瘤患者应用针对丝裂原活化蛋白激酶(mitogen activated protein kinase, MAPK)通路的BRAF抑制剂和MEK抑制剂治疗(图 1)。

细胞毒化疗对晚期黑素瘤患者的初始治疗没有明确的作用。然而，如果免疫治疗或靶向药物不再能控制患者的病情，仍可将细胞毒化疗作为治疗方案。虽然研究没有证明化疗能改善总体生存，但少数患者通过联合方案和单药化疗仍可获得客观缓解。 (参见下文‘联合治疗方案’和‘单药化疗’)

               

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-08.
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