One article to understand: the latest progress in the treatment of melanoma

In recent years, the incidence of melanoma is still rising, but the mortality rate of patients with advanced melanoma has a downward trend
.

This is probably due to the birth of immune checkpoint inhibitors and BRAF targeted therapy

At present, this article mainly systematically elaborates the latest treatment progress of melanoma from the aspects of surgical management and advanced systemic treatment plan
.

Surgical treatment of melanoma

Surgical treatment of melanoma Surgical treatment of melanoma

More than 90% of melanoma patients have local or regional lesions and require surgical treatment, and most of them can be cured after surgery
.

In the early stage, the main surgical method is to remove 5cm margins at the primary tumor site and preventively remove regional lymph nodes
.

Subsequently, a number of randomized clinical trials were launched for the safe margins of enlarged resection, in order to ensure the effectiveness while reducing the invasiveness of the operation

The current safe margins of enlarged resection are fixed in:

Infiltration depth ≤1mm, the safety margin is reduced to 1cm;

1mm＜Infiltration depth＜2mm, the safety margin is reduced to 1-2cm;

Infiltration depth> 2mm, the safety margin is reduced to 2cmm
.

Infiltration depth ≤1mm, the safety margin is reduced to 1cm;

1mm＜Infiltration depth＜2mm, the safety margin is reduced to 1-2cm;

Infiltration depth> 2mm, the safety margin is reduced to 2cmm
.

In addition, the widely controversial role of selective lymph node dissection (CLND) has also become meaningless due to the development of sentinel lymph node biopsy
.

The latter only needs to remove the lymph nodes directly receiving lymphatic drainage, which reduces the occurrence of adverse events such as lymphedema

Treatment options for advanced melanoma

Treatment options for advanced melanoma

1.
Checkpoint immunotherapy

1.
Checkpoint immunotherapy

Anti-CTLA-4 antibody: CTLA-4 is a transmembrane receptor on T cells.
It induces T cell anergy after binding to its ligand B7 molecule and participates in the negative regulation of immune response, thereby causing immune tolerance to tumor cells
.

Representative drugs: ipilimumab and nivolumab

PD-1 monoclonal antibody and PD-L1 monoclonal antibody: PD-1 inhibits the activity of lymphocytes in peripheral tissues when an immune specific response has been established
.

For patients with unresectable metastatic melanoma, anti-PD-1 therapy is the initial single-agent immunotherapy of choice

The combination of checkpoint immunotherapy is a clinically recommended treatment for advanced melanoma
.

For example, in the current standard treatment plan, the combination of "Ipilimumab + Nivolumab" is the first to be used, and the remission rate of the combination of the two can reach 53%

However, although checkpoint immunotherapy improves the survival rate of patients, few patients can recover
.

2.
Targeted therapy

2.
Targeted therapy

Representative drugs in the targeted therapy family are BRAF inhibitors and MEK inhibitors
.

Clinically, the combination of BRAF and MEK is often used to achieve long-term control of the disease, but it is prone to drug resistance
.

At the same time, in practice, we have also found that its response is faster than immunotherapy.

3.
Adjuvant treatment

3.
Adjuvant treatment

For many years, adjuvant therapy has been limited to interferon alfa-2b, which can improve the patient's relapse-free survival rate, but has systemic toxicity, and the survival benefit is uncertain
.

Ipilimumab is the first drug that has been proven to improve recurrence-free survival and overall survival, and the benefits are long-lasting

At present, neoadjuvant therapy has not formed a unified standard, and it is still being explored
.

4.
Vaccine treatment

4.
Vaccine treatment

The development of melanoma vaccines has been going on for more than 100 years.
Although vaccines can cause immune responses, there is a lack of correspondence between immune responses and clinical benefits
.
However, when we used oncolytic virus for intratumoral inoculation, we observed clinical activity, and TVEC was born
.
Its emergence is a new option for patients who cannot tolerate checkpoint immunotherapy
.

references:

[1] Brendan D.
Curti, etal.
Recent Advances in the Treatment of Melanoma.
N Engl J Med 2021; 384:2229-2240.

[2][1]Chen Kexin, Wu Minliang, Wang Yuchong, et al.
Progress in the treatment of melanoma[J].
Chinese Journal of Aesthetic Plastic Surgery, 2021, Volume 32, Issue 1, 60-63, insert 3 pages, ISTIC CA, 2021: National Natural science funding.

Leave a message here