Zusammenfassung
Nachdem über Jahrzehnte in der medikamentösen Therapie des metastasierten Melanoms die Chemotherapie mit Dacarbazin trotz geringer Ansprechraten als Standard galt, konnten in den letzten Jahren erstmals neue, vielversprechende Medikamente entwickelt und zur Zulassung gebracht werden. Dabei handelt es sich insbesondere um Immunmodulatoren wie CTLA4-Antikörper und Kinaseinhibitoren des MAPK-Signalwegs, die neben einer höheren Ansprechrate erstmals eine Verlängerung des Gesamtüberlebens zeigen. Da die Immuntherapeutika jedoch nur bei einem Teil der Patienten zu längeren Remissionen führen und die Kinaseinhibitoren ihre Wirksamkeit aufgrund von Resistenzentwicklung nach einigen Monaten verlieren, ist die Fortführung klinischer Studien auch zukünftig dringend erforderlich. Die klassischen Chemotherapeutika sind ebenso weiterhin fester Bestandteil der Therapie. Durch Kombination der verschiedenen Medikamente wird im Verlauf ermittelt werden müssen, welche Therapieschemata die besten Langzeitansprechraten ergeben.
Abstract
For decades dacarbazine was the standard in the therapy for metastatic melanoma even though response rates were low. In recent years multiple pharmacological approaches have led to new therapy options including immune modulators like anti-CTLA4 antibodies and kinase inhibitors of the MAPK signaling pathway that showed better response rates and increased overall survival. However, since immune modulators lead only in a small subgroup of patients to long-term responses and kinase inhibitors lose their function due to development of resistance after several months, continuation of clinical studies is strongly required. Classical chemotherapeutic drugs will remain a basic part of the therapy especially as combinations of different treatment options have to be focused on in order to achieve better long-term survival rates.
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Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Dr. B.M. Rudolph: Honorare und Reisekosten von BMS; A. Groffik: Honorare und Reisekosten von Roche; C. Stanger: Reisekosten von BMS; Dr. C. Loquai: Honorare und Reisekosten von BMS, Roche und Celgene; Prof. Dr. S. Grabbe: Honorare, Reisekosten und Forschungsunterstützung von BMS, MSD, Roche und Sanofi-Pasteur-MSD.
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Rudolph, B., Groffik, A., Stanger, C. et al. Medikamentöse Therapie des malignen Melanoms. Hautarzt 63, 885–898 (2012). https://doi.org/10.1007/s00105-012-2447-3
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DOI: https://doi.org/10.1007/s00105-012-2447-3