Der Onkologe

, Volume 16, Issue 12, pp 1160–1166

Systemische Therapie des metastasierten Melanoms

  • T.K. Eigentler
  • F. Meier
  • U. Keilholz
  • A. Hauschild
  • C. Garbe
Leitthema
  • 64 Downloads

Zusammenfassung

Erstmalig seit 3 Jahrzenten stehen neue Medikamente für das metastasierte Melanom vor der baldigen Zulassung, und die Behandlung wird sich durch Early-Access-Programme bereits ab 2011 deutlich ändern. Die Therapie des malignen Melanoms im Stadium der Fernmetastasierung bleibt für die Mehrzahl der Patienten dennoch palliativ. Möglichst lang andauernde Remissionen mit Verlängerung der Überlebenszeit werden angestrebt, wobei bei einem kleineren Teil der Patienten auch Heilungen mit den neuen Medikamenten möglich erscheinen. Soweit die Metastasierung ein Organsystem nicht überschreitet und eine operative Entfernung des Tumors möglich ist, ist die operative Metastasenresektion die Therapie der Wahl. Bei ausgedehnter Metastasierung ist eine Systemtherapie indiziert. Neue Therapiestrategien wie die Blockade von „cytotoxic T lymphocyte-associated antigen 4“ (CTLA-4) durch Antikörper induzierten bei einigen Patienten teils lang anhaltende Tumorremissionen und führten zu einer statistisch evidenten Verlängerung des Gesamtüberlebens. Der therapeutische Einsatz von hoch selektiven Tyrosinkinaseinhibitoren zeigte in ersten Phase-II-Studien objektive Ansprechraten von ca. 80% bei vorigem Nachweis der BRAF-V600E-Mutation (bei 40–50% der Melanompatienten vorhanden) und verdeutlicht überzeugend die Notwendigkeit einer individualisierten Tumortherapie in der Zukunft.

Schlüsselwörter

Malignes Melanom Systemtherapie Chemotherapie Anti-CTLA-4-Antikörper Kinaseinhibitoren 

Systemic therapy of metastized melanoma

Abstract

For the first time in three decades new drugs will be approved for systemic treatment of metastatic melanoma in the near future and management will change by early access programs by the beginning of 2011. Treatment of melanoma in the stage of distant metastases however still aims at palliative treatment for most patients and tries to achieve durable tumor remissions with prolongation of survival. However, a cure only seems achievable in a small percentage of patients. As long as metastasis is confined to one organ system and is surgically removable, surgery remains the treatment of first choice. More extensive metastases should be treated systemically. New therapeutic concepts aim at the blockade of CTLA-4 with antibodies and to achieved long lasting tumor remission in some patients and has led to a statistically significant prolongation of the median overall survival. The usage of highly selective tyrosine kinase inhibitors in phase II studies in BRAF V600E mutated metastatic melanoma patients (about 40–50% of all melanoma patients) induced tumor remissions in about 80% which demonstrates the imperative for an individualized anti-tumor treatment in the future.

Keywords

Malignant melanoma Systemic treatment Chemotherapy Anti-CTLA-4 antibodies Kinase inhibitors 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • T.K. Eigentler
    • 1
  • F. Meier
    • 1
  • U. Keilholz
    • 2
  • A. Hauschild
    • 3
  • C. Garbe
    • 1
  1. 1.Zentrum für Dermato-Onkologie, Südwestdeutsches TumorzentrumUniversitäts-Hautklinik, Eberhard-Karls- Universität TübingenTübingenDeutschland
  2. 2.Medizinische Klinik für Hämatologie und Onkologie Charité - Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland
  3. 3.Universitäts-HautklinikKielDeutschland

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