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Aktuelle Aspekte der adjuvanten Therapie des malignen Melanoms

Current aspects of adjuvant therapy of malignant melanoma

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Zusammenfassung

Trotz aller klinisch-wissenschaftlichen Bemühungen in den letzten Jahrzehnten ist die Prognose von Patienten mit malignen Melanomen im Stadium der Fernmetastasierung nach wie vor bis auf wenige Ausnahmen infaust. Eine effiziente, adjuvante Therapie ist daher bei Patienten mit einem bedeutsamen Risiko einer Metastasierung von größtem Interesse. Eine systemische adjuvante Chemotherapie wies in prospektiv-randomisierten Studien im Gegensatz zu ersten Untersuchungen mit historischen Kontrollkollektiven übereinstimmend keinen Vorteil für die Behandelten auf. Die Therapie mit den Interferonen α2a und α2b ist die erste und bisher einzige adjuvante Therapie, die in kontrollierten Studien zu signifikanten Vorteilen für die Behandelten führte und in der Indikation der adjuvanten Therapie des malignen Melanoms in Deutschland zugelassen wurde. Der aktuelle Fokus liegt zum einen auf vergleichenden Untersuchungen zu Standard-Interferon α und pegyliertem Interferon sowie andererseits in der Erprobung innovativer Therapieansätze durch neue Substanzen, wie z. B. Vakzinierung mit MAGE-A3 und dem CTLA4-Antikörper Ipilimumab.

Abstract

Despite intensive clinical and research efforts during recent decades, the prognosis of patients with stage IV melanoma still remains poor. Finding effective adjuvant treatment for patients with a high risk of relapse and metastasis is one of the most urgent needs in clinical research. Systemic adjuvant chemotherapy administered in several clinical trials offered no benefit in terms of improved relapse-free or overall survival. Interferon alpha-2a and -2b treatment was the first treatment in the adjuvant setting which has shown a treatment benefit and received approval in Germany. Today clinical research focuses on improved treatment schedules with conventional interferon compared to pegylated interferon as well as on new compounds such as CTLA4 inhibitors like ipilimumab or a vaccination against the MAGE-A3 peptide.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die korrespondierende Autorin erhielt Reisekostenunterstützungen von essex pharma. Axel Hauschild hat als Berater, Vortragender und Studienleiter finanzielle Zuwendungen von der Firma Schering-Plough (USA//essex pharma GmbH, München) erhalten. Friederike Egberts hat keinen Interessenskonflikt.

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Authors and Affiliations

  1. Klinik für Dermatologie, ­Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland

    K.C. Kähler, F. Egberts & A. Hauschild

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  1. K.C. Kähler
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  2. F. Egberts
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  3. A. Hauschild
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Correspondence to K.C. Kähler.

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Dieser Beitrag ist eine überarbeitete Version der Übersicht aus Der Onkologe 15(2009):758–766.

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Kähler, K., Egberts, F. & Hauschild, A. Aktuelle Aspekte der adjuvanten Therapie des malignen Melanoms. Hautarzt 61, 523–533 (2010). https://doi.org/10.1007/s00105-010-1964-1

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