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Malignes Melanom

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Malignant melanoma

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Zusammenfassung

Klinisches Problem

Die Inzidenz des Melanoms steigt stetig an. Die Prognose bei metastasierter Erkrankung ist weiterhin limitiert.

Therapeutisches Standardverfahren

Bis vor wenigen Jahren war eine palliative Chemotherapie mit begrenzten Ansprechraten Standardtherapie des metastasierten Melanoms.

Neue Therapieverfahren

Immuntherapie und zielgerichtete Therapien stellen neue Behandlungsoptionen dar. Insbesondere Immuncheckpointinhibitoren haben die Prognose verbessert.

Diagnostik

Routinemäßig werden die Lymphabflusssonographie, Computertomographie (CT) von Hals, Thorax und Abdomen sowie die Magnetresonanztomographie (MRT) des Schädels eingesetzt. Alternativ zur CT kann die 18F-Fluordesoxyglukose-Positronenemissionstomographie (18F-FDG-PET) eingesetzt werden.

Leistungsfähigkeit und Bewertung

Immuntherapien bieten die Chance einer langfristigen Erkrankungskontrolle bei metastasiertem Melanom. Unter Ipilimumab erreichen ca. 20 % der Patienten eine langfristige Stabilität der Erkrankungsaktivität. Unter Anti-programmed-cell-death-protein(PD)1-Antikörpern kann ein medianes Überleben von etwa 2 Jahren erzielt werden. Die Kombinationstherapie von Ipilimumab und Nivolumab erzielt eine Ansprechrate von nahezu 60 %, das 2‑Jahres-Überleben liegt ebenfalls bei etwa 60 %. Immunvermittelte Nebenwirkungen bedürfen besonderer Berücksichtigung. Zur Beurteilung des Ansprechens wurden „Immune-related-response-Kriterien“ definiert. Weitere immuntherapeutische Ansätze wie talimogene laherparepvec (T-VEC) als modifiziertes Herpesvirus stehen zur intraläsionalen Injektion zur Verfügung.

Empfehlung für die Praxis

Die individuelle Festlegung der für den Patienten jeweils am besten geeigneten Therapie ist entscheidend. Im Rahmen moderner Therapieregime ist eine engmaschige Patientenbetreuung essenziell.

Abstract

Clinical issue

The incidence of malignant melanoma is continuously increasing. The prognosis of metastatic disease is still limited.

Standard treatment

Until a few years ago palliative chemotherapy with a limited response rate was the standard treatment for metastatic melanoma.

Treatment innovations

Immunotherapy and targeted therapy provide new treatment options. Immune checkpoint inhibitors have significantly improved the prognosis.

Diagnostic work-up

Regional lymph node sonography, computed tomography (CT) of the neck, chest and abdomen and brain magnetic resonance imaging (MRI) are routinely used. As an alternative to CT scans 18 F fluorodeoxyglucose positron emission tomography (FDG-PET) may be used.

Performance and achievements

Immunotherapy provides the chance of long-term disease control in metastatic melanoma. Ipilimumab may provide long-term tumor control in approximately 20% of patients. Median overall survival of approximately 2 years is achieved during therapy with anti-programmed cell death (PD) 1 antibodies. For combined therapy of ipilimumab and nivolumab a response rate of almost 60% is achieved and 2‑year survival is also approximately 60%. The range of immune-mediated side effects demands particular consideration. For response evaluation immune-related response criteria were defined. Furthermore, immunotherapeutic approaches, such as talimogene laherparepvec (T-VEC), which is a modified herpes virus can be used for intralesional injection.

Practical recommendations

An individual definition of the appropriate therapy for each patient is of particular importance. In the context of modern therapy regimens close patient monitoring is crucial.

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Author information

Authors and Affiliations

  1. Nationales Centrum für Tumorerkrankungen, Universitätshautklinik, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland

    J. K. Winkler, K. Buder-Bakhaya, A. Enk & J. C. Hassel

  2. Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland

    A. Dimitrakopoulou-Strauss

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  1. J. K. Winkler
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  2. K. Buder-Bakhaya
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Corresponding author

Correspondence to J. K. Winkler.

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Interessenkonflikt

J. K. Winkler gibt an, ein Vortragshonorar von BMS und Reisekostenunterstützung von Amgen, BMS, MSD, Philochem und Roche erhalten zu haben. K. Buder-Bakhaya erhielt Vortragshonorare von TEVA und Roche sowie Reisekostenerstattung von TEVA, MSD und Roche. A. Enk erhielt Honorare für Vorträge von BMS und Roche und J. C. Hassel hat Honorare für Vorträge von BMS, MSD, Roche und Novartis sowie für Beratungsarbeit von Merck, MSD und Amgen erhalten. A. Dimitrakopoulou-Strauss gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Winkler, J.K., Buder-Bakhaya, K., Dimitrakopoulou-Strauss, A. et al. Malignes Melanom. Radiologe 57, 814–821 (2017). https://doi.org/10.1007/s00117-017-0281-4

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