恶性黑色素瘤——化疗和生物反应调节剂的预后和实际治疗策略。

L Bergmann
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摘要

恶性黑色素瘤(MM)的预后取决于侵袭程度、垂直肿瘤大小、原发部位、临床分期和性别。虽然MM在疾病的早期阶段是可以治愈的,但在晚期和播散性MM中治疗的可能性非常有限。大多数化疗药物在MM中缺乏足够的活性,特别是在生存方面。达卡巴嗪(DTIC)是治疗MM最有效的药物,有效率为20-25%,其次是美法兰(15-20%)、羟脲和铂衍生物。多药方案没有显示比单独使用DTIC更有效。放射治疗可能与局部治疗转移有关。考虑到晚期和播散性MM预后不良和治疗方法有限,需要新的策略。在这种情况下,具有生物反应调节剂的免疫治疗策略对辅助或姑息治疗方法很感兴趣。卡介苗+/- DTIC作为辅助或姑息性治疗的早期试验显示,卡介苗对预后没有影响。α -干扰素(α - ifn)在约15%的患者中引起缓解,γ - ifn在约10%的患者中引起缓解。一种非常有趣的新方法是通过全身给药重组白细胞介素-2 (il -2)诱导和/或激活自体细胞毒性细胞,反应率为20-25%,并在体内繁殖和转移所谓的肿瘤浸润淋巴细胞。需要进一步的试验将il -2与其他细胞因子、化疗、肿瘤疫苗或单克隆抗黑色素瘤细胞联合使用。
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Malignant melanoma--prognosis and actual treatment strategies with chemotherapy and biological response modifiers.

The prognosis of malignant melanoma (MM) depends on the level of invasion, vertical tumour size, location of the primary, clinical stage, and sex. Whereas MMs are potentially curable in the early stage of disease, the therapeutic possibilities are very limited in advanced and disseminated MM. Most chemotherapeutic agents lack sufficient activity in MM especially with regard to survival. Dacarbazine (DTIC) is the most effective drug in MM with response rates of 20-25% followed by other drugs such as melphalan with 15-20%, hydroxyurea and platin derivates. Multidrug regimens were not shown to be more effective than DTIC alone. Radiotherapy may be relevant in local treatment of metastases. With regard to the poor prognosis and limited therapeutic approaches in advanced and disseminated MM, new strategies are required. In this context immunotherapeutic strategies with biological response modifiers are of interest for adjuvant or palliative approaches. Earlier trials with Bacillus Calmette-Guerin (BCG) +/- DTIC as adjuvant or palliative treatment revealed no effect of BCG on the prognosis. Alpha-interferon (alpha-IFN) was shown to induce remissions in about 15% and gamma-IFN in about 10% of patients. A very interesting new approach is the induction and/or activation of autologous cytotoxic cells by systemic administration of recombinant interleukin-2 (rIL-2) with response rates of 20-25% and the in vivo propagation and transfer of so-called tumour infiltrating lymphocytes. Further trials combining rIL-2 with other cytokines, chemotherapy, tumour vaccination or monoclonals against melanoma cells are required.

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Effect of soybean feeding on experimental carcinogenesis--III. Carcinogenecity of nitrite and dibutylamine in mice: a histopathological study. Abstracts from the second annual meeting of the Danish Society for Cancer Research. 14 April 1989. International Conference on Supportive Care in Oncology. Brussels (Belgium), 23-25 August 1988. Proceedings. Proceedings of the Ondansetron Symposium. London, 30 June 1989. Pharmacological and anti-emetic properties of ondansetron.
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