Treatment Following Progression in Metastatic Melanoma: the State of the Art from Scientific Literature to Clinical Need
| العنوان: | Treatment Following Progression in Metastatic Melanoma: the State of the Art from Scientific Literature to Clinical Need |
|---|---|
| المؤلفون: | A. Zuccarini, F. Serra, P. Pedrazzoli, S. Chiellino, T. Dominioni, S. Barruscotti |
| المصدر: | Current Oncology Reports. 23 |
| بيانات النشر: | Springer Science and Business Media LLC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | 0301 basic medicine, Oncology, medicine.medical_specialty, Performance status, business.industry, Melanoma, medicine.medical_treatment, Retrospective cohort study, Immunotherapy, medicine.disease, Targeted therapy, Discontinuation, Clinical trial, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, business, Disease burden |
| الوصف: | In the last few years, the advent of targeted therapy and immunotherapy has improved the management and the prognosis of metastatic melanoma, but the spread of resistance mechanisms can lead to disease progression. The clinical management in this setting can be challenging because the oncologist has to decide what is the best treatment strategy among therapy beyond progression (TBP), therapy change, and the rechallenge approach. This review of the relevant scientific literature is intended to clarify which patients with progressing metastatic melanoma will benefit from continuation of ongoing therapy and which ones will not. The data are based on a total of about 4300 patients coming from the main retrospective studies in the chosen field. The article body is divided into four sections which analyze respectively the targeted therapy beyond progression, the immunotherapy beyond progression, the possible treatment sequences, and finally the rechallenge strategy. Despite the possible approaches of TBP or rechallenge, the patient may not have an optimal response and may need new therapy, which is currently missing. To broaden the pharmacological offer in the fight against melanoma, cancer research is studying new disease targets, like the NRAS, PI3K, and cKIT pathways or combination treatment of targeted therapy plus immunotherapy. Despite the limitations of this work, mainly due to the limited number of studies, their retrospective nature and the lack of comparative studies, the analysis performed allows us to draw some important conclusions: therapy beyond progression, both targeted therapy and immunotherapy, represents a valid treatment option with positive effects on disease control and survival outcomes for patients with low clinical risk, expressed as low disease burden, normal LDH levels, and good performance status; moreover, the prognosis and quality of life of these patients improve when TBP is associated with locoregional treatments. In patients with progressive metastatic melanoma and high clinical risk (high disease burden, high LDH levels, and poor performance status), it is recommended to change therapy, without ever forgetting the possibility of enrolling the patient in a clinical trial. Finally, an efficacious treatment alternative is the rechallenge strategy; this approach consists in a re-treatment with the same drug after a variable interval of discontinuation. Preliminary studies seem to have demonstrated that patients retreated with targeted therapy achieved a greater benefit if they had a low clinical risk and if the drug doublet (BRAF + MEK inhibitors) was used. On the side of immunotherapy, the rechallenge strategy produced a major benefit in patients who prior experienced a severe toxic episode. |
| تدمد: | 1534-6269 1523-3790 |
| DOI: | 10.1007/s11912-021-01065-3 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::14729903d5cbec59ab9d0d4455b81aa0 https://doi.org/10.1007/s11912-021-01065-3 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi...........14729903d5cbec59ab9d0d4455b81aa0 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15346269 15233790 |
|---|---|
| DOI: | 10.1007/s11912-021-01065-3 |