为临床医生提供有关黑色素瘤全身治疗的指导。
ASCO召集了一个专家小组,并对文献进行了系统的审查。
系统评价,一个荟萃分析,并确定了另外34项随机试验.已发表的研究包括广泛的皮肤和非皮肤黑色素瘤的全身性治疗。
在佐剂设置中,nivolumab或pembrolizumab应提供给切除的IIIA/B/C/DBRAF野生型皮肤黑色素瘤患者,而这两种药物中的任何一种或dabrafenib和trametinib的组合应用于BRAF突变型疾病。没有推荐或反对在皮肤黑色素瘤中使用新辅助治疗。在不可切除/转移的环境中,ipilimumab加nivolumab,单独使用Nivolumab,或pembrolizumab单独应提供给BRAF野生型皮肤黑色素瘤患者,而这三种方案或BRAF/MEK抑制剂与dabrafenib/trametinib联合治疗,恩科非尼/比米替尼,或vemurafenib/cobimetinib应用于BRAF突变型疾病。粘膜黑素瘤患者可以提供推荐用于皮肤黑素瘤的相同疗法。没有推荐或反对葡萄膜黑色素瘤的特定疗法。其他信息可在www上获得。asco.org/黑色素瘤指南。
To provide guidance to clinicians regarding the use of systemic therapy for melanoma.
ASCO convened an Expert Panel and conducted a systematic review of the literature.
A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma.
In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-
guidelines.