Therapy for metastatic melanoma-expert opinion.
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ProfessorKonstantin Sergeyevich Titov,Head of the Department of Skin and Soft Tissue Tumors of the MCSC, spoke about modern options for effective treatment of metastatic melanoma - a dangerous oncological disease, in the treatment of which significant progress has been made, to the portalMedvestnik.
New approaches in the treatment of metastatic melanoma can increase the survival rate of patients.
Melanoma in Russia ranks second in terms of the absolute increase in the incidence of malignant tumors after lung cancer. Every year, the number of cases is growing by 5%, and over the past 10 years, the increase was 28%.1 In total, about 95 thousand people are registered in Russia with the diagnosis of "skin melanoma" with the code C-43.2
At an early stage, this disease is often curable. Curability in skin melanoma in situ is achieved in 100% of cases, and in melanoma T1a-5-year survival reaches 95%.
Metastatic melanoma in the late stages is a dangerous disease, but recently significant progress has been made in its treatment, including with the use of combined targeted therapy and immunotherapy.
Combination targeted therapy for melanoma is a personalized type of treatment. It is prescribed only to those patients who have a mutation in the BRAF gene in melanoma. When the gene is mutated, melanoma cells divide faster, survive better, and form their own blood vessels faster. Patients who have this mutation in their genes may be prescribed combination targeted therapy at various stages of the disease.
The head of the Department of Surgery and Oncology of the FNMO RUDN told about the appointment optionsKonstantin Titov:
"The first option of appointment – patients who have a lesion of regional lymph nodes. Here, for preventive purposes, adjuvant targeted therapy is prescribed. The tablet form of medicines allows you not to interrupt treatment and take them both at home and at work, when traveling, and so on. Preventive (adjuvant) immune or combined targeted therapy after radical surgical treatment (removal of metastatic regional lymph nodes) lasts 12 months.
The second option of appointment is when the patient has a so-called metastatic disease. Progression of the tumor with distant metastases. Then it passes into the group of inoperable disseminated tumor. When surgical treatment is practically no longer used (sometimes solidary or residual single metastases are surgically removed after drug therapy). Accordingly, here, regardless of the BRAF mutation, there are two options – this is immunotherapy and combined targeted therapy. Combination targeted therapy is most often used in patients who have multiple metastases with a high growth rate, from which the patient can quickly die. Then we do not have much time for the immunotherapy to work (usually this can only happen at 12-14 weeks). Combined targeted therapy acts directly on the tumor and cells.
This is an "ambulance" for such patients: after 7-10 days from the start of taking targeted drugs, the patient may already notice an improvement in well-being, weakness, pain will decrease, appetite will appear, and, perhaps, even some visible metastases may decrease. With this treatment, the disease can be brought under control in 90% of patients. The five-year survival rate of patients who are taken under the control of combined targeted therapy is 34%. The rest sooner or later develop resistance. Here they already resort to immunotherapy.
At the same time, it is worth noting that the effectiveness of combined targeted therapy is significantly higher than previously used treatment methods, in particular chemotherapy. If with chemotherapy, the five-year survival rate of patients was only 5% of cases, then with combined targeted therapy-34%. Thus, the five-year survival rate of patients due to the introduction of combined targeted therapy increased by 6 times.
In the COMBI D/V clinical trial, the combination targeted therapy also demonstrated benefits in terms of treating patients with metastatic melanoma of the skin with a BRAF gene mutation. The administration of combined targeted therapy to this group of patients, provided a relatively favorable prognosis of the disease in the presence of low tumor load, normal LDH levels and less than 3 areas affected by metastases, showed objective improvements in the key indicators of treatment of metastatic melanoma of the skin. The overall survival rate of patients increased significantly.
In general, for patients with metastatic melanoma with a BRAF mutation in the tumor, we now have at least 3-4 approaches: combined targeted therapy, first-line immunotherapy, second-line immunotherapy, and chemotherapy. Therefore, if we use each method one after the other in turn, we can get a fairly long survival rate."
Expert: Konstantin Sergeevich Titov, MD, Professor, Head of the Department of Surgery and Oncology of the Russian Academy of Medical Sciences; Head of the Oncosurgical Department of Skin and Soft Tissue Tumors of the State Medical Institution of the Moscow State Medical Center named after A. S. Loginov; Deputy Chairman of the ANO "National Academy of Dermatologists and Oncologists".
1. Chissov V. I., Starinsky V. V., Petrova G. V. M.: The state of oncological care for the population of Russia in 2008. FP "P. A. Herzen Moscow State Medical Research Institute" of the Ministry of Health of the Russian Federation, 2009.
2. Kaprin A.D., Starinsky V. V., Petrova G. V. M.: Malignant neoplasms in Russia in 2018 (morbidity and mortality). P. A. Herzen Moscow State Research Institute is a branch of the Federal State Budgetary Institution "NMIC of Radiology" of the Ministry of Health of the Russian Federation. 2019.
