Ponizej cytuje rozdzial na temat
leczenia rozsianej melanomy wyjety z australiskich i nowozelandzkich wytycznych dot. postepowania z pacjentami chorymi na czerniaka.
( jak bede miala czas wieczorem to przetlumacze ten rozdzial).
Jezeli chodzi o Interferon-alfa, to nie jest to niestety zaden cudowny lek - ani tu ani w Szwajcarii. Na leczenie nim odpowiada okolo 15% pacjentow
Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand
Treatment of disseminated melanoma
The outcome for patients with stage IV melanomas is poor. The median survival is only
six to nine months, with an estimated five-year survival of 5–10% depending on the
prognostic factors, the site of metastasis, the number of metastatic sites, and elevated
serum LDH levels.1,2
The standard chemotherapy has been
single agent dacarbazine (DTIC) that has response
rates reported at 5–20%, but only 5% are complete responses and of short duration.3,4
Recently
fotemustine was shown to produce higher overall response rate compared with
dacarbazine, but with only a trend towards overall survival. Unlike DTIC and temozolomide,
fotemustine is associated with higher risk of myelosuppression5.
The
oral alkylating agent temozolomide has equivalent efficacy to dacarbazine (median
survival 7.7 months versus 6.4 respectively).6 Temozolomide resulted in better health-related
quality-of-life outcomes than dacarbazine, both in functional improvements and decreased
symptoms.7
Combination chemotherapy does not improve survival over single agents and may not
improve palliation of more toxic than single agents.8
For example, the
Dartmouth regimen
(cisplatin, carmustine, DTIC and tamoxifen) has a slightly increased response rate but there
is no improvement in survival when compared to dacarbazine alone.4
The combination of
cisplatin and temozolomide did not improve the outcome compared to temozolomide alone.9
The
addition of tamoxifen to chemotherapy is ineffective.10
The biological agent interferon- alpha
achieved single agent response rates around 15%,
while
IL2 phase II trials ranged between 3% and 50%.11,12
Randomised trials of the
combination showed no advantage over single agents.13
Combining
interferon-alpha with chemotherapy did not improve survival.
IL2 was combined with dacarbazine only in phase II trials.14
Similarly,
adding interferon- alpha to temozolomide
improved the response rate but did not translate into a survival
advantage.
Randomised studies of
adding either or both interferon and interleukin to
combination chemotherapy has not resulted in improved survival of patients with metastatic melanoma.15,16
To date no other biological treatment, either vaccines or targeted therapies
such as Bcl-2 antisense therapies, have been effective alone or demonstrated survival
advantages in randomised trials which add them to chemotherapy.17
Radiotherapy can improve symptoms from the effect of local tumours.
The sites commonly requiring treatment in melanoma are
bone, brain, subcutaneous lesions, bulky lymph nodes, liver and adrenal metastases.
Whilst many of these can be treated with short fractionation
regimens such as 8 Gy in one fraction (bone metastases)18 or 20 Gy in five fractions
(brain metastases),19 larger and bulky tumours such as those involving lymph nodes or
widespread cutaneous deposits may require more lengthy schedules, such as 40 Gy in
fifteen fractions or 45 Gy in twenty fractions.
http://www.nzgg.org.nz/gu...ed_melanoma.pdf
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