Подходы к терапии метастатической меланомы кожи в 2020 году: динамичное движение вперед


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Подходы к терапии метастатической меланомы кожи в 2020 году: динамичное движение вперед

Журнал "Медицинский совет" №9/2020

DOI: 10.21518/2079-701X-2020-9-80-93

 И.В. Самойленко, ORCID: 0000-0001-7150-5071, e-mail: i.samoylenko@ronc.ru Л.В. Демидов, ORCID: 0000-0002-8562-6082, e-mail: l.demidov@ronc.ru, Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина

Выбор терапии первой линии метастатической меланомы кожи в последние несколько лет стал довольно непростой задачей: у практикующего онколога появились лекарственные препараты различных классов с различным механизмом действия – блокаторы иммунных чек-пойнтов и ингибиторы тирозинкиназ BRAF/MEK. В данной работе авторы постарались систематизировать собственный опыт и текущие научные сведения о лечении больных метастатической меланомой кожи в первой и последующих линиях терапии. В работе обсуждается важность правильной исходной оценки состояния пациента и распространенности процесса, роль доступных в настоящее время биомаркеров при метастатической меланоме кожи, а также эффективность и безопасность возможных вариантов первой линии терапии данного заболевания. Ввиду отсутствия данных прямого сравнения комбинированной иммунотерапии, комбинированной таргетной терапии, тройной комбинации блокаторов BRAFi + MEKi + aPDl1 и монотерапии aPD1, полученных в результате рандомизированных исследований, нам приходится проводить параллели между исследованиями с различными диагнозами и различными популяциями пациентов. Поскольку практикующему онкологу в своей ежедневной работе приходится выполнять те же действия, мы полагаем, что наш обзор будет для этих врачей весьма полезен. В статье также обсуждаются возможности применения лекарственной терапии во второй и последующих линиях и успешная в ряде случаев стратегия возврата к предыдущему лечению. В качестве иллюстрации успеха тактики последовательной терапии различными препаратами приводится клиническое наблюдение пациентки с метастатической меланомой кожи стопы, которая наблюдается в нашем отделении с 2010 г. Клиническое наблюдение демонстрирует успех возврата к некоторым, ранее уже применяемым линями терапии, в т. ч. после развития прогрессирования на них.

Для цитирования:


Самойленко И.В., Демидов Л.В. Подходы к терапии метастатической меланомы кожи в 2020 году: динамичное движение вперед. Медицинский совет. 2020;(9):80–93. doi: 10.21518/2079-701X-2020-9-80-93


Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.


Approaches to metastatic skin melanoma therapy in 2020: a dynamic way forward

 Igor V. Samoylenko, ORCID: 0000-0001-7150-5071, e-mail: i.samoylenko@ronc.ru Lev V. Demidov, ORCID: 0000-0002-8562-6082, e-mail: l.demidov@ronc.ru, N.N. Blokhin National Medical Research Center of Oncology

The choice of first-line therapy for metastatic skin melanoma has become quite a difficult task in the last few years: a practicing oncologist has got drugs of different classes with different mechanisms of action – immune checkpoint blockers and BRAF/MEK tyrosine kinase inhibitors. In this study, the authors have tried to systematize their own experience and current scientific information about the treatment of patients with metastatic skin melanoma in the first and subsequent lines of therapy. The paper discusses the importance of correct initial assessment of the patient’s condition and prevalence of the process, the role of currently available biomarkers in metastatic skin melanoma, as well as the effectiveness and safety of possible first-line therapy options for this disease. Due to the lack of data for direct comparison of combined immunotherapy, combined targeted therapy, triple combination of BRAFi + MEKi + aPDl1 blockers and aPD1 monotherapy obtained from randomized studies, we have to draw parallels between studies with different diagnoses and different patient populations. Since the practicing oncologist has to do the same thing in his or her daily work, we believe that our review will be very useful for these doctors. The article also discusses the possibility of using drug therapy in the second and subsequent lines and a successful strategy to return to previous treatment in some cases. The clinical observation of a patient with metastatic foot skin melanoma, which has been observed in our department since 2010, is given as an illustration of the success of sequential treatment tactics with different drugs. Clinical observation shows the success of returning to some previously used therapy lines, including after the progression on them.

For citation:


Samoylenko I.V., Demidov L.V. Approaches to treatment of metastatic skin melanoma in 2020: a dynamic way forward. Meditsinskiy sovet = Medical Council. 2020;(9):80–93. (In Russ.) doi: 10.21518/2079-701X-2020-9-80-93


Conflict of interest: the authors declare that there is no conflict of interest.


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