Aktuelle Therapie des malignen Melanoms[*]

Zusammenfassung

Während die Inzidenz des kutanen Melanoms weiterhin beständig steigt, haben sich die Mortalitätszahlen stabilisiert.

Die Exzision des Primärtumors mit angepasstem Sicherheitsabstand ist die Therapie der Wahl. Ab einer vertikalen Tumordicke von 1,0 mm wird die Durchführung einer Wächterlymphknotenbiopsie empfohlen. In der adjuvanten Situation ist Interferon-α die einzige Substanz, die in prospektiv randomisierten Studien einen Vorteil hinsichtlich des rezidivfreien- und Gesamtüberlebens für eine kleine Subgruppe der Patienten gezeigt hat. Die optimale Dosierung ist nach wie vor offen.

Die Therapie bei Fernmetastasierung ist in der Regel palliativ. Primär wird versucht, durch operative, radioonkologische und chemotherapeutische Maßnahmen das Tumorleiden in Remission zu bringen. Als systemische Standardtherapie wird am ehesten die Monochemotherapie mit Dacarbazin angesehen. Die aktuelle Forschung konzentriert sich auf die Möglichkeiten der Immuntherapie und der Blockade molekularer Zielstrukturen („targeted therapies”). In Zukunft werden zudem individualisierte Therapien, die z. B. auf Mutationsanalysen beruhen, die therapeutische Optionen ergänzen.

Abstract

Although the incidence of melanoma is still rising in Caucasian populations, the increase in mortality has leveled off.

Primary melanomas are now excised with adjusted surgical margins. Sentinel-node biopsy is recommended as a nodal staging procedure in patients with tumor thickness of 1 mm and more. Adjuvant therapy with interferon-α in high-risk patients offers a small benefit in terms of recurrence-free and overall survival; the optimal dosage and duration of this treatment are still to be defined.

The treatment in Stage IV disease is still considered palliative. The main intention in tumor treatment is the achievement of a remission by surgical, radio- and chemotherapeutic options. Therapy with dacarbazine remains the first-line systemic treatment approach of choice. A range of new treatment modalities, including targeted molecules, immunologic approaches with monoclonal antibodies, and mutation based treatment options are under development; hopefully, new treatment modalities will be available in the near future.

1 Nach einem Vortrag gehalten anlässlich des Symposions „Moderne Aspekte der Dermatoonkologie” organisiert vom Tumorzentrum und der Klinik für Dermatologie, Venerologie und Allergologie – Immunologisches Zentrum, Städtisches Klinikum Dessau, März 2007.

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1 Nach einem Vortrag gehalten anlässlich des Symposions „Moderne Aspekte der Dermatoonkologie” organisiert vom Tumorzentrum und der Klinik für Dermatologie, Venerologie und Allergologie – Immunologisches Zentrum, Städtisches Klinikum Dessau, März 2007.