Publication: Evolución del tratamiento del melanoma
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2016
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Abstract
El melanoma es la forma más agresiva de cáncer de piel, debido a su elevado potencial metastásico y a sus altas tasas de mortalidad. En el tratamiento de la enfermedad metastásica, tradicionalmente se disponía de dos opciones terapéuticas: la dacarbazina y la interleucina-2. El gran progreso en el conocimiento de las vías de señalización implicadas en el desarrollo del melanoma y de su inmunobiología ha permitido el desarrollo de nuevas terapias para pacientes con melanoma metastásico, que revolucionaron el tratamiento de esta enfermedad a partir del año 2011. En la presente revisión bibliográfica se exponen las opciones terapéuticas disponibles en la actualidad, que se encuadran en dos modalidades: las terapias dirigidas (inhibidores de B-RAF, de MEK y de c-KIT) y la inmunoterapia (anti-CTLA-4, anti-PD-1 y viroterapia oncolítica). Además, se describen las nuevas terapias que se encuentran en fase de desarrollo, como la vacunación terapéutica, la terapia celular adoptiva y la terapia celular CAR. Los recientes avances han mejorado los datos de supervivencia en pacientes con melanoma metastásico, aunque se requieren estudios que comparen las diferentes opciones terapéuticas entre sí, con el fin de determinar el esquema de tratamiento óptimo en el manejo de esta enfermedad.
Melanoma is the most aggressive form of skin cancer, due to its metastatic potential and high mortality rates. Traditionally, systemic therapy for metastatic melanoma has only included two drugs: dacarbazine and interleukin-2. Given the tremendous progress in understanding the molecular signaling pathway of melanoma development and its immunobiology, breakthroughs in molecular targeted therapies and immunotherapies have revolutionized the standard of care for patients with advanced melanoma since 2011. This review presents the currently available therapies for metastatic melanoma, which comprises two modalities: targeted therapies (B-RAF, MEK and c-KIT inhibitors) and immunotherapy (CTLA-4 and PD-1 checkpoint inhibitors and oncolytic virotherapy). Besides, novel therapies which are currently under development, such as therapeutic vaccines, adoptive cell therapy and CAR cell therapy are described. Recent therapeutic advances have demonstrated a significant increase in survival rates in patients with advanced melanoma, even though results from studies that compare the novel treatments amongst each other are needed, in order to define the optimal therapeutic scheme for the treatment of this malignant disease.
Melanoma is the most aggressive form of skin cancer, due to its metastatic potential and high mortality rates. Traditionally, systemic therapy for metastatic melanoma has only included two drugs: dacarbazine and interleukin-2. Given the tremendous progress in understanding the molecular signaling pathway of melanoma development and its immunobiology, breakthroughs in molecular targeted therapies and immunotherapies have revolutionized the standard of care for patients with advanced melanoma since 2011. This review presents the currently available therapies for metastatic melanoma, which comprises two modalities: targeted therapies (B-RAF, MEK and c-KIT inhibitors) and immunotherapy (CTLA-4 and PD-1 checkpoint inhibitors and oncolytic virotherapy). Besides, novel therapies which are currently under development, such as therapeutic vaccines, adoptive cell therapy and CAR cell therapy are described. Recent therapeutic advances have demonstrated a significant increase in survival rates in patients with advanced melanoma, even though results from studies that compare the novel treatments amongst each other are needed, in order to define the optimal therapeutic scheme for the treatment of this malignant disease.