Preoperative (Neoadjuvant) Therapy for Resectable ：术前（新辅助）治疗为手术切除.ppt

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2018-06-05 发布于浙江
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Preoperative (Neoadjuvant) Therapy for Resectable ：术前（新辅助）治疗为手术切除.ppt

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Preoperative (Neoadjuvant) Therapy for Resectable ：术前（新辅助）治疗为手术切除

Not the end….Thank you ACOS Surgical Oncology In-Depth Review 2014 Douglas M. Iddings D.O., FACS FACOS Surgical Oncologist Melanoma Surgical management and beyond No disclosures Objectives Discuss the old and new era in melanoma therapy. Review the new and emerging treatments. Discuss the mechanism of action. Discuss a possible standard approach Discuss implications for surgeons Case examples Melanoma Questions What year marked the new era in systemic treatment of stage IV metastatic melanoma? What are the new emerging systemic treatment agents? Is there any evidence or hope for neo-adjuvant treatment in melanoma? What is the NCCN preferred treatment? Melanoma of the skin All cancers 2013 total new cancers 1,660,290 Melanoma of the Skin 2013 estimated new cases = 76,690 45,060 men (5%) and 31,630 (6%) female 2013 estimated deaths = 9,480 6,280 men and 3,200 female Melanoma of the skin Recommended Margins…..unchanged. Tumor thickness Recommended Margins In situ 0.5 – 1.0 mm ≤ 1.0 mm 1.0 mm (category 1) 1.01 – 2 mm 1 – 2 mm (category 1) 2.01 – 4 mm 2.0 mm (category 1) 4 mm 2.0 mm (category 1) New and emerging treatments in Metastatic Melanoma Old era as of February 2011 Dacarbazine (DTIC), 1970’s Response rates 10% with no proven impact on survival. High-dose IFN, 1995 The only approved adjuvant therapy Consistent benefit on relapse-free survival but controversial survival benefit High-dose IL-2, 1998 Response rate 16% in highly selected patients Rarely used outside of high volume centers New era in Metastatic Melanoma Drugs approved for Melanoma by FDA in 2011 Pegylated interferon alfa-2b Improved RFS in adjuvant therapy of stage III melanoma No proven impact on survival (5 year treatment regimen) Ipilimumab (anti-CTLA4 monoclonal antibody) Immunotherapy for stage IV melanoma Improved overall survival in 2 phase III trials Vemurafenib (V600 mutant BRAF inhibitor) For BRAF mutant melanoma (45% incidence) Rapid response rates, rarely durable Improved su