Adjuvantno liječenje melanoma

master's thesis

• Title (english): Adjuvant treatment of melanoma
• Author: Ana Kelečić
• Mentor: Jasmina Marić Brozić (mentor)
• Committee member: Nikola Đaković (predsjednik povjerenstva)
• Committee member: Marija Gamulin (član povjerenstva)
• Committee member: Jasmina Marić Brozić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Clinical Oncology); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Incidencija melanoma povećava se brže od bilo koje druge maligne bolesti i predstavlja važan
javnozdravstveni problem. Potpuno kirurško odstranjenje primarna je metoda liječenja
melanoma u ranim stadijima bolesti. Nakon kompletnog kirurškog odstranjenja, rizik povrata
bolesti ovisi o stadiju bolesti. Desetogodišnje preživljenje se kreće od 98% za stadij IA do 24%
za stadij IIID. Cilj adjuvantne terapije je uništiti mikrometastaze i smanjiti stopu povrata bolesti.
Interferon α-2b je dvadeset godina bio jedina odobrena terapija za adjuvantno liječenje
melanoma, usprkos upitnoj učinkovitosti i čestim nuspojavama. Uspjeh inhibitora imunoloških
kontrolnih točaka i ciljane terapije u liječenju uznapredovalog melanoma otvorio je put kliničkim
ispitivanjima u adjuvantnom liječenju melanoma. Rezultati provedenih kliničkih ispitivanja
doveli su do odobrenja PD-1 inhibitora i BRAF/MEK inhibitora za adjuvantno liječenje
visokorizičnog melanoma. Rezultati ispitivanja pokazali su učinak na produljenje preživljenja
bez recidiva, no učinak na ukupno preživljenje do sada nije dosegnut. Zbog nepostojanja
pouzdanih prediktivnih biomarkera poseban problem predstavljaju pitanja koga sve liječiti
adjuvantnom terapijom i koju terapiju odabrati. PD-1 inhibitori i BRAF/MEK inhibitori razlikuju
se u načinu primjene i profilu nuspojava. Trenutno je adjuvantno liječenje odobreno za stadije
IIB, IIC, III i operirane stadije IV. Ovaj rad prezentira dosadašnje dosege u adjuvantnom
liječenju melanoma, izdvajajući najznačajnija klinička ispitivanja.

Abstract (english)

The incidence of melanoma is increasing faster than of any other malignant disease and
represents an important public health problem. Complete surgical removal is the primary
method of treating melanoma in the early stages of the disease. After complete surgical
removal, the risk of disease recurrence depends on the stage of the disease. Ten-year survival
ranges from 98% for stage IA to 24% for stage IIID. The goal of adjuvant therapy is to destroy
micrometastases and reduce the rate of disease recurrence. Interferon α-2b had been the only
approved therapy for the adjuvant treatment of melanoma for twenty years, despite its
questionable efficacy and frequent side effects. The success of immune checkpoint inhibitors
and targeted therapies in the treatment of advanced melanoma has paved the way for clinical
trials in the adjuvant treatment of melanoma. The results of the conducted clinical trials led to
the approval of PD-1 inhibitors and BRAF/MEK inhibitors for the adjuvant treatment of highrisk
melanoma. The results of the trial showed an effect on prolonging survival without
recurrence, but the effect on overall survival has not been reached so far. Due to the lack of
reliable predictive biomarkers, the questions of whom to treat with adjuvant therapy and which
therapy to choose, pose a particular problem. PD-1 inhibitors and BRAF/MEK inhibitors differ
in their mode of administration and side effect profile. Currently, adjuvant treatment is approved
for stages IIB, IIC, III, and operated stage IV. This paper presents the achievements so far in
the adjuvant treatment of melanoma, highlighting the most important clinical trials.

• Keywords: melanom; adjuvantno liječenje; imunoterapija; ciljana terapija
• Keywords (english): melanoma; adjuvant treatment; immunotherapy; targeted therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:001669
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-13 08:49:35