Russian Journal of OncologyRussian Journal of OncologyРоссийский онкологический журнал1028-99842412-9119Eco-Vector62824310.17816/onco628243ReviewsНаучные обзорыReview ArticleSurgical treatment of distant metastases of cutaneous melanomaХирургическое лечение отдалённых метастазов меланомы кожиhttps://orcid.org/0009-0009-1826-88509139-2916TeleginAlexander A.ТелегинАлександр Алексеевич
Russian Federation
dock996@bk.ruhttps://orcid.org/0000-0001-8880-17581177-8997ProzorenkoEvgeny V.ПрозоренкоЕвгений Владимирович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

prozorenko_e_v@staff.sechenov.ruhttps://orcid.org/0000-0001-7150-50713691-8923SamoylenkoIgor V.СамойленкоИгорь Вячеславович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

i.samoylenko@ronc.ruhttps://orcid.org/0000-0001-5841-74801404-7422SevyanNadezhda V.СевянНадежда Вагаршаковна
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

sevyan_n_v@staff.sechenov.ruN.N. Blokhin National Medical Research Center of OncologyНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый МГМУ имени И.М. Сеченова Минздрава России (Сеченовский Университет)12092024220920242841891950203202417062024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://rjonco.com/1028-9984/article/view/628243

This article addresses the issue of surgical treatment effectiveness in cases of disseminated melanoma. It is shown that disseminated melanoma can be divided into truly disseminated and oligometastatic processes, where distant metastases are resectable. Previously, surgical intervention was the treatment of choice for patients with resectable distant metastases, however, with the development of new therapeutic approaches, such as immune checkpoint inhibitors and targeted therapies, the role of surgery has become less straightforward. However, tumor burden reduction through surgical removal of metastatic lesions may enhance the immune response. Combined treatment, involving surgical intervention and systemic therapy, has emerged as a new approach in treatment of disseminated melanoma, improving efficacy and prognosis. The article emphasizes the need for further research to determine the optimal approach for treatment in this patient population.

Данная статья рассматривает вопрос эффективности хирургического лечения диссеминированной меланомы кожи. Показано, что диссеминированная меланома может быть разделена на истинно диссеминированный процесс и олигометастатический процесс, в котором отдалённые метастазы являются резектабельными. Ранее хирургическое лечение было методом выбора для пациентов с отдалёнными резектабельными метастазами, но с развитием новых терапевтических подходов, таких как ингибиторы контрольных точек иммунитета и таргетные препараты, роль хирургии стала спорной. Однако снижение опухолевой массы после хирургического удаления метастатических очагов может улучшить иммунный ответ организма.

Комбинированное лечение, включающее хирургическое вмешательство и системную терапию, стало новым подходом в лечении диссеминированной меланомы, повышая эффективность и улучшая прогноз у пациентов. В статье подчёркивается необходимость дальнейших исследований для определения оптимального подхода к лечению этой группы пациентов.

cutaneous melanomadisseminated melanomadistant metastasesoligometastatic processsurgical treatmentimmune checkpoint inhibitorstargeted therapiescombined treatmentмеланома кожидиссеминированная меланомаотдалённые метастазыолигометастатический процессхирургическое лечениеингибиторы контрольных точек иммунитетатаргетные препаратыкомбинированное лечениеBeckham TH, Yang TJ, Gomez D, et al. Metastasis-directed therapy for oligometastasis and beyond. Br J Cancer. 2021;124(1):136–141. doi: 10.1038/s41416-020-01128-5Beckham T.H., Yang T.J., Gomez D., et al. Metastasis-directed therapy for oligometastasis and beyond // Br J Cancer. 2021. Vol. 124, N 1. P. 136–141. doi: 10.1038/s41416-020-01128-5AlGhamdi H, Dhont J, Krayem M, et al. The Road to Dissemination: The Concept of Oligometastases and the Barriers for Widespread Disease. Cancers (Basel). 2022;14(8):2046. doi: 10.3390/cancers14082046AlGhamdi H., Dhont J., Krayem M., et al. The Road to Dissemination: The Concept of Oligometastases and the Barriers for Widespread Disease // Cancers (Basel). 2022. Vol. 14, N 8. P. 2046. doi: 10.3390/cancers14082046Leung AM, Hari DM, Morton DL. Surgery for Distant Melanoma Metastasis. Cancer J. 2012;18(2):176–184. doi: 10.1097/PPO.0b013e31824bc981Leung A.M., Hari D.M., Morton D.L. Surgery for Distant Melanoma Metastasis // Cancer J. 2012. Vol. 18, N 2. P. 176–184. doi: 10.1097/PPO.0b013e31824bc981Huang AC, Postow MA, Orlowski RJ, et al. T-cell invigoration to tumour burden ratio associated with anti-PD-1 response. Nature. 2017;545(7652):60–65. doi: 10.1038/nature22079Huang A.C., Postow M.A., Orlowski R.J., et al. T-cell invigoration to tumour burden ratio associated with anti-PD-1 response // Nature. 2017. Vol. 545, N 7652. P. 60–65. doi: 10.1038/nature22079Steininger J, Gellrich FF, Schulz A, et al. Systemic Therapy of Metastatic Melanoma: On the Road to Cure. Cancers. 2021;13(6):1430. doi: 10.3390/cancers13061430Steininger J., Gellrich F.F., Schulz A., et al. Systemic Therapy of Metastatic Melanoma: On the Road to Cure // Cancers. 2021. Vol. 13, N 6. P. 1430. doi: 10.3390/cancers13061430Long GV, Grob J-J, Nathan P, et al. Factors predictive of response, disease progression, and overall survival after dabrafenib and trametinib combination treatment: a pooled analysis of individual patient data from randomised trials. Lancet Oncol. 2016;17(12):1743–1754. doi: 10.1016/S1470-2045(16)30578-2Long G.V., Grob J.-J., Nathan P., et al. Factors predictive of response, disease progression, and overall survival after dabrafenib and trametinib combination treatment: a pooled analysis of individual patient data from randomised trials // Lancet Oncol. 2016. Vol. 17, N 12. P. 1743–1754. doi: 10.1016/S1470-2045(16)30578-2Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377(19):1813–1823. doi: 10.1056/NEJMoa1708539Long G.V., Hauschild A., Santinami M., et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma // N Engl J Med. 2017. Vol. 377, N 19. P. 1813–1823. doi: 10.1056/NEJMoa1708539Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824–1835. doi: 10.1056/NEJMoa1709030Weber J., Mandala M., Del Vecchio M., et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma // N Engl J Med. 2017. Vol. 377, N 19. P. 1824–1835. doi: 10.1056/NEJMoa1709030Rose DM, Essner R, Hughes TM, et al. Surgical resection for metastatic melanoma to the liver: the John Wayne Cancer Institute and Sydney Melanoma Unit experience. Arch Surg. 2001;136(8):950–955. doi: 10.1001/archsurg.136.8.950Rose D.M., Essner R., Hughes T.M., et al. Surgical resection for metastatic melanoma to the liver: the John Wayne Cancer Institute and Sydney Melanoma Unit experience // Arch Surg. 2001. Vol. 136, N 8. P. 950–955. doi: 10.1001/archsurg.136.8.950Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg. 1995;181(3):193–201.Barth A., Wanek L.A., Morton D.L. Prognostic factors in 1,521 melanoma patients with distant metastases // J Am Coll Surg. 1995. Vol. 181, N 3. P. 193–201.Ollila DW, Hsueh EC, Stern SL, et al. Metastasectomy for recurrent stage IV melanoma. J Surg Oncol. 1999;71(4):209–213. doi: 10.1002/(sici)1096-9098(199908)71:4<209::aid-jso1>3.0.co;2-2Ollila D.W., Hsueh E.C., Stern S.L., et al. Metastasectomy for recurrent stage IV melanoma // J Surg Oncol. 1999. Vol. 71, N 4. P. 209–213. doi: 10.1002/(sici)1096-9098(199908)71:4<209::aid-jso1>3.0.co;2-2Wasif N, Bagaria SP, Ray P, et al. Does metastasectomy improve survival in patients with Stage IV melanoma? A cancer registry analysis of outcomes. J Surg Oncol. 2011;104(2):111–115. doi: 10.1002/jso.21903Wasif N., Bagaria S.P., Ray P., et al. Does metastasectomy improve survival in patients with Stage IV melanoma? A cancer registry analysis of outcomes // J Surg Oncol. 2011. Vol. 104, N 2. P. 111–115. doi: 10.1002/jso.21903Orlova KV, Ledin E, Zhukova NV, et al. The role of surgery (metastasectomy) in advanced BRAF positive melanoma during modern therapy. Journal of Clinical Oncology. 2022;40:e21512–e21512. doi: 10.1200/JCO.2022.40.16_suppl.e21512Orlova K.V., Ledin E., Zhukova N.V., et al. The role of surgery (metastasectomy) in advanced BRAF positive melanoma during modern therapy // Journal of Clinical Oncology. 2022. Vol. 40. P. e21512–e21512. doi: 10.1200/JCO.2022.40.16_suppl.e21512Atkins MB, Lee SJ, Chmielowski B, et al. Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134. Randomized Controlled Trial. J Clin Oncol. 2023;41(2):186–197. doi: 10.1200/JCO.22.01763Atkins M.B., Lee S.J., Chmielowski B., et al. Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134. Randomized Controlled Trial // J Clin Oncol. 2023. Vol. 41, N 2. P. 186–197. doi: 10.1200/JCO.22.01763Olbryt M. Potential Biomarkers of Skin Melanoma Resistance to Targeted Therapy-Present State and Perspectives. Cancers (Basel). 2022;14(9):2315. doi: 10.3390/cancers14092315Olbryt M. Potential Biomarkers of Skin Melanoma Resistance to Targeted Therapy-Present State and Perspectives // Cancers (Basel). 2022. Vol. 14, N 9. P. 2315. doi: 10.3390/cancers14092315Amaral T, Seeber O, Mersi E, et al. Primary Resistance to PD-1-Based Immunotherapy—A Study in 319 Patients with Stage IV Melanoma. Cancers (Basel). 2020;12(4):1027. doi: 10.3390/cancers12041027Amaral T., Seeber O., Mersi E., et al. Primary Resistance to PD-1-Based Immunotherapy—A Study in 319 Patients with Stage IV Melanoma // Cancers (Basel). 2020. Vol. 12, N 4. P. 1027. doi: 10.3390/cancers12041027Prozorenko EV, Glushakov RI, Karakhan VB, et al. Cerebral metastases as a cause of non — traumatic intracranial hemorrhage: long-term results of surgical treatment. Military medical journal. 2020;341(8):46–53. EDN: ATIAUCПрозоренко Е.В., Глушаков Р.И., Карахан В.Б., и др. Церебральные метастазы как причина нетравматических внутричерепных кровоизлияний: отдалённые результаты хирургического лечения // Военно-медицинский журнал. 2020. Т. 341, № 8. С. 46–53. EDN: ATIAUCProzorenko E, Karahan V, Bekyashev A, et al. Hemorrhagic cerebral metastasis of melanoma and soft tissue sarcomas: surgical treatment and its results. Sarkomy kostei, myagkikh tkanei i opukholi kozhi. 2015;(3):3–7. EDN: VWZWJFПрозоренко Е.В., Карахан В.Б., Бекяшев А.Х., и др. Геморрагические церебральные метастазы меланом и мягкотканных сарком: хирургическое лечение и его результаты // Саркомы костей, мягких тканей и опухоли кожи. 2015. № 3. С. 3–7. EDN: VWZWJF