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Current management of melanoma patients with nodal metastases

The management of melanoma patients with nodal metastases has undergone dramatic changes over the last decade. In the past, the standard of care for patients with a positive sentinel lymph node biopsy (SLNB) was a completion lymph node dissection (CLND), while patients with palpable macroscopic noda...

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Autores principales: Han, Dale, van Akkooi, Alexander C. J., Straker, Richard J., Shannon, Adrienne B., Karakousis, Giorgos C., Wang, Lin, Kim, Kevin B., Reintgen, Douglas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102663/
https://www.ncbi.nlm.nih.gov/pubmed/33961168
http://dx.doi.org/10.1007/s10585-021-10099-7
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author Han, Dale
van Akkooi, Alexander C. J.
Straker, Richard J.
Shannon, Adrienne B.
Karakousis, Giorgos C.
Wang, Lin
Kim, Kevin B.
Reintgen, Douglas
author_facet Han, Dale
van Akkooi, Alexander C. J.
Straker, Richard J.
Shannon, Adrienne B.
Karakousis, Giorgos C.
Wang, Lin
Kim, Kevin B.
Reintgen, Douglas
author_sort Han, Dale
collection PubMed
description The management of melanoma patients with nodal metastases has undergone dramatic changes over the last decade. In the past, the standard of care for patients with a positive sentinel lymph node biopsy (SLNB) was a completion lymph node dissection (CLND), while patients with palpable macroscopic nodal disease underwent a therapeutic lymphadenectomy in cases with no evidence of systemic spread. However, studies have shown that SLN metastases present as a spectrum of disease, with certain SLN-based factors being prognostic of and correlated with outcomes. Furthermore, the results of key clinical trials demonstrate that CLND provides no survival benefit over nodal observation in positive SLN patients, while other clinical trials have shown that adjuvant immune checkpoint inhibitor therapy or targeted therapy after CLND is associated with a recurrence-free survival benefit. Given the efficacy of these systemic therapies in the adjuvant setting, these agents are now being evaluated and utilized as neoadjuvant treatments in patients with regionally-localized or resectable metastatic melanoma. Multiple options now exist to treat melanoma patients with nodal disease, and determining the best treatment course for a particular case requires an in-depth knowledge of current data and an informed discussion with the patient. This review will provide an overview of the various options for treating melanoma patients with nodal metastases and will discuss the data that supported the development of these treatment options.
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spelling pubmed-81026632021-05-07 Current management of melanoma patients with nodal metastases Han, Dale van Akkooi, Alexander C. J. Straker, Richard J. Shannon, Adrienne B. Karakousis, Giorgos C. Wang, Lin Kim, Kevin B. Reintgen, Douglas Clin Exp Metastasis Review The management of melanoma patients with nodal metastases has undergone dramatic changes over the last decade. In the past, the standard of care for patients with a positive sentinel lymph node biopsy (SLNB) was a completion lymph node dissection (CLND), while patients with palpable macroscopic nodal disease underwent a therapeutic lymphadenectomy in cases with no evidence of systemic spread. However, studies have shown that SLN metastases present as a spectrum of disease, with certain SLN-based factors being prognostic of and correlated with outcomes. Furthermore, the results of key clinical trials demonstrate that CLND provides no survival benefit over nodal observation in positive SLN patients, while other clinical trials have shown that adjuvant immune checkpoint inhibitor therapy or targeted therapy after CLND is associated with a recurrence-free survival benefit. Given the efficacy of these systemic therapies in the adjuvant setting, these agents are now being evaluated and utilized as neoadjuvant treatments in patients with regionally-localized or resectable metastatic melanoma. Multiple options now exist to treat melanoma patients with nodal disease, and determining the best treatment course for a particular case requires an in-depth knowledge of current data and an informed discussion with the patient. This review will provide an overview of the various options for treating melanoma patients with nodal metastases and will discuss the data that supported the development of these treatment options. Springer Netherlands 2021-05-07 2022 /pmc/articles/PMC8102663/ /pubmed/33961168 http://dx.doi.org/10.1007/s10585-021-10099-7 Text en © The Author(s), under exclusive licence to Springer Nature B.V. 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review
Han, Dale
van Akkooi, Alexander C. J.
Straker, Richard J.
Shannon, Adrienne B.
Karakousis, Giorgos C.
Wang, Lin
Kim, Kevin B.
Reintgen, Douglas
Current management of melanoma patients with nodal metastases
title Current management of melanoma patients with nodal metastases
title_full Current management of melanoma patients with nodal metastases
title_fullStr Current management of melanoma patients with nodal metastases
title_full_unstemmed Current management of melanoma patients with nodal metastases
title_short Current management of melanoma patients with nodal metastases
title_sort current management of melanoma patients with nodal metastases
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102663/
https://www.ncbi.nlm.nih.gov/pubmed/33961168
http://dx.doi.org/10.1007/s10585-021-10099-7
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