9 Things to Know About Adjuvant Therapy For Melanoma

如果你的黑素瘤厚4毫米，或2毫米ulceration（皮肤顶层的崩溃），或者已经蔓延到淋巴结，你的复发风险较高。“如果你有一点点传播，我们知道你的蔓延风险很高，”Sancy Leachman，M.D.，Ph.D。俄勒冈州俄勒冈州卫生和科学大学骑士癌研究所黑素瘤研究计划主任。可以进行初级黑素瘤和节点的去除，但关注的是微观癌细胞将丧吻和移动。这就是佐剂治疗发挥作用的地方。

Adjuvant therapy is given to those withresectable stage III melanoma。In layman’s terms, that means melanoma that has spread to the lymph nodes but can be fully removed with surgery. In some cases, it can be given for stage IV melanoma, too, says Allison Betof Warner, M.D., a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City. “If somebody has just one or two sites of metastatic disease, and they can be surgically removed, then we can consider adjuvant therapy for a year after that surgery,” she says.

几年后，只有一个FDA批准的黑色素瘤辅助治疗药物：静脉或注射药物干扰素。它是你身体已经产生的蛋白质的合成版本，使您的免疫细胞杀死癌症。必须以高剂量给出，因此它带来毒性和令人不愉快的副作用的风险。现在有更好的药物选择，包括检查点抑制剂(a type of免疫疗法) andtargeted therapies, which home in on the specific genetic mutation causing your tumors to grow.

YourT细胞（免疫细胞）have checkpoints that act as brakes to stop them from attacking healthy cells, but that means sneaky cancer cells can sneak by undetected. Checkpoint inhibitors release those brakes so your immune cells find and destroy cancer. These drugs are also known asPD-1 inhibitors，他们采取行动的具体检查站。最常用于佐剂治疗的人是Opdivo（Nivolumab）和Yervoy（Ipilmumab），持续一年。后者导致更长的复发期，副作用较少，研究The New England Journal of Medicineshowed.

你很聪明地问你可能需要的任何MED的这个问题。一点保证：检查点抑制剂的最常见副作用是相当温和的，包括疲劳，皮疹，恶心，关节疼痛，食欲不足，令人遗憾，便秘或腹泻，美国癌症学会。In more severe cases though, your immune system can get too revved up by immunotherapy, resulting in inflammation and damage to other organs such as the lungs, liver, or kidneys.

Your doctor may have tested your melanoma for DNA mutations, most commonly BRAF and MEK mutations. Certain drugs target proteins in these mutations, blocking molecules that allow the tumors to grow and spread. In recent years, targeted therapies—Tafinilar (dabrafenib), and (Mekinist (trametinib). Keytruda (pembrolizumab)—has been approved for adjuvant use but is not classified as targeted therapy, but as immunotherapy. In 2018, the FDA approved a combination of dabrafenib and trametinib. This power pairing yielded a 58% survival rate at three years versus 39% with the placebo, in a study in the新英格兰医学杂志。

Happily, compared to immunotherapy, the side effects stemming from targeted therapy tend to be short-lived. The majority of them are flu-like and include fever, chills, fatigue, nausea, and skin rashes. Your physician can help manage any issues you’re contending with by prescribing a short-term course of steroids, if necessary, so pipe up about any issues you’re experiencing (yep, however not-a-big deal they may seem).

Radiation, which uses high-energy X-ray beams to destroy tumors, isn’t typically a go-to treatment for melanoma, but it can be used as an adjuvant treatment to kill off cancer cells in distant organs. In a study inThe Lancet Oncology，研究人员发现，只有10.2％的参与者有一个淋巴结解剖(removal) for melanoma plus a course of radiation had a recurrence within 5 years compared to 40.6% who had undergone lymph node dissection alone.

一旦你completed your treatment, you’ll need to be super diligent with doctor follow-ups. According to the黑色素瘤研究联盟, you should check your own skin and lymph nodes monthly. Expect to see your doctor for an in-office exam every three to six months for the first two years after your adjuvant therapy, every three to 12 months for the next three years, and then once a year after that. The five-year survival rate for stage III melanoma is 63.6%, but experts say advances in treatments and adjuvant therapies should continue to increase that number over time.