Title Suvremeni pristup terapiji metastatskog melanoma
Author Ivona Jerković
Mentor Marija Petković (mentor)
Committee member Ines Mrakovčić-Šutić (predsjednik povjerenstva)
Committee member Ivana Marić (član povjerenstva)
Committee member Darinka Vučković (član povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Oncology and Radiotherapy) Rijeka
Defense date and country 2017-07-14, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Oncology
Abstract Melanom je maligni tumor podrijetla melanocita. Najmaligniji je tumor kože, iako je po učestalosti tek na trećem mjestu. Osim na koži, javlja se na svim mjestima gdje se nalaze melanociti – sluznica, žilnica oka, leptomeninge. Najčešće se javlja u područjima visoke insolacije, a najvišu incidenciju bilježi Australija. To ne čudi jer se kao jedan od glavnih rizičnih faktora spominje izloženost sunčevom zračenju. Kod mlađih se, prije svega, povezuje s višestrukom akutnom izloženosti suncu, a kod starijih se više povezuje s kroničnom izloženošću suncu. Fenotipska obilježja osobe također se smatraju važnim rizičnim faktorom. U većoj opasnosti su osobe svijetle puti, svijetle boje očiju i kose. Samo se 5-10% melanoma povezuje s genetski naslijeđenim materijalom, no pozitivna obiteljska anamneza mora ukazati na povećani oprez. Povećan broj displastičnih madeža ili madež koji svojim izgledom odudara od ostalih madeža na tijelu, onaj koji odstupa od ABCDE pravila, mora pobuditi kliničku sumnju na melanom. Suspektnu leziju treba odstraniti i patohistološki okarakterizirati. O nalazu fizikalnog pregleda i izvještaju patologa ovise daljnji dijagnostični i terapijski postupci. Primarna terapijska opcija u liječenju melanoma je kirurgija, no u slučaju metastatske bolesti indicirana je sustavna primjena lijekova. Kao prva linija liječenja preporučuju se BRAF inhibitori, sami ili u kombinaciji s MEK inhibitorima ili imunoterapijski lijekovi, isto kao monoterapija ili kombinacija lijekova. U slučaju nedostupnosti ovih lijekova, razvoja rezistencije ili pojave toksičnih učinaka, primjenjuju se tradicionalni kemoterapijski protokoli. Pacijentima čije loše opće stanje ne dozvoljava primjenu terapije, moramo osigurati najbolju moguću palijativnu skrb.
Abstract (english) Melanoma is a malignant tumor that originates from melanocytes. Melanoma ranks third in the overall number of skin cancers but it is the most malignant of them all. Except on the skin, it may occur at other sites, such as mucosa, the choroid and leptomeninges. It is the most common in areas of high insolation, therefore the highest incidence is recorded in Australia. Considering the fact that the main risk factor is exposure to sunlight, this incidence is not surprising. In children and young adults it is primarily associated with multiple acute sun exposure, and in the elderly with chronic sun exposure. Phenotypic characteristics are also considered as an important risk factor. People with fair skin, light – colored eyes and hair are at greater risk. Only 5 – 10 % of melanomas are associated with inherited genetic material, but positive family history should indicate increased caution. Increased number of dysplastic moles or a mole that differs from other moles on the body, moles deviating from ABCDE rule, should arouse clinical suspicion of melanoma. Suspicious lesion should be excised and histologically evaluated. Further analysis and therapeutic procedures depend on physical examination findings and a pathology report. The primary therapeutic option in the melanoma treatment is surgery, but if metastatic disease is present, systemic therapy is indicated. BRAF inhibitors are recommended as first line treatment, alone or in combination with MEK inhibitors. For BRAF mutation negative patients immunotherapeutic drugs are recommended as first line treatment , as well as a single agent or combination therapy. If such a treatment is unavailable, if patients develop resistance or toxic adverse effects, traditional chemotherapy may be administered. For patients whose general health condition does not allow the application of therapy, we need to ensure the best possible palliative care.
Keywords
melanom
imunoterapija
ciljana terapija
kemoterapija
Keywords (english)
melanoma
immunotherapy
targeted therapy
chemotherapy
Language croatian
URN:NBN urn:nbn:hr:184:737483
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
Terms of use
Created on 2018-06-15 15:30:30