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Chemoimmunotherpy for malignant melanoma in different stages


Author: Mariana Rogojinaru
Degree:doctor of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Year:2007
Scientific adviser: Iurie Bulat
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Institution:
Scientific council:

Status

The thesis was presented on the 5 December, 2006
Approved by NCAA on the 18 January, 2007

Abstract

Adobe PDF document – 0.24 Mb / in romanian

Thesis

CZU 616.5-006.91-085.277.3+615.37

Adobe PDF document 0.93 Mb / in romanian
108 pages

Summary

Malignant melanoma is an extremely dangerous skin disease which is characterized by fast development, precocious appearance of metastasis and small efficiency of the contemporary methods of treatment.

331 patients with MM in different stages were included in the research. The paper estimates the efficiency of four original chemo-immunotherapeutical regimes in the treatment of MM at different stages of process: dissemination, high risk after radical conventional surgical treatment and regional metastasis.

122 persons from the total share of patients presented disseminated forms: the prospective group of research consisted of 62 patients, which got a drug treatment with 4 components and the retrospective group of 60 patients that got a monotherapy treatment with DTIC. The chemo-immunotherapeutical regime made up of 4 preparations demonstrated a higher efficiency in the treatment of disseminated malignant melanoma than the mono-chemiotherapheutical regime with Dacarbazine: the installment of the objective response was 43,5% comparatively with 20% (p<0,01); that means an increase of the average standing of the objective response: 5,7 months verso 3,1 months (p<0,01) and of the span of survival: 14 months verso 8,9 months (p<0,01) with a higher but acceptable degree of toxicity.

The employment of the combination of Lomustin, Vincristin, Hydroxiurea and IFN as a second line of metastatic malignant melanoma’s treatment at 24 patients were obtained partial responses at 25% of patients, with a short duration of improvements – 5 months.

A prospective randomized research was made and devoted to the assessment of the efficiency of DTIC and IFN combination as an adjuvant treatment at patients with high risk of MM in stages IIB, IIC, IIIA. Were created two groups: 1) the group of study – 85 patients that got adjuvant treatment with Dacarbazine and IFN after the surgical intervention; 2) the group of control – 82 patients that were supervised without adjuvant treatment after the surgical intervention. At the median follow-up of 36 months, at patients treated with Dacarbazine and Interferon was stood out an inconsiderable improvement of survival without disease with 15,2% (p>0,05), without increase of disease-free survival (10,6 months verso 10,4 months, p>0,05) and of overall survival (24,4 months verso 23,4 months, p>0,05).

18 patients with regional ganglion metastasis were included in the research after the excision of primary focus. Was investigated the efficiency of the combination of Dacarbazine, Cisplatine and IFN as a neoadjuvant treatment. As a result of the effectuation of neoadjuvant treatment at patients with advanced local evolution was obtained an objective clinical response in 61,1% of cases and medicinal pathomorphose of I degree in 50% of cases, II degree – 33,3%, III degree – 16,7% of cases; and the period till advance was 15,6 months. The obtained results will be used to optimize the further tactics of treatment at patients with MM at different stages of process dissemination.