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ÖSSZEFOGLALÁS A BRAFV600E/K génmutáció a melanoma kialakulásá-ban és progressziójában is fontos pathogenetikai tényező. Az esetek felében kimutatható a tumor metasztázisban és hatásának ellensúlyozására kifejlesztett célzott molekulá- Kulcsszavak: áttétes melanoma -BRAF inhibitor -MEK inhibitor -gyógyszer mellékhatás SUMMARY An important pathogenic factor in both the development and progression of melanoma is the V600E/K mutation of BRAF, which can be found in half of metastatic tumors. It is unsurprising therefore that molecular inhibitors targeting its effect are able to offer significantly higher progression free and overall survival as compared to conventional chemotherapy in the majority of patients diagnosed with metastatic melanoma. Moreover, the combination of BRAF-and MEK inhibitor therapy has greatly improved the prognosis of patients with confirmed mutations in distant metastases, showing that optimal use of new therapeutic agents by broadening clinical expertise is an effective way of expanding the inventory of anti-melanoma agents. The management of potential adverse events related to new treatments is also improved by their widespread use and the consequent enhancement of practical knowledge related to the new agents, ultimately leading to the improvement of quality of life of patients. Key words: metastatic melanoma -BRAF inhibitor -MEK inhibitor -drug adverse eventA melanoma pathofiziológiájáról szerzett, az elmúlt év-tizedben robbanásszerűen felhalmozódott ismereteink és a modern biotechnológia lehetővé tették új típusú onkoterá-piák megjelenését, mint amilyenek a célzott molekuláris inhibitorok vagy a biológiai terápiák, és ezzel megváltoztatták a metasztatikus betegek túlélési esélyeit és átírták a korábbi kezelési irányvonalakat (1-3). A melanoma kialakulásában és progressziójában kulcsszerepet játszó génmutációk komplex módon, az intracelluláris jelátviteli folyamatok kö-zötti egyensúly megbomlását okozva vezetnek megnöve-kedett sejttúléléséhez, kórosan fokozott sejtproliferációhoz. Az egyik legfontosabb pathogenetikai lépés a MAPK (Mitogén Aktivált Protein-Kináz)-útvonal aktivitásának fokozódása (4), ami igen gyakran, a melanomás eseteknek a 160 Levelező szerző: Dr. Szabó Imre Lőrinc
ÖSSZEFOGLALÁS A BRAFV600E/K génmutáció a melanoma kialakulásá-ban és progressziójában is fontos pathogenetikai tényező. Az esetek felében kimutatható a tumor metasztázisban és hatásának ellensúlyozására kifejlesztett célzott molekulá- Kulcsszavak: áttétes melanoma -BRAF inhibitor -MEK inhibitor -gyógyszer mellékhatás SUMMARY An important pathogenic factor in both the development and progression of melanoma is the V600E/K mutation of BRAF, which can be found in half of metastatic tumors. It is unsurprising therefore that molecular inhibitors targeting its effect are able to offer significantly higher progression free and overall survival as compared to conventional chemotherapy in the majority of patients diagnosed with metastatic melanoma. Moreover, the combination of BRAF-and MEK inhibitor therapy has greatly improved the prognosis of patients with confirmed mutations in distant metastases, showing that optimal use of new therapeutic agents by broadening clinical expertise is an effective way of expanding the inventory of anti-melanoma agents. The management of potential adverse events related to new treatments is also improved by their widespread use and the consequent enhancement of practical knowledge related to the new agents, ultimately leading to the improvement of quality of life of patients. Key words: metastatic melanoma -BRAF inhibitor -MEK inhibitor -drug adverse eventA melanoma pathofiziológiájáról szerzett, az elmúlt év-tizedben robbanásszerűen felhalmozódott ismereteink és a modern biotechnológia lehetővé tették új típusú onkoterá-piák megjelenését, mint amilyenek a célzott molekuláris inhibitorok vagy a biológiai terápiák, és ezzel megváltoztatták a metasztatikus betegek túlélési esélyeit és átírták a korábbi kezelési irányvonalakat (1-3). A melanoma kialakulásában és progressziójában kulcsszerepet játszó génmutációk komplex módon, az intracelluláris jelátviteli folyamatok kö-zötti egyensúly megbomlását okozva vezetnek megnöve-kedett sejttúléléséhez, kórosan fokozott sejtproliferációhoz. Az egyik legfontosabb pathogenetikai lépés a MAPK (Mitogén Aktivált Protein-Kináz)-útvonal aktivitásának fokozódása (4), ami igen gyakran, a melanomás eseteknek a 160 Levelező szerző: Dr. Szabó Imre Lőrinc
than 48 hours, but this improved spontaneously after 3 to 4 days. No serious adverse effects stopped the treatments.Discussion | Although narrow-band UV-B phototherapy is the most widely used treatment modality for patients with vitiligo, it is associated with unnecessary UV exposure to normal skin. 3 Because a majority of patients have limited involvement of their body surface, targeted phototherapy including a 308-nm xenon chloride excimer laser (EL) has been considered the treatment of choice for localized vitiligo. 4 In this study, we observed a marked response using a 311-nm TSL to treat patients with nonsegmental vitiligo on the face and neck. The initial response was fast, and the overall efficacy of the TSL treatment was comparable to that reported for EL treatment. 5 The therapeutic mechanism of TSL would involve immune modulation and melanocyte stimulation, as in narrow-band UV-B and EL treatment. 6 The 311-nm TSL has several advantages. It does not require the periodic gas charging that is crucial for EL maintenance. In addition, the 311-nm wavelength of TSL can penetrate deeper than the 308-nm wavelength of EL. The gain-switched 311-nm TSL is a promising option for treating vitiligo. Further research is needed, including clinical trials comparing EL and TSL.
IMPORTANCE Obesity is a cancer risk factor, and bariatric surgery in patients with obesity is associated with reduced cancer risk. However, evidence of an association among obesity, bariatric surgery, and skin cancer, including melanoma, is limited.OBJECTIVE To investigate the association of bariatric surgery with skin cancer (squamous cell carcinoma and melanoma) and melanoma incidence. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized controlled trial, the Swedish Obese Subjects (SOS) study, is ongoing at 25 surgical departments and 480 primary health care centers in Sweden and was designed to examine outcomes after bariatric surgery. The study included 2007 patients with obesity who underwent bariatric surgery and 2040 contemporaneously matched controls who received conventional obesity treatment.
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