진행성 악성 흑색종(Malignant Melanoma)의 새로운 내과적 치료
New Systemic Treatment for Malignant Melanoma
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현재까지의 결과를 종합해 볼 때 악성 흑색종의 치료는 근치적 절제이다. 수술적 치료가 불가능한 전이성 흑색종의 경우 최근 다양한 표적치료제 및 면역요법의 임상 결과가 발표되면서 생존율의 향상을 가져왔다. 최근의 분자생물학의 발전으로 악성 흑색종을 분자생물학적․유전적 특성에 따라 세분화하여 이에 따른 적절한 표적치료제의 사용으로 이제까지 예후가 아주 불량한 것으로 여겨왔던 악성 흑색종에서도 환자의 생명연장을 기대할 수 있게 되었다. 다만 국내에서는 dacarbazine 단독 또는 병합요법이 여전히 1차 약제로 규정하고 있으며 새로이 개발된 표적치료제가 국내에 시판되어 있지 않거나 고가이어서 임상에서 사용하는 데 여전히 제한점이 많이 있다. 최근의 대규모 3상 임상시험 결과를 바탕으로 한 국내 보험 규정의 수정과 의료행정을 담당하는 정부부처와의 긴밀한 토의를 통하여 가능한 빠른 시일 안에 흑색종 환자들이 치료의 혜택을 받을 수 있도록 하는 노력이 절실히 필요하다.
Abstract
Although early stage melanoma can be cured by complete resection, the prognosis of the patients with unresectable or metastatic disease is dismal with the overall survival less than 1 year based on resistance to chemotherapeutic agents. Dacarbazine as either a single agent or in combination regimens with other cytotoxic agents has still remained as a standard in Korea for more than three decades although it has not been associated with any survival benefit for metastatic melanoma. Recently, according to advances in molecular science and immunology, the mechanisms responsible for biology of melanoma have been elucidated and then new agents targeting these mechanisms have been introduced leading survival benefit in patients with metastatic melanoma. Unfortunately, however, it is still difficult to give those new drugs to these patients in Korea because of the health insurance guidelines still defining dacarbazine as a front line regimen and moreover high cost and unavailability in the practice. Therefore, amendment of current guidelines and an in-depth discussion with the government for the earlier use of the novel drugs are strongly needed for the patients’ sake.
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