Melanoma Treatment Options

Immunotherapy is one of several types of treatment considered to be standard of care for melanoma. The common types of treatment are the following:Melanoma_Table_1.jpg

  • Surgery is the removal of the melanoma and surrounding normal tissue.
  • Chemotherapy includes drugs to stop the growth of cancer cells. How it is given depends on the type and stage of the cancer.
  • Radiation therapy is the use of high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
  • Targeted therapy includes drugs or other substances to attack cancer cells, usually by targeting a specific abnormal gene or protein.
  • Immunotherapy activates the body’s immune system to enable immune cells to attack and destroy cancer cells.

The use of the body’s own immune system makes immunotherapy fundamentally different from other cancer treatments. Many immunotherapy strategies currently exist (see Table 1). Additional immunotherapies, used alone and in conjunction with other treatments, are being studied in clinical trials.

Immunotherapy depends on a functioning immune system, so it will likely be important that your patients not have any autoimmune disorders and are not taking any chronic immunosuppressive medications. After taking into consideration these and other factors, such as their overall health, type and stage of their melanoma and treatment history, one or a combination of these treatments may be recommended.

Once treatment begins, monitoring is key. More monitoring, assistance and follow-up occurs with immunotherapy than for most other treatment options. The patient will likely undergo radiographic imaging to allow the doctor to evaluate how well treatment is working by measuring the size of the tumor as treatment progresses. The side effects of immunotherapy can include what has been termed an “immune-mediated adverse event,” which mimics an autoimmune response in almost any tissue. However, if caught early, these immune-mediated adverse events can be reversed with corticosteroids and, if severe, a temporary break from immunotherapy may be indicated. You should discuss the potential side effects with your patient, and remind them that they should alert their health care team immediately if they notice warning signs.  

If immunotherapy is not suggested for the patient, reassure them that multiple methods can be used to combat cancer, and other approaches may be effective. In addition, your patient may be a candidate for a clinical trial that offers access to a leading-edge treatment that is not yet available. Discuss all of the options with your patient before treatment begins.

Words To Know

Trmt_Options_Checkpoint_Inhibitors.jpgCTLA-4 (cytotoxic T-lymphocyte-associated antigen-4) – A protein receptor found on the surface of T cells. This protein is part of the CTLA-4 checkpoint pathway, which can shut down an immune system response in its early stages. Certain cancer cells have the ability to turn on this checkpoint, which stops the immune response against the cancer cells.

Immune checkpoint pathways – The system of checks and balances in place to prevent overactivation of the immune system. Different pathways function at different stages of the immune response to help regulate the length and intensity of T cell activity; turning on an immune checkpoint typically results in shutting down the immune system response.

Interferon – A protein released by immune cells that helps regulate different immune cell activity; types of interferon include alfa, beta, gamma and lambda. Different types help regulate different functions, including prompting increased T cell activity, stimulating natural killer cells or affecting certain cell functions that influence tumor cell growth. Laboratory-made versions of the IFN-alfa protein are currently FDA-approved to treat certain types of cancer. 

Interleukin – A protein produced by cells of the immune system that helps regulate the production of certain immune cells, how they function during an immune response and their production of cytokines. The laboratory-made version of this protein, aldesleukin (Proleukin), is currently FDA-approved to treat metastatic melanoma and metastatic renal cell carcinoma (kidney cancer).

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SITC Resources

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The authors present  a case of sequential immune-related adverse events (irAEs) in a patient with metastatic melanoma treated with single-agent anti-programmed cell death-1 (PD-1) therapy, pembrolizumab. Although numerous cases of irAEs have been reported, sequential multi-organ involvement, including ...
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