• Other Treatments for Melanoma

    The primary treatment for melanoma is surgical. Although requiring further clinical trials, in some cases, biological therapy may be used in the treatment of melanoma.
    Hundreds of combination therapies are currently in trials. Advanced melanoma patients should be considered for enrollment in a trial for their own benefit as well as for the advancement of melanoma treatment. Thus far, no single investigative approach stands out as highly effective; however, they all hold promise with rare patients showing durable responses. Most treatment protocols are evaluating combinations of adjuvant therapies, hoping to achieve a synergistic effect. Ongoing research into the biology of melanoma continues to suggest new drug targets that will block tumor progression or enhance host response.
    For instance, a new drug called vemurafenib (Zelboraf) is used to treat patients with unresectable or metastatic melanoma caused by a specific gene mutation. The gene mutation, known as BRAF V600E, causes the body to make a mutated protein. This mutated protein causes skin cells to divide uncontrollably (cancer). Vemurafenib works by blocking the protein's functions. Although the drug is not a cure for advanced melanoma, it can increase a patient's survival rate.

    Biological Therapy

    Biological therapy involves using medications or substances made by the body to increase or restore the body's natural defenses against cancer. It is also called biological response modifier (BRM) therapy or immunotherapy. Examples include interferon, interleukin 2, and melanoma vaccines.
    The drugs or vaccines stimulate the body to mount a defense against the cancer. Biological therapy may be started after surgery to prevent recurrences. Side effects include chills, fever, aches, depression, and fatigue and can be a significant barrier to successful treatment for some patients.

    Stage III Patients

    Patients with stage III melanoma may benefit from adjuvant interferon therapy. It is used to prevent disease recurrence after surgery. Other therapies that may be used in this patient group include:
    • Limb perfusion—for arm or leg melanoma, a heated chemotherapy drug is infused into the limb
    • Radiation therapy —used to treat the lymph node areas
    • Clinical trials—ongoing clinical trials may be beneficial

    Stage IV Patients

    Because stage IV melanomas have spread, they are difficult to treat. Chemotherapy may be used to shrink the tumor size. High doses of interferon or interleukin-2 may be used to stop or slow tumor growth. Side effects from interleukin-2 can include flu-like symptoms and fluid build-up. Fluid build-up can be severe in some patients and require hospitalization. Other therapies may include:
    • Biochemotherapy—combined chemotherapy (temozolomide) and biological agents (interleukin-2, interferon, or both) may be used to shrink tumors and extend life
    • Clinical trials—there may be clinical trials that patients can participate in for the treatment of this disease

    Promising Therapies

    Researchers are currently studying new drugs and therapies to treat melanoma. Therapies being studied include:
    • Melanoma vaccines—researchers are studying vaccines that may help the body fight melanoma; currently only available in clinical trials
    • Tumor infiltrating lymphocytes (TILs)—special cells that show promise in shrinking tumors are being studied
    • Genetically altered T-cells—cells in the body that when altered may be able to shrink tumor cells
    • Gene therapy—researchers are studying ways to alter genes so that they fight melanoma more effectively

    References

    American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .

    Bedikian AY, Johnson MM, Warneke CL, McIntyre S, Papadopoulos N, Hwu WJ, Kim K, Hwu P. Systemic therapy for unresectable metastatic melanoma: impact of biochemotherapy on long-term survival. J Immunotoxicol . 2008 Apr;5(2):201-7.

    Detailed guide: immunotherapy. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F4%5F4X%5FImmunotherapy%5F50.asp?sitearea= . Accessed December 23, 2009.

    Eggermont AM, Robert C. New drugs in melanoma: It's a whole new world. Eur J Cancer . 2011 Sep;47(14):2150-2157.

    Hancock BW, Wheatley K, Harris S, Ives, et al. Adjuvant interferon in high-risk melanoma: the AIM HIGH Study—United Kingdom Coordinating Committee on Cancer Research randomized study of adjuvant low-dose extended-duration interferon Alfa-2a in high-risk resected malignant melanoma. J Clin Oncol . 2004;22(1):11-4;7-10.

    Hancock BW, Wheatley K, Harris S, Ives, et al. Low-dose interferon doesn't help high-risk melanoma patients [summary]. American Cancer Society website. http://www.cancer.org/docroot/NWS/content/NWS1%5F1%5F1x%5FLow-Dose%5FInterferon%5FDoesnt%5FHelp%5FHigh-Risk%5FMelanoma%5FPatients.asp . Accessed: November 18, 2004.

    Lens M. The role of vaccine therapy in the treatment of melanoma. Expert Opin Biol Ther . 2008 Mar;8(3):315-23. Review.

    Lipson EJ, Drake CG. Ipilimumab: an anti-CTLA-4 antibody for metastatic melanoma. Clin Cancer Res . 2011 Sep 7.

    Melanoma treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page5 . Accessed December 22, 2009.

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

    Stein JA, Brownell I. Treatment approaches for advanced cutaneous melanoma. J Drugs Dermatol . 2008 Feb;7(2):175-9. Review.

    Treatment of melanoma by stage. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F4%5F4X%5FTreatment%5Fof%5FMelanoma%5FSkin%5FCancer%5Fby%5FStage%5F50.asp?sitearea= . Accessed December 22, 2009.

    What’s new in melanoma research and treatment? American Cancer Society website. Availabe at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F4%5F6X%5FWhats%5Fnew%5Fin%5Fmelanoma%5Fresearch%5Fand%5Ftreatment%5F50.asp?sitearea=m . Accessed December 23, 2009.

    Zelboraf (vemurafenib) prescribing information. United States Food and Drug Administration website. Available at: http://www.accessdata.fda.gov/drugsatfda%5Fdocs/label/2011/202429s000lbl.pdf . Accessed September 27, 2011.

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