Metastatic melanoma is the most dangerous form of skin cancer. Early detection is important in treating it; once it spreads to other areas of the body, treatment options become very limited. Some of the types of treatments used are:
Immunotherapy uses drugs to work with your immune system to slow or stop the growth of cancer cells. There are two main types of drugs used in this type of treatment: interleukin-2 and ipilimumab.
Interleukin-2, when used in high doses stops the growth of cancer cells in some patients. For some, the cancer disappeared for as much as 5 years. This treatment usually requires hospitalization. The drugs are administered directly into your vein, 3 times per day for 5 days. This regime is repeated twice a month.
Side effects from interleukin-2 include low blood pressure, irregular heart rates, fluid in the lungs and fever. Because of the severe side effects, this treatment is usually used for younger, otherwise, healthy patients.
Ipilimumab works to stimulate the body’s immune system to help fight and destroy the cancer. It helps to decrease the spread of the cancer and prolong life. You receive this medication once every 3 weeks, for a total of four doses. In some cases, however, this medication causes your body to destroy its own tissues, which can cause severe problems, such as diarrhea, bleeding of the intestines, hepatitis, inflammation of the pituitary, thyroid or adrenal glands.
When receiving immunotherapy, it is important to stay in close contact with your doctor and let him or her know of any side-effects you are experiencing, no matter how mild. Based on the side-effects, your doctor will determine if you should continue or stop this treatment.
Approximately one-half of metastatic melanomas have a mutation called BRAF. This mutation produces a protein that causes cancer cells to grow. A medication called Vemurafenib is a BRAF inhibitor - it blocks the protein. With this treatment, tumors with BRAF may shrink and slow down the progression of your cancer. Unfortunately, no matter how long treatment lasts, the tumors do start to grow again.
Side effects of vermurafenib include increased skin photosensitivity, joint pain, fatigue and growth of non-melanoma skin cancers.
Chemotherapy is not normally a first-choice treatment for metastatic melanoma, and is not considered to be as effective as immunotherapy. It is sometimes used when immunotherapy or BRAF inhibitors are not working. There are two types of chemotherapy: single agent and combination.
Single agent chemotherapy includes only one drug and may help in patients where the disease has not progressed rapidly or has only spread to limited areas in the body. Combination chemotherapy usually includes 4 different drugs" DTIC, cisplatin, BCNU and tamoxifen. Chemotherapy works to stop cancer cells from dividing and multiplying.
In the early stages of melanoma, when it has spread to only a limited number of sites in the body, surgery may be an alternative, however, because it spreads rapidly, surgery is not always a viable option. Surgery to remove a tumor may also help if there is a specific tumor causing pain.
Research for more effective treatments is ongoing and desperately needed. Clinical trials are ongoing and as we learn more about this disease and how it progresses, more effective treatments will hopefully emerge.
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"Therapy for Metastatic Melanoma: The Past, Present and Future," 2012, Laura Finn, Svetomir M. Markovic, Richard W. Joseph, BMC Medicine
"Treatment of Metastatic Melanoma: A New World Opens," Date Unknown, Elizabeth C. Smyth M.D. and Richard D. Carvajal, M.D. , Skin Cancer Foundation
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