Treatment Options for Metastatic Melanoma
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. Until recently, there were only two FDA-approved drugs to treat stage 4 melanoma, neither of which offered much hope for long-term survival. Research into new treatments has brought about a renewed hope for people living with melanoma.
Some of the types of treatments used today include:
Immunotherapy uses drugs to work with your immune system to slow or stop the growth of cancer cells in some people. The most commonly used immunotherapy drugs for metastatic melanoma include Keytruda (pembrolizumab), Opdivo (nivolumab) and Yervoy (ipilimumab.)
Research combining beta-blockers with immunotherapy has shown promise. Adding these heart medications increased the effectiveness of the immunotherapy according to the study completed at the Penn State College of Medicine in Hershey.
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, which produces a protein that causes cancer cells to grow. Medications such as Zelboraf (vemurafenib), Tafinlar (dabrafenib), Mekinist (trametinib) and Cotellic (cobimetinib) are used in targeted therapy that blocks the protein. With this treatment, tumors with BRAF may shrink and slow down the progression of your cancer. These medications can help extend the life of someone with metastatic melanoma but they do not cure it. Unfortunately, no matter how long treatment lasts, the tumors usually start to grow again.
Targeted therapy using drugs such as Gleevec (imatinib) and Tasigna (nilotinib) may help treat melanomas which have changes in the C-KIT gene, according to the American Cancer Society. As with melanomas with the BRAF mutation, these treatments can extend life expectancy but they do not cure the cancer.
Chemotherapy is not normally a first-choice treatment for metastatic melanoma and is not considered to be as effective as immunotherapy. Chemotherapy works to stop cancer cells from dividing and multiplying. 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.
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 melanoma 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.