Adjuvant Therapy for Melanoma: Questions to Ask Your Doctor

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When you’re diagnosed with a higher-stage melanoma — such as stage 3 or stage 4 — your oncologist may suggest use of adjuvant therapy. Like any treatment plan suggestion, this should prompt an in-depth conversation with your care team, suggests Collin Vu, M.D., medical oncologist and hematologist at MemorialCare Cancer Institute at Orange Coast Medical Center in California. He told HealthCentral by phone that adjuvant therapy may not have the long track record of other melanoma treatments, but that it’s an exciting development.


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“These therapies are highly effective, and mark a drastic, positive change for those with advanced melanoma,” Dr. Vu says. “If you’re a patient, you shouldn’t be nervous about this treatment option. But it’s good to have a long talk with your doctor to understand everything that’s involved.”

If you or a loved one is about to have that conversation, here are some questions to consider:


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Am I a good candidate for adjuvant therapy?

This type of therapy is used for specific patients with advanced melanoma who have had surgery to remove their tumors, says Dr. Vu. If you’re stage 1 or stage 2, you likely don’t require additional therapy, he said. You may also not be a candidate if your cancer has metastasized to other areas of your body, he adds, since that may require a different type of treatment.


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What types of adjuvant therapy will we be considering?

There are various types of therapy, but the two major ones you’ll likely be looking at for advanced melanoma are immunotherapy and targeted therapy, says Dr. Vu. “It turns out that melanoma is very responsive to immune system changes,” he notes. “That means stimulating the immune system to destroy cancer cells with these therapies works very well.”


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How do we choose one adjuvant therapy over the other?

At this point, the therapies are too new to determine which one is considered best for someone with advanced melanoma, Dr. Vu says. But, he adds, knowing whether to use targeted therapy depends on genetic abnormalities that affect the cancer pathway. If you’re tested for those gene differences and don’t have them, you’ll be better off with immunotherapy instead of targeted therapy.


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What are the side effects of adjuvant therapy for melanoma?

Knowing the potential side effects is important, even if they might be considered minor, says Dr. Vu. Talk with your doctor about everything you might experience, from the common to the rare, he advises. For example, diarrhea is a very common reaction to these therapies, while hormonal dysfunction is much less seen but still a risk. “Talking about side effects helps you understand what your experience might be going forward,” says Dr. Vu.


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How long does this treatment take?

Your adjuvant therapy will depend on your specific medical situation, Dr. Vu says, but most likely, you’ll be on this treatment for about a year. He suggests asking your oncologist about what type of checkups will be necessary in that timeframe, including what tests will need to be done, so you know what to expect.


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How will I be taking the medication?

Targeted therapy is usually delivered orally, while immunotherapy drugs are often given via an IV. That’s helpful to know, Dr. Vu says, since the former can be taken at home, and the latter will require regular visits to an infusion center. Talk to your doctor about medication schedules, he advises, and also whether side effects or dosage will change during the course of treatment.


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How can I know if the adjuvant therapy is working?

Adjuvant therapies for melanoma are used to significantly reduce the risk that melanoma will return, says Dr. Vu. “The way you know that the treatment is working is that the cancer doesn’t come back,” he notes. “This is therapy that’s about prevention, not about reducing tumor size or treating active cancer cells.”


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Is it a concern that this is a newer therapy?

Patients can sometimes feel nervous with treatments that have only been used for a few years, because there’s no data on long-term usage, notes Dr. Vu. However, he emphasizes that much like any approved therapy, extensive testing and trials have been done already. If you feel hesitant, express those concerns to your oncologist, and any other hesitation you might have.


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What results have you seen with other patients?

Although doctors can’t discuss specific cases due to privacy regulations, they can speak in general about results they’ve seen. This type of conversation can be helpful, Dr. Vu says, because it’s often useful to hear real-life stories as a way to know what to expect.


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Is adjuvant therapy considered a cure for my melanoma?

“No one has a crystal ball when it comes to recurrence of cancer,” says Dr. Vu. “But we can say that a significant portion of people using this type of therapy have not had their melanoma come back.”

As with the other questions on this list, talking with your doctor about this therapy should help you feel like you know what’s ahead to some degree, and that can go a long way toward feeling optimistic about the treatment, Dr. Vu says.