In recent years there have been major advancements in treating melanoma. The medications used to treat melanoma are changing as new formulations are being introduced into clinics.
The medications currently being used include:
However, not everyone is suitable for these drugs. Your specialist will discuss an appropriate treatment with you, and many people are entered into clinical trials (see clinical trials, below).
Some of the available medications are discussed below.
Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill the cancer. It is normally used to treat melanoma that has spread to parts of the body and is mainly given to help relieve symptoms of advanced melanoma.
Several different chemotherapy drugs are used to treat melanoma and are occasionally given in combination. The drugs most commonly used for melanoma are dacarbazine and temozolomide. However, many different types of drugs can be used. Your specialist can discuss with you which drugs are the most suitable.
Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight. Dacarbazine is given through a drip and temozolomide is given in tablet-form. Chemotherapy sessions are usually given once every three to four weeks, with gaps between treatment intended to give your body and blood time to recover.
The main side effects of chemotherapy are caused by their influence on the rest of the body. Side effects include infection, nausea and vomiting, tiredness and sore mouth. Many side effects can be prevented or controlled with medicines that your doctor can prescribe.
Electrochemotherapy is a possible treatment for melanoma. It may be considered if:
- surgery isn't suitable or hasn't worked
- radiotherapy and chemotherapy haven't worked
The procedure involves giving chemotherapy intravenously (directly into a vein). Short, powerful pulses of electricity are then directed to the tumour using electrodes.
These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour. The procedure is usually carried out using general anaesthetic (where you're asleep) but some people may be able to have local anaesthetic (where you're awake but the area is numbed).
Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers.
It usually takes around six weeks for results to appear and the procedure usually needs to be repeated.
Your specialist can give you more detailed information about this treatment option.
Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin.
Immunotherapy uses drugs (often derived from substances that occur naturally in the body) that encourage your body's immune system to work against the melanoma. Two such treatments in regular use for melanoma are interferon-alpha and interleukin-2. Both are given as an injection (into the blood, under the skin, or into lumps of melanoma).
Side effects include flu-like symptoms, such as chills, a high temperature, joint pain and fatigue.
There is ongoing research into producing a vaccine for melanoma, either to treat advanced melanoma or to be used after surgery in patients who have a high risk of the melanoma coming back.
Vaccines are designed to focus the body’s immune system so it recognises the melanoma and can work against it. Vaccines are usually given as an injection under the skin every few weeks, often over a period of months.
As more research is needed into vaccines, they are only given as part of a clinical trial.
Our immune systems make antibodies all the time, usually as a way of controlling infections. They are substances that recognise something which doesn’t belong in the body and help to destroy it. Antibodies can be produced in the laboratory and can be made to recognise and lock onto specific targets, either in the cancer or in specific parts of the body.
Antibodies produced in the laboratory are usually called monoclonal antibodies.
Ipilimumab is a monoclonal antibody that has been licensed for use in the UK since 2011. It works like an accelerator for the immune system, allowing the body to work against all sorts of conditions, including cancer.
In December 2012, NICE recommended ipilimumab as a possible treatment for people with previously treated advanced melanoma that has spread or cannot be surgically removed.
Signalling inhibitors are drugs that work by disrupting the messages (signals) a cancer uses to co-ordinate its growth. There are hundreds of these signals, and it is difficult to know which ones need to be blocked. Most of the signals have short, technical names. Two that are of current interest in relation to melanoma are BRAF and MEK.
There are drugs available that can interfere with these signals, but most are currently only widely available as part of clinical trials.
NICE recommends a signalling inhibitor called vemurafenib as a possible treatment for melanoma that has spread or cannot be surgically removed.
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