Understanding the Latest Advancements in Melanoma Treatment

Skin cancer that spreads to other parts of the body and can be fatal is called melanoma. Strong medications are used in chemotherapy to kill cancer cells and stop them from increasing. It may be given by injection into a vein (intravenous treatment) or by mouth.

Another new way to treat advanced melanoma is through immunotherapy. Immune checkpoint inhibitors like pembrolizumab and nivolumab have significantly increased survival rates for patients with metastatic melanoma.

Chemotherapy

Chemotherapy involves a combination of drugs that target cancer cells, killing them or preventing their growth. Your medical oncologist, a specialist who oversees drug therapies, will plan your chemotherapy treatments.

You may receive the drugs orally (pills), through a soft, thin tube called a catheter placed in a large vein in your chest area (intravenous or IV), or into the cerebrospinal fluid surrounding your spinal cord via a port placed during surgery (intrathecal). You can also get topical or oral chemotherapy through creams that you rub onto the skin.

If your chemotherapy kills all of the cancer cells, you might not be able to detect any more on scans or with other tests. It is called a complete response. If some cancer cells persist, your treatment may shrink them to the point where surgery or radiation therapy can be used to remove them. It is called a partial response. You can continue receiving these drugs to maintain a complete response or as maintenance therapy.

Surgery

Surgical removal is the most common melanoma treatment Memphis. If the cancer has spread, chemotherapy or immunotherapy may also be used.

In a trial led by a program, combining the anti-PD-1 drug relatlimab with another immunotherapy called nivolumab (now FDA-approved under the brand name Opdualag) significantly improved how long people lived with advanced melanoma that hadn’t been removed surgically or spread. The results of this study have influenced standard clinical practice.

Some melanomas have mutations in the BRAF gene, which cause them to grow faster than normal cells. These melanomas can be treated with medicines that block a protein that fuels the growth of these abnormal cells, such as a combination of Yervoy (ipilimumab) and pembrolizumab.

Tebentafusp has been approved to treat metastatic uveal melanoma in the eye. This therapy uses a bispecific fusion protein that allows immune T cells to recognize and target uveal melanoma cells. Researchers are examining TIL treatment for other types of cancer and studying ways to improve its effectiveness.

Radiation Therapy

Radiation therapy is used to treat melanoma when it has spread beyond the primary tumor site. In patients with metastatic melanoma, radiation can reduce the size of the tumor and lessen symptoms such as pain, nausea, or headaches. It can also be used to prevent further tumor growth.

Although historically, melanoma was thought to be a radioresistant tumor due to broad shoulders in the cell survival curves, recent advances have shown that melanoma is highly sensitive to radiation, even at low doses. Additionally, stereotactic body radiation therapy (SBRT) is an effective and non-invasive treatment option for both cutaneous and mucosal melanomas.

Immunotherapy

Immunotherapies, which boost the immune system, improve survival for many people with melanoma. These drugs block proteins that suppress the body’s immune system, such as PD-1 or CTLA-4. 

Some patients with melanoma that have spread or can’t be removed with surgery have mutations in the BRAF gene. These patients may respond to a combination of targeted therapy and the PD-1 checkpoint inhibitors vemurafenib and dabrafenib.

Other approaches to treating melanoma include oncolytic virus therapy, in which doctors use modified versions of viruses that cause cold sores to attack and destroy the cancer cells inside the tumor. Clinical trials of new combinations of immunotherapy and other treatments are underway. These trials investigate drugs that target different aspects of the immune system, such as TIM3 inhibitors, LAG3 inhibitors, OX40 agonists, and GITR agonists.