What to Know About Immunotherapy for Melanoma

Melanoma: Immunotherapy

Immunotherapy is a type of treatment that uses your body’s own immune system. It uses medicines that boost certain parts of the immune system. This helps your body fight off cancer cells. The treatments are known as biologic medicines. They help your immune cells recognize and attack the cancer cells.

Your doctor may suggest immunotherapy if one of these cases applies to you:

  • You have advanced melanoma. In this case, the goal of immunotherapy is to help shrink the tumor. You may have this treatment alone. Or you may have it along with chemotherapy. Your doctor may suggest a clinical trial of a new immunotherapy medicine that could help you.

  • You have had surgery to remove the melanoma. Immunotherapy used after surgery may help delay the amount of time before the cancer comes back.

The types of immunotherapy medicines used for melanoma include:

  • Anti-CTLA-4 therapy

  • Anti-PD-1 therapy 

  • Cytokine therapy (interferon alpha, interleukin-2)

  • Vaccine therapy

Anti-CTLA-4 therapy 

Ipilimumab is a medicine that uses an antibody to target a protein called CTLA-4. An antibody is a substance that attacks other substances in the body. The CTLA-4 protein helps block the T-cell immune response. T-cells are an important part of the immune system. CTLA-4 protein may help melanoma cells survive, so targeting it boosts the immune system to help fight melanoma. This medicine is used to treat advanced melanoma. It is given as an intravenous (IV) infusion, usually once every 3 weeks for 4 treatments.

Side effects of the medicine can sometimes be severe. In some cases the immune system may attack other parts of the body. It may attack the intestines, liver, nerves, skin, eyes, glands that make hormones, or other organs. This can lead to serious or even life-threatening symptoms. Other side effects can include:

  • Feeling tired

  • Skin rash

  • Itching 

  • Diarrhea

  • Allergic reactions during medicine infusion 

It's important to report any side effects to your doctor or nurse right away.

Anti-PD-1 therapy

Pembrolizumab is a medicine that uses an antibody to block the PD-1 protein. This helps the immune system to attack melanoma cells. This medicine is used to treat advanced melanoma. It’s given as an IV infusion every 3 weeks. 

Common side effects can include:

  • Cough

  • Feeling tired

  • Nausea

  • Skin rash

  • Itching

  • Loss of appetite

  • Constipation

  • Joint pain

  • Diarrhea

Like ipilimumab, this type of treatment can cause the immune system to attack other organs in the body. This can lead to serious side effects.

Cytokine therapy

Cytokines are proteins that trigger your immune system. These two cytokines are used to treat melanoma:

  • Interferon-alpha

  • Interleukin-2

Doctors use medicines with cytokines to boost general immunity. For example, the interleukin-2 cytokine helps the growth of certain white blood cells. These medicines are given by IV or as injections.

Side effects from cytokine therapy can be serious, and can include:

  • Fever

  • Chills

  • Aches

  • Depression

  • Low blood cell counts

  • Fatigue (severe tiredness)

  • Stomach upset

  • Vomiting

  • Diarrhea

  • Fluid buildup in the body

Some side effects are specific to certain cytokines. For example, high doses of interleukin-2 can cause low blood pressure and large amounts of fluid to build up in the body. High doses of interferon alpha can cause more severe forms of many of the side effects above, as well as effects on the heart and liver. People getting these treatments often need to be watched closely. Some people can't take the high doses needed for treatment. But side effects usually get better after the treatment is done.  

Vaccine therapy

Vaccines have not yet been approved to treat melanoma. But some vaccines are being tested.

Bacille Calmette-Guerin (BCG) is a germ related to the one that causes tuberculosis. BCG does not cause serious disease in humans, but it does make the immune system active. The BCG vaccine can work like a cytokine, boosting the entire immune system. It can be used to help treat melanoma by injecting it directly into a tumor.

Other types of vaccines that target melanoma cells are being tested in clinical trials. The most common types of vaccines are pieces of proteins called peptides, and dead cancer cells. These may be injected under the skin with other immune boosters. The theory is that they may create an immune reaction in the body to the vaccine that will also work against the cancer cells.

The side effects seen in clinical trials so far have been mild, and may include: 

  • Pain

  • Swelling

  • Redness at the injection site

Talking with your doctor

Make sure to talk with your doctor about these medicines and their affects. He or she will discuss with you the risks and benefits. You can also ask your doctor about clinical trials. You may be eligible for a clinical trial that tests a new medicine.

 
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