Immunotherapy stimulates a patient's own immune system to recognize and destroy cancer cells more effectively. Several types of immunotherapy can be used in treating patients with advanced melanoma.
Ipilimumab for advanced melanoma
Ipilimumab (Yervoy) is a monoclonal antibody, a man-made version of an immune system protein. It targets CTLA-4, a protein that normally helps keep immune system cells called T cells in check. By blocking the action of CTLA-4, ipilimumab is thought to boost the immune response against melanoma cells in the body.
This drug is given as an intravenous (IV infusion), usually once every 3 weeks for 4 treatments. In patients with melanomas that can't be removed by surgery or that have spread to other parts of the body, it has been shown to help people live an average of several months longer. Doctors are now studying its use for earlier stage melanomas as well.
This drug works by basically removing the brakes off the body's immune system. This can be helpful against cancer cells, but it can also lead to serious side effects. In some cases the immune system starts to attack other parts of the body, which can cause serious problems in the intestines, liver, hormone-making glands, nerves, skin, eyes, or other organs. In some people these side effects have been fatal.
These immune-related side effects most often occur during treatment, but some have been reported up to a few months after treatment has finished. It is very important to report any new side effects to your health care team promptly. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
Cytokines for advanced melanoma
Cytokines are proteins that boost the immune system in a general way. Two man-made versions of natural cytokines, interferon-alpha and interleukin-2 (IL-2), are sometimes used in patients with melanoma. They are given as intravenous (IV) infusions, at least at first. Some patients or caregivers may be able to learn how to give injections under the skin at home. Both drugs can help shrink advanced (stage III and IV) melanomas in about 10% to 20% of patients when used alone. These drugs may also be given along with chemotherapy drugs (known as biochemotherapy) for stage IV melanoma.
Side effects of cytokine therapy may include flu-like symptoms such as fever, chills, aches, severe tiredness, drowsiness, and low blood cell counts. Interleukin-2, particularly in high doses, can cause fluid to build up in the body so that the person swells up and can feel quite sick. Because of this and other possible serious side effects, high-dose IL-2 is given only in centers that have experience with this type of treatment.
Interferon-alpha as adjuvant therapy
Patients with thicker melanomas often have cancer cells that have spread to other parts of the body. Even after all apparent cancer has been removed by surgery, some of these cells may remain. Interferon-alpha can be used as an added (adjuvant) therapy after surgery to try to prevent these cells from spreading and growing. This may delay the recurrence of melanoma, but it is not yet clear if it improves survival.
High doses must be used for the interferon to be effective. But many patients cannot tolerate the side effects of high-dose therapy. These can include fever, chills, aches, depression, severe tiredness, and effects on the heart and liver. Patients getting this drug need to be closely watched by a doctor who is experienced with this treatment.
When deciding whether to use adjuvant therapy, patients and their doctors should take into account the potential benefits and side effects of this treatment.
Bacille Calmette-Guerin (BCG) vaccine
BCG is a germ related to the one that causes tuberculosis. BCG does not cause serious disease in humans, but it does activate the immune system. The BCG vaccine works kind of like a cytokine, enhancing the entire immune system. It is not directed specifically at melanoma cells. It is sometimes used to help treat stage III melanomas by injecting it directly into tumors.
Imiquimod cream
Imiquimod (Aldara) is a drug that, when applied as a cream, stimulates a local immune response against skin cancer cells. For very early (stage 0) melanomas in sensitive areas on the face, some doctors may use imiquimod if surgery might be disfiguring. It may also be used for some melanomas that have spread along the skin. Still, not all doctors agree on whether it should be used for melanoma.
The cream is applied anywhere from once a day to 2 times a week for around 3 months. Some people may have serious skin reactions to this drug. Imiquimod is not used for more advanced melanomas.
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