Chemotherapy (chemo) uses drugs that kill cancer cells. The drugs are usually injected into a vein or taken by mouth as a pill. They travel through the bloodstream to all parts of the body and attack cancer cells that have already spread beyond the skin. Because the drugs reach all areas of the body, this is called a systemic therapy.
Chemo can be used to treat advanced melanoma, but it is not often used as the first treatment since newer forms of immunotherapy and targeted drugs have become available. Chemo is usually not as effective in melanoma as it is in some other types of cancer, but it may relieve symptoms or extend survival for some patients.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each chemotherapy cycle typically lasts for a few weeks.
Several chemo drugs can be used to treat melanoma:
- Dacarbazine (also called DTIC)
- Carmustine (also known as BCNU)
Some of these drugs are given alone, while others are often combined with other drugs. It’s not clear if using combinations of drugs is more helpful than using a single drug, but it can add to the side effects.
Some studies suggest that combining chemo drugs with immunotherapy drugs such as interferon-alpha and/or interleukin-2 (see “Immunotherapy for melanoma skin cancer”) may be more effective than a single chemo drug alone, although it’s not clear if this helps people live longer. This type of treatment is also called biochemotherapy or chemoimmunotherapy.
Isolated limb perfusion: This is a type of chemotherapy sometimes used to treat advanced melanomas that are confined to an arm or leg. It is done during a surgical procedure. The blood flow of the arm or leg is separated from the rest of the body, and a high dose of chemotherapy is circulated through the limb for a short period of time. This lets doctors give high doses to the area of the tumor without exposing internal organs to these doses, which would otherwise cause severe side effects.
To do this, a tube is placed into the artery that feeds blood into the limb, and a second tube is placed into the vein that drains blood from it. The tubes are connected to a special machine in the operating room. A tourniquet is tied around the limb to make sure the chemotherapy doesn’t enter the rest of the body. A high dose of chemotherapy (usually with a drug called melphalan) is then infused into the blood in the limb through the artery. During the treatment session, the blood exits the limb through the tube in the vein, is heated by the machine (to help the chemo work better), and is then returned back to the limb through the tube in the artery. By the end of the treatment the drug is completely washed out of the limb, and the tubes are removed so that the circulation is returned to normal.
Possible side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs and the length of time they are given. These side effects may include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea or constipation
- Increased risk of infection (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
These side effects usually go away once treatment is finished. There are often ways to lessen side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about drugs to help reduce side effects.
Some chemo drugs can have other side effects. For example, some drugs can damage nerve endings (a condition called neuropathy). This can lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This usually goes away once treatment is stopped, but for some people it can last a long time. For more information, see Peripheral Neuropathy Caused by Chemotherapy.
Be sure to talk with your cancer care team about what to expect in terms of side effects. While you are getting chemo, report any side effects to your medical team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent side effects from getting worse.
To learn more, see the Chemotherapy section of our website.
Last Revised: 02/01/2016