Chemotherapy for Melanoma Skin Cancer

Chemotherapy (chemo) is treatment with drugs that kill cancer cells. The drugs are usually given IV (into a vein) or taken by mouth as a pill. Chemo is sometimes used to treat advanced melanoma.

When might chemotherapy be used for melanoma?

Chemo might be used to treat advanced melanoma after other treatments have been tried. It’s rarely used as the first treatment because newer forms of immunotherapy and targeted drugs are typically more effective. Chemo can sometimes shrink tumors or stop their growth for a time, although it’s not clear whether it can help people live longer.

Which chemo drugs are used to treat melanoma?

Several chemo drugs can be used to treat melanoma, including:

• Dacarbazine (DTIC)
• Temozolomide
• Nab-paclitaxel
• Paclitaxel
• Cisplatin
• Carboplatin

Some of these drugs are given alone, while others are more often combined, such as carboplatin and paclitaxel. It’s not clear whether using combinations of drugs is more helpful than using a single drug, but it can add to the side effects.

Doctors often give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks.

How is chemotherapy given?

Chemo to treat melanoma can be given in different ways.

Systemic chemo for advanced melanoma

For melanoma that has spread to other parts of the body, chemo is usually given as an IV infusion. Some chemo drugs, such as temozolomide, can be taken by mouth as capsules.

Isolated limb perfusion (ILP) and isolated limb infusion (ILI) for melanoma on an arm or leg

These approaches for giving chemo are sometimes used to treat melanoma on an arm or leg that can’t be removed with surgery. They are being used less often now that other treatments such as immunotherapy and targeted drugs have become available. But they might still be an option if these treatments have already been tried or can’t be used for some reason.

How it works

These approaches keep the chemo in the limb and limit its reach to other parts of the body, where it could cause more side effects. This 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 chemo is circulated through the limb for a short time. This lets doctors give high doses to the area of the tumor without exposing other parts of the body to these high doses.

How it’s done

A tourniquet is tied around the limb to help limit the chemo entering the rest of the body. 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.

• For ILP, the artery and vein are first surgically separated from the circulation to the rest of the body. Then they are hooked up to tubes going to a special machine in the operating room.
• For ILI, long tubes (catheters) are inserted through the skin and into the artery and vein. This method is less complex and takes less time, and it might not require general anesthesia (where you are in a deep sleep).

Next, chemo, usually with a drug called melphalan, is infused into the blood in the limb through the artery. This is done by machine in ILP and by using a syringe in ILI.

During the treatment, the blood exits the limb through the tube in the vein, the chemo is added, and then the blood is returned to the limb through the tube in the artery. During ILP, the drug can also be heated by the machine to help the chemo work better.

By the end of the treatment, the drug is washed out of the limb. The tubes are removed, and for ILP, the blood vessels are stitched back together so that the circulation is returned to normal.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are used. The side effects of chemo can 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

Some chemo drugs can have other side effects. For example, some drugs can damage nerves and cause peripheral neuropathy. This occurs mainly in the hands and feet and causes symptoms such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness.. It usually goes away once treatment is stopped, but for some people it can last a long time.

Managing side effects

Most side effects usually go away once treatment is finished. Be sure to talk with your cancer care team about what to expect.

While you are getting chemo, report any side effects to your medical team so that they can be treated promptly. There are often ways to lessen side effects. For example, drugs can help prevent or reduce nausea and vomiting.

In some cases, the doses of chemo might need to be reduced or treatment might need to be delayed or stopped to prevent side effects from getting worse.