Surgery

To remove the cancerous tumors or lymph nodes that have metastasized or spread to other areas of the body, if they are few in number and are causing symptoms

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Treatment Options

Treatment given in addition to a primary cancer treatment (such as surgery) is recommended for Stage IV Melanoma. These are systemic therapies that go through the bloodstream to reach and affect cancer cells throughout the body.

A)     Yervoy is a monoclonal antibody that has been approved by the Federal Drug Administration (FDA) for the treatment of unresectable or metastatic melanoma.

Purpose

• Yervoy is designed to resolve and strengthen the immune system by successfully activating T-cells, a critical component of the immune system, thereby sustaining an active immune response to fight the cancer cells.
• Studies indicate that it improves overall median survival by 4 months.

Treatment Side Effects

• Yervoy can cause powerful autoimmune reactions in which the immune system attacks normal cells in the body. 15% of patients reported autoimmune reactions that were classified as severe and some fatalities did occur.

• Common side effects resulting from Yervoy include fatigue, diarrhea, nausea and rash.  The most common severe immune-mediated adverse reactions are entercolitis, hepatitis, dermatitis (including toxic epidermal necrolysis), neuropathy, and endorcrinopathy.

B)     Zelboraf is a kinase inhibitor that has been approved by the FDA for the treatment of patients with the BRAF V600E mutation, as determined by an FDA approved test with unresectable or metastatic melanoma.

Purpose

• The BRAF protein is normally involved in regulating cell growth, but is mutated in about half of the patients with late-stage melanomas. Zelboraf works by blocking the function of the V600E-mutated BRAF protein.
• In a trial comparing Zelboraf to dacarbazine in patients with the BRAF V600E mutation, the dacarbazine group had a median survival time of 8 months, with 64% still living. Median survival time has still not been reached for patients in Zelboraf group, with 77% still living.

Treatment Side Effects

• Squamous cell carcinoma occurred in 24% of patients receiving Zelboraf.
• Photosensitivity (skin sensitivity when exposed to the light) often occurs and patients taking Zelboraf should avoid sun exposure.
• Other common effects resulting from Zelboraf include joint pain, rash, hair loss, fatigue, nausea, itching, and warts.

C)     Interleukin-2 (IL-2) is approved by the FDA for the treatment of advanced metastatic melanomas.  It appears to benefit approximately 16% of patients with disease shrinkage, of which 5% appear to derive long term durable responses.

Purpose

• These are established and experimental systemic therapies that go through the bloodstream to reach and affect cancer cells throughout the body.  Chemotherapy uses toxic drugs to destroy cancer cells. Immunotherapy uses natural and manufactured substances to help the body's immune systems fight diseases more effectively.

Treatment Side Effects

• These treatments may cause severe side effects. Please see immunotherapy for more information on Interleukin-2

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Radiation is used to the shrink the tumors in organs where surgery is not possible or may be complicated, and for relieving symptoms of cancer in the brain or bone..

Radiation therapy uses x-rays and gamma rays to kill cancer cells.

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Clinical Trials

Clinical trials are research studies to evaluate new therapies and improve cancer care. These studies are responsible for most of the advances in cancer prevention, diagnosis, and treatment. If you have melanoma, you may be eligible to participate in a clinical trial.

Several experimental treatments are currently being tested in clinical trials.

• Experimental vaccines, GM-CSF, CTLA4-blocking antibodies, interleukins, and others therapies designed to boost the immune system to fight the return of melanoma

• Chemotherapy treatments

Except for chemotherapy, all of these treatments are designed to boost the immune system. These therapies have not yet been shown to extend overall survival in any randomized, controlled, trials in any stage of melanoma and in some cases may even worsen survival rates. Scientists are constantly working to improve the efficacy of these treatments.

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