Our new guide, Options for Stage III Melanoma: Making the Decision That’s Right for You, is written for patients, families, and caregivers, in language all of us can understand. It’s a thorough exploration of all of the options for Stage III patients, and the many considerations of each option, including side effects, fertility issues, financial issues, and drug administration.
This month’s In Plain English article is a short summary of these options and our guide.
Stage III melanoma is melanoma that has spread from the original site to one or more nearby lymph nodes, or to the skin/tissue in between. Stage III is divided into four substages: A, B, C, and D.
Most Stage III patients will be given their diagnosis after they’ve had surgery to remove the primary tumor and after a sentinel lymph node biopsy has shown that one or more lymph nodes is positive for melanoma.
Stage III melanoma is considered high-risk—meaning it has a high likelihood of recurring or spreading. In fact, patients with Stage III melanoma have a 68% risk that their melanoma will recur within the next five years.
This high risk for recurrence is confusing to some patients: How can my melanoma spread if the primary tumor and the positive lymph nodes have been removed from my body?
The answer is that even though the surgeon removed the primary tumor and the lymph nodes, melanoma cells might have already broken away from the primary tumor or the lymph node(s) and are now elsewhere in the body. In this case, the spreading has already happened; the patient and physicians just don’t know it yet because it’s not visible nor is it causing symptoms.
That’s where adjuvant therapy comes in
Adjuvant means “helper,” and these treatments are used in addition to the primary treatment, which in this case is surgery. Adjuvant therapies are designed to eradicate potential breakaway melanoma cells.
Melanoma has had an adjuvant treatment for decades—high-dose Interferon—but it was highly toxic and did not improve survival. Now, Stage III melanoma has multiple adjuvant treatment options—and they are proven to reduce the risk of the melanoma coming back.
After the primary tumor and the positive lymph nodes are removed, Stage III patients and their medical oncologists will need to decide what to do next. There are three possible options: targeted therapy, immunotherapy, or active surveillance (no medication involved).
Before any further discussion occurs on next steps, AIM recommends that patients ask for their tumor to be tested for a marker called BRAF (pronounced “Be-Raf”). Approximately 50% of all melanoma patients have this marker, and those who do are eligible for targeted therapy as well as immunotherapy. It’s critical, therefore, that patients know whether they are BRAF positive in order to really know what their options are.
Targeted therapy works by blocking certain proteins to stop the melanoma from growing. The current targeted treatment approved for Stage III melanoma is a combination of two drugs—Tafinlar and Mekinist. Again, only those whose tumors are BRAF positive are eligible for targeted therapy.
The second option available for Stage III patients is immunotherapy. Immunotherapy uses medications that are designed to “awaken” the body’s own immune system to help fight any remaining cancer cells. There are three approved immunotherapy drugs for Stage III patients: Keytruda, Opdivo, and Yervoy, although the last is typically not used. Oncologists may recommend one over the others depending on a patient’s individual situation.
The third option for Stage III patients is active surveillance, which means monitoring the body for signs of melanoma recurrence. Patients who have a relatively low risk of recurrence and those who have had health problems and cannot tolerate the side effects of adjuvant treatment are examples of those who might choose active surveillance instead of treatment.
For many years, Stage III melanoma patients had only one available treatment—and it had no overall survival benefit. Now there are treatment options which could potentially reduce the risk of your melanoma coming back. But each of these drugs has different side effects, financial considerations, and delivery methods. If we also consider active surveillance, it means that there is a lot for Stage III patients to learn before they can make a decision on which option is best for them.
AIM is here to help! Please read AIM’s new guide called Options for Stage III Melanoma: Making the Decision That’s Right for You (see below).