Several new treatment options for metastatic melanoma are available. These new therapies are allowing some patients to live longer. Newer treatment options, as well as those being studied in clinical trials, are changing the way the disease is managed.
“There are so many new treatment options for people with metastatic melanoma that much of the information available is historical. There is so much more reason to be optimistic now, patients can do very well.” – Michael Postow, MD, Memorial Sloan-Kettering Cancer Center
Treatment Options for Metastatic Melanoma
Treatment for metastatic melanoma tends to fall into three categories:
- Local therapies -- include surgery and radiation that are limited to the tumor
- Systemic therapies -- medications given by mouth or in a vein that travel through the bloodstream to kill the cancer cells
- Palliative care -- various drug and non-drug therapies that are recommended to help you feel better
In some patients with metastatic disease, surgery
can be used to remove cancer tumors or lymph nodes, especially if they are causing symptoms.
uses high-energy X-rays to kill cancer cells. With advanced disease, radiation is used mostly to help alleviate symptoms from the cancer. It is also often used to treat metastases to the brain.
This treatment activates or triggers the immune system to recognize and fight cancer cells. These include:
- Ipilimumab (Yervoy®)
- Proleukin (aldesleukin, commonly known as high dose interleukin-2)
- Studies are investigating adoptive cell therapies that select and make immune cells to fight cancer and antibodies against Programmed death-1 receptor axis, among others
are designed to target specific proteins or stop genetic mutations that can promote cancer.
Roughly half of patients with melanoma have a mutated or abnormally activated BRAF gene, which actually signals the cancer cells to grow.
- Vemurafenib (Zelboraf®) and Dabrafenib (Tafinlar®) are drugs that can shut down the abnormal BRAF protein (produced when the BRAF gene is abnormally activated)
- Trametinib (Mekinist™) blocks a different protein called MEK. This protein is in the same family as the BRAF protein.
- Studies are also looking at combining two or more different targeted therapies
Some patients don’t respond right away, so you may need to be patient.
Some patients may benefit from chemotherapy
. Chemotherapy can be given by mouth or through a vein (intravenously).
Chemotherapy drugs most often used for metastatic melanoma include:
- Dacarbazine (DTIC-Dome®) – given into a vein
- Temozolomide (TEMODAR®) - given as a pill, but may not be covered by health insurance because it is very similar to dacarbazine (CSC’s free booklet, Coping with the Cost of Care, has useful information.)
- Combination chemotherapy
Palliative care is a critical part of cancer care, regardless of what type of treatment you are getting. It can help address physical symptoms (for example, pain, fatigue, appetite changes) and emotional stress, depression, and anxiety, which often come with having cancer.
may offer patients access to the most promising therapies for metastatic disease. These studies may test new ways to use or combine drugs or techniques that are already approved or investigate novel therapies.
Ask your doctor if a clinical trial would be suitable for you either locally or elsewhere. They are available as a first treatment, and may be the best option for some patients.
Patients who respond to the newer therapies are living longer. But every patient is different. For some patients with advanced disease, radiation or surgery may be options; it depends on location and extent of the tumor.
With many of these therapies, the cancer cells eventually learn to outsmart the medication, so it’s important to know what other treatments are available or under study.
Ongoing monitoring of your disease and regular doctor’s visits will be part of any treatment plan. Be sure to keep follow up appointments and take all medications as prescribed.
Questions to Ask
- Who do you recommend for a second opinion?
- Which treatment(s) do you recommend and why?
- Am I eligible for a clinical trial here or elsewhere?
- What will this treatment mean for my day-to-day life?
- What kind of side effects might I experience, for how long, and how can I manage them?
- How do I know if a treatment is working?
- What should my family and friends expect?
- Has my melanoma been tested for BRAF or other abnormal genes?
- Can my pain be better controlled?
- What else can I do to stay as healthy as possible?
- What other resources are available to me both in and outside the hospital? (for example, a patient advocate, social worker, nutritionist or counselor)
Take Note Tip: Remember each case of melanoma is its own story, especially as it can affect people in different ways depending on where it spreads. The disease doesn’t follow an exact pattern. What works for one person may not work for you.