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Melanoma Treatment: Stage IV
Old Therapies
Although chemotherapy in very few instances produces dramatic regression of disseminated melanoma, it only rarely results in long-term survival. Indeed, in a recent review of chemotherapy for cancer in advanced stages, melanoma patients were classed with those who could expect only "minor response—no demonstrable prolongation of survival" from chemotherapy. Another option that is an older therapy includes immunological hormones called cytokines, such as IL2 also called Interleukin. In a few patients, disease may actually melt away and have a sustained response. But the rate of response is in less than 10% of patients with much associated toxicity. The role of IL2 intermixed with Yervoy and other therapies may hold promise in the future although that remains unproven.
NEW Therapies
New therapies that stimulate the immune system to attack melanoma may offer effective therapy in the future. For example, anti-CTLA 4, or Ipilimumab, now approved by the FDA as Yervoy, is a human monoclonal antibody which targets certain cells in the body by attaching themselves to those molecules. This causes some cancer cells to die and makes others more likely to be killed by other therapies. Ipilimumab is a more general immune booster. It blocks a protein called CTLA-4 that acts as a brake on T cells, the soldiers of the immune system. Yervoy is usually administered through three infusions over a 4 months. Response can be slow but also be durable. Approximately 15 to 20% of melanoma patients respond to Yervoy. A molecure akin to Yervoy is Anti-PD1 and also anti PDL, both still early in clinical trial but is said to be highly promising and less toxic than Yervoy.
New Targeted Therapies for Melanoma:
BRAF and MEK
When you are diagnosed with melanoma your oncologist may bring up the term BRAF or
MEK with you. And Zelboraf (aka Plx 4032, or Vemurafenib,) a BRAF
inhibitor was approved for prescription by the FDA in the fall of 2011.
Approximately, 50% of melanoma patients tumor tissue tests positive for this genetic
mutation. A mutated BRAF accelerates tumor cell growth and this change can increase the
growth and spread of cancer cells.Therefore, these BRAF drugs target the cancer- causing mutation
in melanoma. The BRAF oral medication should not be given to those without the mutation as it
could actually accelerate tumor progression. BRAF mutations usually arise from sun exposed skin and
rarely from those melanomas such as mucosal, ocular or acral whose origin is not clearly known
yet.In order for these therapies to work most effectively, you need first to be BRAF
positive.Your tumor tissue must test positive for the BRAF gene before you can be prescribed
this oral agent. MEK on the other hand is a bit different with less information available on
its performance. It does appear that you can be Braf Negative and respond to the MEK drugs.
BRAF and MEK have been combined in clinical trials but results are not available yet.
There are many clinical trials to explore, with new therapies arising every day.
Our helpline, 866-463-6663 or email
cpoole@melanomainternational.org, to find
help matching you to a treatment trial if that is what you choose to do. Also be sure to look
at the ongoing discussions of current therapies at
www.melanomaforum.org
. You can also go to:
www.clinicaltrials.gov
and put melanoma in the search for a list of trials.
SOURCE: Poole, Catherine, Guerry, DuPont, M.D., Melanoma Prevention Detection and
Treatment, New Haven: Yale University Press, 2005.
GENERAL DISCLAIMER
The MIF Website is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through this Website should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.
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© 2008 Melanoma International Foundation. All Rights Reserved.
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The MIF Website is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through this Website should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.