Biological therapies for advanced melanoma
There have been a number of new developments in the use of biological therapies for the treatment of advanced melanoma.
Biological therapies are substances that target the differences between cancer cells and normal cells (for this reason they are often called targeted therapies). They have been shown to help specific groups of people with melanoma.
There are different types of biological therapies that may be used to treat advanced melanoma. These include ipilimumab, vemurafenib and interferon.
Ipilimumab (Yervoy™) is a new drug that triggers the body's immune system to attack cancer cells. It has been shown to help shrink or slow the growth of advanced melanoma for a period of time.
Ipilimumab can be prescribed in the UK for people with advanced melanoma who have already had some other form of drug treatment, such as chemotherapy. However, it was only licensed in July 2011 and hasn't yet been recommended for use on the NHS by the National Institute for Health and Clinical Excellence (NICE) in England and Wales, or by the Scottish Medicines Consortium (SMC) in Scotland. This means that ipilimumab may not be generally available on the NHS. If you live in England, though, your doctor can apply for you to have treatment with ipilimumab funded through the Cancer Drugs Fund. This is a fund for cancer drugs that aren't routinely available on the NHS.
Each infusion of ipilimumab is given over approximately 90 minutes. The infusion is repeated every three weeks. Up to four treatments are given to begin with.
Some of the more common side effects of ipilimumab include fatigue, diarrhoea, skin rashes and itching. Ipilimumab can cause inflammation in different parts of the body, such as the bowel, liver, skin and eyes. Occasionally this may result in more serious side effects, including persistent diarrhoea, changes in the way the liver works, skin rashes and blisters affecting several areas of the body, and blurred or double vision.
It's important that these side effects are reported straight away to the medical team or your clinical nurse specialist.
If these side effects occur, you will usually be prescribed steroid tablets to help reduce the inflammation caused by the ipilimumab. Depending on the severity of the side effects, treatment occasionally needs to be delayed or sometimes stopped.
Your doctor or nurse will give you more detailed information about ipilimumab and its side effects.
Vemurafenib is a new drug that has recently been shown to delay the growth of advanced melanoma. It only works in people who have a specific change (mutation) in a gene called BRAF, which helps regulate a protein involved in cell growth. Doctors can identify if you have the BRAF gene mutation, by testing a piece of melanoma tissue that has already been removed during tests to diagnose your melanoma or during surgery. About 40–50% of people with advanced melanoma (4–5 in 10) have a mutation in the BRAF gene. Vemurafenib is not effective in people who don't have the BRAF gene mutation.
It's expected that vemurafenib will be licensed in Europe in early 2012 for people with advanced melanoma who have the BRAFgene mutation. The drug will then need to be approved for use on the NHS by the National Institute for Health and Clinical Excellence (NICE) in England and Wales, and by the Scottish Medicines Consortium (SMC) for use in Scotland. This process can take some time. However, if you live in England, once vemurafenib is licensed, your doctors may be able to apply for treatment to be funded through the Cancer Drugs Fund.
Vemurafenib is given as a tablet, which is taken daily by mouth. Common side effects include a rash, increased sun sensitivity, joint pain, hair loss and tiredness. Your doctors will let you know if vemurafenib is a suitable treatment for you.
Interferon is sometimes offered as a treatment for advanced melanoma. Interferon is not a new drug. It's produced naturally by the body to fight infection, but is made in laboratories for use as a cancer treatment. It's sometimes called immunotherapy treatment, because it can help to stimulate the body's immune system. Interferon aims to help control the cancer and improve your symptoms by stimulating the body's own cells to attack the melanoma cells.
It's usually given as an injection just under the skin (subcutaneously), although it can also be given through a drip (infusion). Your specialist doctor or nurse will explain how often it will be given to you and for how long.
Interferon can cause flu-like symptoms. These include chills, fever, headaches, a temperature, tiredness and pain in your joints and muscles. It can also temporarily reduce the number of normal cells in your blood, especially in the first month. These side effects can become less troublesome after a short while and will go away once your treatment ends.
Other biological therapies
Back to top
Other new biological therapies that block some of the enzymes involved in cell growth, as well as other cancer vaccines (for example, MAGE-A3 vaccine, OncoVEX GM-CSF), are being researched as treatments for advanced melanoma. If there are clinical trials testing these or other drugs, your hospital team will give you more information about them. We have more information about clinical trials.
Contraception and fertility
Back to top
It's not advisable to become pregnant or father a child while having chemotherapy or biological therapies, because the drugs may harm the developing baby. For this reason, your doctor will advise you to use a reliable method of contraception (usually barrier methods such as condoms or the cap) throughout your treatment and for a few months afterwards. You can discuss this with your doctor or nurse.
Your ability to become pregnant or father a child may be affected by chemotherapy or biological therapies. It's important to discuss fertility with your doctor or nurse before starting treatment.