Adjuvant treatments for melanoma
After surgery to remove a melanoma, other treatments are usually only needed if there’s a high risk your melanoma may come back.
The risk of melanoma coming back depends on its stage when you were diagnosed. Your doctor will be able to explain more about the stage of your cancer and whether there’s a risk it may come back. They may refer you to a cancer specialist at a cancer centre to discuss possible treatment. Adjuvant treatments are usually given within a clinical research trial.
The aim of adjuvant treatment is to reduce the risk of the cancer coming back. At present, no adjuvant treatments have been proven to help people with melanoma live for longer. However, doctors are continuing to look at new drugs to see how helpful they might be.
Your specialist will be able to tell you about any research trials that are in progress and whether a particular trial is suitable for you. These trials aim to find effective adjuvant treatments for melanoma.
Drug treatments known as biological therapies are used as adjuvant treatments for melanoma. They are substances that target the differences between cancer cells and normal cells. For this reason they are often called targeted therapies.
We’ve listed some of the different biological therapies that may be used in a trial below. These are either currently being tested as adjuvant treatments for melanoma or are likely to be tested in the near future. Your specialists will be able to give you more detailed information about current drug trials and whether a specific trial is suitable for you.
Monoclonal antibodies recognise and lock onto specific proteins (receptors) on the surface of cells. This helps the body’s immune system recognise the cancer cells and destroy them.
Ipilimumab, which is also known as Yervoy™ is a new monoclonal antibody drug. It’s already been shown to help control advanced melanoma for a period of time. However, it’s not known yet whether ipilimumab can also help delay or stop a melanoma coming back after surgery, so doctors still need to research this.
One international study (NCT00636168) is currently underway to help doctors find out if ipilimumab is an effective adjuvant treatment for people with stage 3 melanoma. This is melanoma that has spread to nearby lymph nodes. Your cancer specialist will let you know if there’s a trial testing ipilimumab near where you live and if it’s suitable for you.
Ipilimumab is given as a drip (infusion) into a vein (intravenously). Each infusion is given over about 90 minutes. The infusion is repeated every three weeks for up to four treatments. Some of the side effects of ipilimumab include fatigue, diarrhoea and skin changes. Rarely, some people may have side effects due to inflammation of various parts of the body, such as the bowels, liver, skin and eyes. Your cancer specialist will give you detailed information about the drug and its side effects.
Avastin® is a monoclonal antibody drug that recognises and ‘locks’ onto a protein (known as a receptor) found on the surface of some cancer cells. It blocks the receptor from connecting with a different protein, called vascular endothelial growth factor (VEGF). VEGF helps cancer cells develop a new blood supply. Cancers need a blood supply to grow and, by interfering with this process, Avastin can help the cancer stop growing. Drugs that work in this way are sometimes called anti-angiogenesis drugs.
Avastin is already used to treat some other cancers. A study, which is recruiting patients until July 2012, is trying to find out if taking Avastin after surgery helps stop or delay a melanoma coming back. Avastin is given as a drip into a vein (intravenous infusion). If you’re having Avastin, it’ll probably be given every three weeks for about a year. Some of the side effects of Avastin include high blood pressure, slower healing of wounds and circulation problems (such as a small increase in the risk of a blood clot).
Cancer growth inhibitors
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In order to grow and divide, cancer cells ‘communicate’ with each other using chemical signals. Cancer growth inhibitors are drugs that interfere with this process and so affect the cancer’s ability to develop.
Vemurafenib is a new cancer growth inhibitor (known as a BRAF inhibitor) that has recently been found to shrink or slow the growth of advanced melanoma. It only works for people with melanoma who have a specific change (mutation) in a gene. This gene normally helps regulate a protein that’s involved in cell growth. This drug may also be an effective adjuvant treatment to help stop or delay melanoma coming back after surgery in people who have this gene mutation. However, doctors don’t know this yet without carrying out research trials.
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 hospital team will let you know if there are trials testing vemurafenib as an adjuvant treatment and whether they are suitable for you.
Other new cancer growth inhibitors
Other new cancer growth inhibitors, known as MEK inhibitors, block some of the enzymes involved in cell growth. At the moment these are being researched as treatments for advanced melanoma. But in the future these drugs are likely to be tested in adjuvant drug trials to see if they stop or delay melanoma coming back after surgery. They may be used either alone or in combination with other biological therapies or chemotherapy drugs. If clinical trials testing these drugs are available, your hospital team will give you more information about them.
Interferon is a protein that the body produces naturally to fight infection. It’s also made in laboratories for use as a cancer treatment. Very occasionally it may be given as an adjuvant treatment for melanoma as part of a clinical trial.
Interferon has already been tested in research trials to treat melanoma. There’s no evidence that interferon as an adjuvant treatment improves survival rates, but some results show that interferon may help delay melanoma coming back.