What are targeted therapies?

Targeted therapies are substances that target the differences between cancer cells and normal cells. They are sometimes called biological therapies.

There are a number of targeted therapies that may be used to treat advanced melanoma. Your doctor will let you know if there is a suitable treatment for you.

At the moment the main targeted therapies to treat advanced melanoma are:

  • Ipilimumab – This triggers the body’s immune system to attack cancer cells.
  • Vemurafenib – This delays the growth of advanced melanoma in patients who have a specific change in a gene called BRAF.
  • Dabrafenib – This slows or stops the BRAF gene growing.

New treatments for advanced melanoma are currently being researched in clinical trials.

You may experience side effects as part of these therapies. Your doctor will discuss these with you and you should let them know if you have any concerns.

It’s advisable not to become pregnant or father a child while having targeted therapy. You should talk to your doctor or nurse if you are concerned about contraception or your fertility during treatment.

Targeted treatments

Targeted therapies are substances that target the differences between cancer cells and normal cells. They are often called biological therapies. Different types of targeted therapy may be used to treat advanced melanoma. Some are available on the NHS and others are only used in clinical trials at the moment.


Immunotherapy – ipilimumab

Ipilimumab (Yervoy™) belongs to a group of cancer drugs known as monoclonal antibodies. Ipilimumab is a drug that triggers the body’s immune system to attack cancer cells. It helps to shrink or slow the growth of advanced melanoma.

You have ipilimumab as an infusion (drip) into a vein over about 90 minutes. The infusion is repeated every three weeks. Up to four treatments are given.

Common side effects of ipilimumab include:

  • fatigue
  • diarrhoea
  • skin rashes
  • itching.

Ipilimumab can cause inflammation in different parts of the body, such as the bowel, liver, skin and eyes. Occasionally this can cause 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 to report these side effects straight away to your 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 may be delayed or sometimes stopped. Your doctor or nurse will give you more detailed information about ipilimumab and its side effects.


Vemurafenib

Vemurafenib (Zelboraf®) is a targeted therapy drug available in the UK. It delays 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 tell if you have the mutation by testing melanoma tissue that has been removed during tests to diagnose your melanoma or during surgery. Vemurafenib is not effective in people who don’t have the BRAF gene mutation.

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 doctor will let you know if vemurafenib is a suitable treatment for you.


Dabrafenib

Dabrafenib (Tafinlar™) is a targeted therapy drug that is also used to treat people who have tested positive for the BRAF gene mutation (see vemurafenib). This drug slows or stops the BRAF protein being produced, which delays the growth of advanced melanoma. It is licensed for use in the UK but may not be widely available on the NHS.

Dabrafenib is given as a tablet, which is taken twice a day by mouth. You have to take the tablets at least two hours before eating or at least one hour after eating. Common side effects include skin changes, fever, headache, feeling or being sick, loss of appetite, diarrhoea and tiredness. Your doctor will let you know if dabrafenib is a suitable treatment for you.


New therapies

New therapies that block some of the enzymes involved in cell growth are being researched as treatments for advanced melanoma. These include the MEK inhibitor, trametinib or anti-PD1 agents, pembrolizumab or nivolumab. Research is also looking at using cancer vaccines for advanced melanoma. For example, MAGE-A3 vaccine and OncoVEX GM-CSF.

If there are clinical trials testing these or other drugs, your hospital team will give you more information about them.


Contraception

Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in semen or vaginal fluid. It’s not advisable to become pregnant or father a child while having chemotherapy, 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.


Back to Targeted (biological) therapies explained

Monoclonal antibodies

Monoclonal antibodies can attach themselves to cancer cells to prevent them from growing.