Treatment for advanced melanoma

 

Treatment for advanced melanoma of the skin

Your treatment team will advise you on the best treatment for your advanced melanoma. Treatments may include surgery, radiation treatment, targeted therapies, immunotherapy, chemotherapy and palliative care.

Advanced melanoma means your melanoma is unlikely to be cured. However, in recent years new treatments that are more effective have been developed. These new treatments can lead to remission that may last for many months and possibly years.

How surgery is used in treatment for advanced melanoma of the skin

Surgery can be used to:

•  assess and remove lymph nodes (lymph node dissection)

• help control the growth of advanced melanoma and relieve symptoms

• treat melanoma that has spread to:

    • areas of skin distant from the original melanoma

    • lymph nodes distant from the original melanoma    

    • the brain

    • the liver (if the cancer has spread to a single place in the liver)

    • the lungs (if the cancer has spread to a single place in the lungs).

Plastic surgery is sometimes needed to place a skin graft over a large area where tissue has been removed.

resize melanoma surgery skin graft2 

 

Surgery to remove lymph nodes

If melanoma cells are found in your lymph nodes, your doctor may occasionally decide to remove some or all of the nodes in the affected area (lymph node dissection). This is no longer a routine procedure. This helps to prevent cancer spreading to other parts of your body. The lymph nodes are removed in hospital under a general anaesthetic.

For a small number of people, swelling may occur in or around an area where lymph nodes have been removed. This is called lymphoedema.

Contact your doctor if you notice swelling or have heaviness, tightness, stiffness or pain in the affected area.

 

How radiation treatment is used for advanced melanoma of the skin

Radiation treatment uses radiation to kill melanoma cells. The radiation can be precisely targeted to melanoma sites on your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue. It may be given to shrink the tumour or to reduce the likelihood of the cancer returning to the area being treated. It can also be used to relieve symptoms such as pain or swelling. The treatment is usually given daily. The length of treatment will depend on the size and type of the cancer and your general health.

 

Side effects of radiation treatment

The side effects of radiation treatment depend on the part of your body being treated. Side effects may include tiredness and skin reddening similar to sunburn. Talk with your treatment team about any possible side effects and how to manage them. Follow the skincare advice given to you.

A potential side effect of radiation to lymph nodes is lymphoedema.

See page 42 for more information about lymphoedema.

You can read more about radiation treatment in the Cancer Society booklet Radiation/Haumanu Iraruke.

 

Targeted treatments for advanced melanoma

Targeted treatments aim to stop (block or inhibit) melanoma cells growing by targeting changes (mutations) in the genes of a cell. These changes may be either on the surface of the cell or on the growth pathway inside the cell.

Targeted treatments work for specific gene changes, such as changes to a gene called BRAF, present in about 35 percent of all melanomas. Changes in this gene lead to the production of a changed BRAF protein, which helps melanoma to grow. Treatments that aim to target this change and stop the melanoma cells growing and dividing are called BRAF inhibitors. Examples of BRAF inhibitor drugs are Tafinlar (Dabrafenib) and Zelboraf (Vemurafenib). The current standard of care is to combine a BRAF and MEK inhibitor, such as Vemurafenib with cobmetinib, or dabrafenib with trametinib.

 

Immunotherapy treatment for advanced melanoma of the skin

This is the name given to treatment that boosts the body’s own immune system to fight cancer. Advanced melanoma can produce a substance that turns off a type of white cell (called a T-cell) so that the T-cell can no longer fight off the melanoma. The medications Keytruda (Pembrolizumab) and Opdivo (Nivolumab) are treatments that allow the T-cell to stay active (turned on) to fight melanoma cells.

 "The doctors gave me six months. I’ve had Pembrolizumab and I’m going strong 18 months later. I’m feeling really good." Karen

 

Side effects of targeted treatments and immunotherapy

The side effects of targeted treatments and immunotherapy can depend on the type of treatment you are having. Talk to your doctor about the side effects that you may experience.

Targeted treatments and immunotherapy may have long-term side effects. They may affect the thyroid, causing an underactive thyroid. They can sometimes cause diabetes and lung or nerve problems. If you have specific side effects from drug treatments for melanoma you should discuss these with your oncologist, as there may be ways to manage them effectively.

The two tables below provide more in-depth information on targeted treatments and immunotherapy. Information correct at time of publishing (September 2018). Please check with your oncologist about any changes to the funded medication for your condition.

 

More information about targeted treatments for advanced melanoma

 targeted treatment for advanced melanoma

 

More information about immunotherapy for advanced melanoma

immunotherapies for advanced melanoma2

Funded immunotherapy and targeted treatments are only available when certain criteria are met. Please discuss with your specialist.

 

The availability of new therapies for advanced melanoma

There have been many recent advances in melanoma treatment, and more are expected in the near future. Unfortunately, these treatments are expensive and PHARMAC is not able to provide funding for all the treatments that might be helpful for the management of your melanoma. You may like to ask your oncologist if there are any unfunded treatments available that may be beneficial for you. Your oncologist will be able to give you an estimate of the cost involved if you choose to fund your own treatment.

 

How chemotherapy is used for advanced melanoma

This is the treatment of cancer with anti-cancer medications. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The medications work by stopping cancer cells growing and reproducing.

Chemotherapy can be given before or after surgery and is usually given by injecting the medication into a vein (IV treatment). There are other ways of having chemotherapy, including tablets. For multiple melanoma nodules found only on an arm or a leg, chemotherapy may be given directly into the blood vessels of the limb. This is called limb infusion/perfusion and is not widely available.

Chemotherapy is occasionally used as palliative treatment for melanoma that cannot be treated by other methods.

 

Side effects of chemotherapy

Some medications used in chemotherapy can cause side effects. The side effects are specific to the chemotherapy medications used. They may include an increased risk of infection, feeling sick (nauseous), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. Generally these side effects are temporary. Talk to your treatment team about how to manage them.

If you develop a fever (a temperature of 38 degrees Celsius or over), or you feel unwell even with a normal temperature, don’t wait to see what happens. Phone your cancer treatment team or hospital immediately for advice.

Ki te puta te kirikā ki a koe (he pāmahana 38 C, neke atu rānei), ki te māuiui rānei koe, ahakoa te pai o tō pāmahana, kaua e whakakeke. Me wawe tonu te waea atu mō ētahi tohutohu ki tō wāhi maimoa matepukupuku, ki tō mātai matepukupuku, ki tō tapuhi mātai matepukupuku, ki tō hōhipera rānei.