Your doctor has several options for treating your skin cancer. These include surgery, radiation, chemotherapy, and immunotherapy. Immunotherapy is a relatively new treatment that revs up your body’s immune system to destroy the cancer or slow its growth. Your doctor might recommend this treatment if your cancer has spread to your lymph nodes or other organs. They may also recommend it if your cancer is in a location that makes surgery difficult.
Immunotherapy can help some people with late-stage melanoma live longer. It might also be useful for people with other forms of skin cancer.
Here are the different types of immunotherapy drugs available to treat skin cancer.
Your immune system regularly monitors your body for enemy invaders like bacteria, viruses, and cancer. Once it spots foreign cells, it sends out an army of fighters called T cells to destroy them. To launch this attack, your immune system needs to be able to distinguish your own cells from foreign ones. One way it tells friend from foe is by using a system of immune checkpoints.
Checkpoints are proteins on the surface of your cells that tell your immune system they’re friendly. When T cells identify checkpoints, they leave the cells alone. This system normally works well. However, some cancer cells have acquired the ability to cloak themselves in checkpoints and hide from an immune system attack.
Checkpoint inhibitors block checkpoint proteins on cancer cells. Once the cloak has been removed, immune cells can effectively find and destroy the cancer.
Checkpoint inhibitor drugs used to treat melanoma are:
- pembrolizumab (Keytruda)
- nivolumab (Opdivo)
- ipilimumab (Yervoy)
You’ll get these drugs as an infusion into a vein every two weeks or so. Side effects from checkpoint inhibitors include:
- skin rash
Cytokines are proteins your body makes to help regulate the immune response. Man-made cytokines intensify your immune system response to help it attack the cancer more efficiently.
Two types of cytokines treat melanoma:
- interleukin-2 (IL-2)
You get these treatments as intravenous (IV) infusions or injections. If you have late-stage melanoma, you may get a cytokine together with chemotherapy, surgery, or other treatments.
Side effects of cytokines include:
- extreme fatigue
- swelling in your body
Oncolytic virus therapy
Most viruses — including the cold and flu virus — get into your cells and make you sick. Oncolytic viruses are different. They’re engineered in a laboratory to only infect and kill cancer cells. Oncolytic viruses also alert your immune system to target the cancer.
Talimogene laherparepvec (Imlygic) is an oncolytic virus that treats melanoma. It’s used for cancers that surgery hasn’t been able to treat. Imlygic is injected into the tumor once every two weeks. Side effects include fatigue, chills, and other flu-like symptoms.
Bacille Calmette-Guerin (BCG) vaccine
Vaccines like the ones used to prevent measles or polio work by priming your immune system to recognize and attack viruses or bacteria. The BCG vaccine activates your immune system to attack melanoma cells when it’s injected into the tumor. It’s made from the bacteria that cause tuberculosis, but they’ve been weakened to the point that they can’t make you sick.
Immunotherapy isn’t always delivered through a needle. Imiquimod (Aldara) is a cream that stimulates your immune system to attack cancer. Your doctor might recommend this for early-stage skin cancer. They may also recommend it for cancer on your face or a sensitive area where surgery would be difficult.
You apply this cream two to five times a week for about three months. Aldara can cause side effects like:
- redness or crusting of the skin
- flu-like symptoms
The type of immunotherapy treatment you receive depends on the size and stage of your cancer, as well as your personal preferences. Ask about the risks and benefits of each treatment before making your decision.