If you have melanoma skin cancer, your doctor might recommend immunotherapy. This type of treatment may help boost your immune system’s response against cancer.
Several types of immunotherapy drugs are available for the treatment of melanoma. In most cases, these drugs are prescribed to people with stage 3 or stage 4 melanoma. But in some cases, your doctor might prescribe immunotherapy to treat less advanced melanoma.
Read on to learn more about the role that immunotherapy may play in the treatment of this disease.
To understand the success rates of immunotherapy, it’s important to differentiate between the different types available. There are three main groups of immunotherapy used to treat melanoma:
- checkpoint inhibitors
- cytokine therapy
- oncolytic virus therapy
Checkpoint inhibitors
Checkpoint inhibitors are drugs that may help your immune system recognize and kill melanoma skin cancer cells.
The Food and Drug Administration (FDA) has approved three types of checkpoint inhibitors for treating melanoma:
- ipilimumab (Yervoy), which blocks the checkpoint protein CTL4-A
- pembrolizumab (Keytruda), which blocks the checkpoint protein PD-1
- nivolumab (Opdivo), which also blocks PD-1
Your doctor may prescribe one or more checkpoint inhibitors if you have stage 3 or stage 4 melanoma that can’t be removed with surgery. In other cases, they may prescribe checkpoint inhibitors in combination with surgery.
Cytokine therapy
Treatment with cytokines may help boost your immune system and strengthen its response against cancer.
The FDA has approved three types of cytokines for the treatment of melanoma:
- interferon alfa-2b (Intron A)
- pegylated interferon alfa-2b (Sylatron)
- interleukin-2 (aldesleukin, Proleukin)
Interferon alfa-2b or pegylated interferon alfa-2b is generally prescribed after melanoma has been removed with surgery. This is known as adjuvant treatment. It may help lower the chances of the cancer returning.
Proleukin is most often used to treat stage 3 or stage 4 melanoma that has spread.
Oncolytic virus therapy
Oncolytic viruses are viruses that have been modified to infect and kill cancer cells. They may also trigger your immune system to attack cancer cells in your body.
Talimogene laherparepvec (Imlygic) is an oncolytic virus that’s been approved to treat melanoma. It’s also known as T-VEC.
Imlygic is typically prescribed before surgery. This is known as neoadjuvant treatment.
Immunotherapy can help prolong life in some people with stage 3 or stage 4 melanoma — including some people who have melanoma that can’t be removed with surgery.
When melanoma can’t be surgically removed, it’s known as unresectable melanoma.
Ipilimumab (Yervoy)
In a review published in 2015, researchers pooled the results of 12 past studies on the checkpoint inhibitor Yervoy. They found that in people with unresectable stage 3 or stage 4 melanoma, 22 percent of those patients who received Yervoy were alive 3 years later.
However, some studies have found lower rates of success in people treated with this drug.
When researchers from the EURO-VOYAGE study looked at treatment outcomes in 1,043 people with advanced melanoma, they found that 10.9 percent who received Yervoy lived for at least 3 years. Eight percent of people who received this drug survived for 4 years or more.
Pembrolizumab (Keytruda)
Research suggests that treatment with Keytruda alone may benefit some people more than treatment with Yervoy alone.
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The authors of a more recent study estimated that the 5-year overall survival rate in people with advanced melanoma who were treated with Keytruda was 34 percent. They found that people who received this drug lived for a median average of about two years.
Nivolumab (Opdivo)
Studies have also found that treatment with Opdivo alone may increase the chances of survival more than treatment with Yervoy alone.
When investigators compared these treatments in people with unresectable stage 3 or stage 4 melanoma, they found that people who were treated with Opdivo alone survived for a median average of about 3 years. People who were treated with Yervoy alone survived for a median average of about 20 months.
The same study found that the 4-year overall survival rate was 46 percent in people who were treated with Opdivo alone, compared to 30 percent in people treated with Yervoy alone.
Nivolumab + ipilimumab (Opdivo + Yervoy)
Some of the most promising treatment outcomes for people with unresectable melanoma have been found in patients treated with a combination of Opdivo and Yervoy.
In a small study published in the Journal of Clinical Oncology, scientists reported a 3-year overall survival rate of 63 percent among 94 patients treated with this combination of drugs. All of the patients had stage 3 or stage 4 melanoma that couldn’t be removed with surgery.
Although researchers have linked this combination of medications to improved survival rates, they’ve also found it causes more frequent serious side effects than either medication alone.
Larger studies on this combination therapy are needed.
Cytokines
For most people with melanoma, the potential benefits of treatment with cytokine therapy appear to be smaller than those of taking checkpoint inhibitors. However, some patients who don’t respond well to other treatments might benefit from cytokine therapy.
In 2010, researchers published a review of studies on interferon alfa-2b in the treatment of stage 2 or stage 3 melanoma. The authors found that patients who received high doses of interferon alfa-2b after surgery had marginally better disease-free survival rates, compared to those who didn’t receive this treatment. They also found that patients who received interferon alfa-2b after surgery had slightly better overall survival rates.
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According to another review, studies have found that melanoma becomes undetectable after treatment with high doses of interleukin-2 in 4 to 9 percent of people with unresectable melanoma. In another 7 to 13 percent of people, high doses of interleukin-2 have been shown to shrink unresectable melanoma tumors.
Talimogene laherparepvec (Imlygic)
Research presented at the 2019 European Society for Medical Oncology conference suggests that administering Imlygic before surgically removing melanoma may help some patients live longer.
This study found that among people with advanced stage melanoma who were treated with surgery alone, 77.4 percent survived for at least 2 years. Among those treated with a combination of surgery and Imlygic, 88.9 percent survived for at least two years.
More research is needed on the potential effects of this treatment.
Immunotherapy can cause side effects, which vary depending on the specific type and dose of immunotherapy that you receive.
For example, potential side effects include:
- fatigue
- fever
- chills
- nausea
- vomiting
- diarrhea
- skin rash
These are only some of the potential side effects that immunotherapy may cause. To learn more about the potential side effects of specific immunotherapy treatments, talk to your doctor.
The side effects of immunotherapy are usually mild, but in some cases they can be serious.
If you think you might be experiencing side effects, let your doctor know immediately.
The out-of-pocket cost of immunotherapy varies, depending in large part on:
- the type and dose of immunotherapy you receive
- whether or not you have health insurance coverage for the treatment
- whether or not you’re eligible for patient assistance programs for the treatment
- whether you receive the treatment as part of a clinical trial
To learn more about the cost of your recommended treatment plan, talk to your doctor, pharmacist, and insurance provider.
If you’re finding it hard to afford the costs of care, let your treatment team know.
They might recommend changes to your treatment plan. Or they may know about an assistance program that can help cover the costs of your care. In some cases, they may encourage you to enroll in a clinical trial that will allow you to access the drug for free while taking part in research.
In addition to the immunotherapy treatments that have been approved for treating melanoma, scientists are currently studying other experimental immunotherapy approaches.
Some researchers are developing and testing new types of immunotherapy drugs. Others are studying the safety and efficacy of combining multiple types of immunotherapy. Other researchers are trying to identify strategies for learning which patients are most likely to benefit from which treatments.
If your doctor thinks you might benefit from receiving an experimental treatment or taking part in a research study on immunotherapy, they might encourage you to enroll in a clinical trial.
Before you enroll in any trial, make sure you understand the potential benefits and risks.
To help support your physical and mental health while you undergo immunotherapy or other cancer treatments, your doctor may encourage you to make some lifestyle changes.
For example, they may encourage you to:
- adjust your sleep habits to get more rest
- tweak your diet to get more nutrients or calories
- change your exercise habits to get enough activity, without taxing your body too much
- wash your hands and limit your exposure to sick people to reduce your risk of infection
- develop stress management and relaxation techniques
In some cases, adjusting your daily habits may help you cope with side effects of treatment. For example, getting more rest may help you manage fatigue. Making changes to your diet may help you manage nausea or loss of appetite.
If you need help adjusting your lifestyle habits or managing the side effects of treatment, your doctor may refer you to a professional for support. For example, a dietitian can help you adjust your eating habits.
Your outlook with melanoma cancer depends on many factors, including:
- your overall health
- the stage of cancer you have
- the size, number, and location of tumors in your body
- the type of treatment you receive
- how your body responds to treatment
Your doctor can help you learn more about your condition and long-term outlook. They can also help you understand your treatment options, including the effects that treatment might have on the length and quality of your life.
