Straightforward trustworthy advice for malignant melanoma patients and carers

Frequently Asked Questions: What established treatments are there for Melanoma?

If you have a stage 1 or even stage 2 melanoma, surgery has a good chance of curing you. If that doesn't work, and/or you go to stage 3 or 4, there are still no reliably curative treatments.

Interferon is favoured in America, and some other places as a treatment in addition to surgery. It may improve short term survival chances, but not long term. It can be a very harsh treatment, and many people fail to complete the course for this reason.

Radiation is favoured by the Australians in addition to surgery. Any improvements in survival rates are slight enough that the UK and US authorities cannot see them, and of course, radiotherapy is no picnic.

Dacarbazine was the only chemotherapy agent approved for use on melanoma by the US FDA before the newer and more effective ipiplimuab and vemurafenib came along. Dacarbazine wasn't terribly effective, giving tumour shrinkage in about 15% of patients, and making no difference to survival times, but the new drugs can extend life in a high percentage of patients. There are even complete cures reported.

BRAF

BRAF is a human gene that makes a protein called B-Raf. The B-Raf protein is involved in sending signals inside cells, which are involved in directing cell growth. In 2002, it was shown to be faulty (mutated) in human cancers. Drugs that treat cancers driven by BRAF have been developed. Two of these drugs, vemurafenib and dabrafenib are approved by FDA for treatment of late-stage melanoma.

MEK

A MEK inhibitor is a chemical or drug that inhibits a biochemical switch upstream of the gene which produces B-Raf, which is often overactive in BRAF-mutated melanoma. Hence MEK inhibitors can increase the effectiveness of BRAF drugs.Trametinib /Mekinist is a MEK inhibitor drug with anti-cancer activity. It inhibits MEK1 and MEK2. Trametinib had good results for V600E mutated metastatic melanoma in a phase III clinical trial. In May 2013, trametinib was approved by the Food and Drug Administration for the treatment of melanoma.

CTLA-4

Cytotoxic T lymphocytes (CTLs) can recognize and destroy cancer cells. However, there is also an inhibitory mechanism via a gene called CTLA-4 that interrupts this destruction. CTLA4 inhibitors turn off this inhibitory mechanism and allows CTLs to continue to destroy cancer cells. Ipilimumab /Yervoy works this way, and was approved by the FDA in March 2011 to treat patients with late-stage melanoma that has spread or cannot be removed by surgery. On February 1, 2012, Health Canada approved ipilimumab for "treatment of unresectable or metastatic melanoma in patients who have failed or do not tolerate other systemic therapy for advanced disease." Additionally Ipilimumab was approved in both the UK and European Union (EU), for second line treatment of metastatic melanoma, November 2012.

Further reading from CRUK

 

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