Immunotherapy Treatment Options for Melanoma

A doctor shows a patient an x-ray.

As the name implies, immunotherapy is a treatment method that encourages a person’s own immune system to fight cancer. It can be used alone or in combination with other treatments, such as surgery and radiation therapy. A cancer specialist’s decision to include immunotherapy to treat melanoma depends on many factors, including the stage and type of the malignancy and the patient’s overall health condition.

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Types of immunotherapy for melanoma

There are two primary ways that different immunotherapies empower the body to combat cancer:

  • Using drugs to stimulate the immune system’s natural defenses to identify and attack cancer cells
  • Administering to melanoma patients substances that have been engineered to simulate cancer-fighting immune system components

The U.S. Food and Drug Administration (FDA) has approved the use of several types of immunotherapy as treatment for melanoma. Here’s a brief description of some of them:

Checkpoint inhibitors

This is a newer type of immunotherapy that has shown a lot of promise for patients with advanced stages of melanoma. "Checkpoints" are proteins on immune cells that must be switched off to allow an immune system response to become fully engaged. Sometimes, melanoma cells use checkpoints to evade the body’s immune system attacks. Immune checkpoint inhibitors are drugs that are designed to target and block these checkpoints, thereby allowing the immune system to effectively attack the melanoma cells.

For example, nivolumab, a prescription medication marketed under the brand name Opdivo, is an FDA-approved immunotherapy that’s often used to treat advanced melanoma that can’t be removed by surgery. It can also be used after melanoma surgery to reduce the risk of cancer regrowth, which is a treatment method known as adjuvant therapy.

How does it work? Opdivo blocks the activity of a checkpoint protein so that the body’s T cells recognize and attack melanoma cells. Studies have shown that combining Opdivo with another immunotherapy drug—ipilimumab, marketed as Yervoy—can extend the lifespan of patients with metastatic (advanced) melanoma.

Pembrolizumab (Keytruda) is another immune checkpoint inhibitor that is an FDA-approved treatment for melanoma. Like other immunotherapy medications, it is usually delivered through intravenous (IV) infusion in an outpatient setting. Checkpoint inhibitors differ in how frequently and for how long they are given.

Dr. Patrick Hwu in the Moffitt lab
Immunology offers hope for melanoma patients. Learn More

Oncolytic virus therapy

Oncolytic viruses are viruses that have been engineered in a laboratory to preferentially infect cancer cells. They are usually injected directly into tumors on or close to the skin. In addition to destroying the melanoma cells at the injection site, oncolytic viruses can attract the immune system to the tumor site, leading it to target and attack melanoma cells at other locations besides the injection sites.

Cellular therapies

This approach uses immune cells taken from a patient’s own body and grown in the laboratory that are then reinfused into the patient to attack melanoma tumors that have grown despite the use of other forms of immunotherapy. This approach is still experimental, requires the patient to have good heart and lung function and is very labor intensive; therefore, only a few centers (including Moffitt) currently offer this approach. While still in clinical trial testing, Dr. Amod A. Sarnaik and colleagues found that the tumor-infiltrating lymphocyte (TIL) therapy, lifileucel, produced durable responses in patients with metastatic melanoma.

Side effects of immunotherapy

The use of immunotherapy is associated with side effects different than those associated with traditional chemotherapy. Most side effects are a consequence of over-stimulation of the immune system, leading the immune system to attack normal, noncancerous cells in the body.

The most common immunotherapy side effects include rashes, diarrhea and inflammation of the liver or lungs. Less common side effects include damaging the functions of the endocrine system (leading to diabetes, hypothyroidism, fatigue and other conditions), the neurologic system (causing weakness, numbness, headaches, confusion and other issues) and the cardiovascular system (resulting in swelling, lightheadedness, heart failure and other problems). Most side effects gradually resolve after stopping immunotherapy, but steroids and hormone replacement may be required—sometimes for extended periods of time—and some side effects can be permanent.

Moffitt's approach to melanoma immunotherapy

The Cutaneous Oncology Program at Moffitt Cancer Center takes a multispecialty, patient-focused approach to the treatment of skin cancers. Our melanoma team comprises physicians from every treatment specialty—medical oncology, radiation oncology, surgical oncology, dermatology and others—all trained and experienced in the treatment of melanoma. Additionally, our cutaneous oncology team treats a high volume of cancer cases, including patients with complex and advanced-stage cancers. This translates into a wealth of melanoma treatment expertise that many other cancer hospitals can’t match.

Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center, nationally renowned for its comprehensive treatment and supportive care, as well as its groundbreaking research and robust clinical trials program, which includes a wide range of immunotherapy options for melanoma and many other forms of cancer. As a result of our approach to melanoma treatment, our survival rates for patients with melanoma are significantly higher than the national average.

If you’d like to consult with an oncologist specializing in immunotherapy treatment options for melanoma, call 1-888-663-3488 or fill out a new patient registration form online. You don’t need a referral to visit Moffitt, and we’re committed to connecting every new patient with a cancer expert as quickly as possible.

References

American Cancer Society – Immunotherapy
Melanoma Research Alliance – Opdivo (Nivolumab)           
National Cancer Institute – Drugs Approved for Melanoma
AIM at Melanoma – FDA Approved Drugs