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Biological therapy for melanoma

Biological therapies are treatments that use natural substances from the body, or that change chemical processes in cancer cells. Some types stimulate the immune system to attack cancer cells. Biological therapies can help some people with advanced melanoma. There are different types of biological therapies. 

Drugs that target gene changes (targeted treatments)

The doctor looks to see if the melanoma cells have changes (mutations) in certain genes, such as the BRAF gene. About 40 to 50 people out of every 100 people with melanoma skin cancer (40 - 50%) have this gene change. If you have changes in the BRAF gene, your doctor may offer you drugs that target this gene change. These drugs include Vemurafenib and Dabrafenib. You take these as tablets.

Immunotherapy

Immunotherapy is a type of biological therapy that helps the body's natural defence system (immune system) to find and destroy melanoma cells. The immunotherapy drugs ipilimumab, pembrolizumab and nivolumab are used for melanoma.  You have these drugs by drip into a vein. 

Newer biological therapies

Doctors are looking at some new biological treatments for melanoma. These include nivolumab, MEK inhibitors and melanoma vaccines.

Side effects

Different drugs have different side effects. And some people react more than others.  Some side effects of biological therapy include tiredness, a rash, feeling sick, and diarrhoea

CR PDF Icon View and print the quick guide for treating advanced melanoma.

 

 

What biological therapy is

Biological therapies are treatments that use substances made naturally by the body, or that change chemical processes in cancer cells.

The two main types of biological therapy for melanoma are

  • Targeted treatments
  • Immunotherapy

Biological therapies can help some people with advanced melanoma. 

Read more about biological therapies.

 

When you might have biological therapy

You may have biological therapy as a treatment for stage 4 (advanced) melanoma that has spread to another part of the body. The doctor may do genetic testing on your melanoma cells. This helps them decide which biological treatment may help you.

You may also have biological therapy to stop your melanoma coming back if melanoma cells were found in your lymph nodes. Biological therapy used in this way is called adjuvant therapy. We don’t know yet whether it helps to prevent melanoma coming back. So you have adjuvant biological therapy as part of a clinical trial.

Read more about genetic tests on your melanoma.

 

Drugs that target gene changes (targeted treatments)

The doctor looks to see if the melanoma cells have changes (mutations) in certain genes, such as the BRAF V600 gene. About 40 to 50 out of every 100 people with skin melanoma (40-50%) have this gene change. The change to the gene causes it to make an overactive BRAF protein. This makes cells grow and divide too fast.  

Targeted treatments that stop cells producing the BRAF protein and can slow or stop the growth of the cancer include

  • Vemurafenib (Zelboraf)
  • Dabrafenib (Tafinlar)

These drugs are not likely to work in people who don’t have the BRAF gene change.

Vemurafenib (Zelboraf)

You take vemurafenib as tablets, twice a day. You carry on taking it for as long as it is working.

The side effects include

  • Joint pain
  • Tiredness
  • Skin rash
  • Skin sensitivity to sunlight
  • Feeling sick
  • Hair loss
  • Itching

Some people also develop squamous cell skin cancers. These can easily be removed when found early. Tell your doctor if you notice any skin changes.

If your melanoma is BRAF V600 positive, most doctors think that vemurafenib may be the best treatment option for you. So your doctor may offer you this treatment first, instead of other treatments like chemotherapy.

Read more about Vemurafenib.
 

Dabrafenib (Tafinlar)

You take dabrafenib (Tafinlar) twice a day. You carry on taking it for as long as it is working.

The side effects include

  • Skin changes – a rash, dryness, itching
  • Sore, peeling, reddened hands and feet
  • Headaches
  • Feeling sick
  • Diarrhoea
  • Loss of appetite
  • Feeling weak and lacking in energy
  • A raised temperature (fever)
  • Joint pain
  • Tiredness
  • Hair loss

Some people taking dabrafenib develop squamous cell skin cancers. These can easily be removed when found early. Tell your doctor if you notice any changes in your skin.

Read more about dabrafenib.

Decisions about treatment

Research looking at dabrafenib and vemurafenib shows that they work as well as each other. But they cause slightly different side effects. Dabrafenib does not cause as much sensitivity to light (photosensitivity) but is more likely to cause a high temperature (fever).

You can talk to your doctor about which treatment may be best for you.

 

melanoma gene - new drugs

 

Immunotherapy

Immunotherapy is a type of biological therapy that helps the body's natural defence system (immune system) to find and destroy melanoma cells.

The immunotherapy drugs for melanoma are

  • Ipilimumab
  • Pembrolizumab
  • Nivolumab

Doctors used to use 2 immunotherapy drugs called interferon and interleukin 2 to treat melanoma. They don’t use these drugs very often any more.

Ipilimumab (Yervoy)

Ipilimumab is a type of drug called a monoclonal antibody. It helps some people with advanced melanoma to live longer.  

You have ipilimumab into a vein by drip every 4 weeks. You usually have 4 doses. So the whole course takes 16 weeks.

The side effects of ipilimumab include

  • A mild effect on the liver
  • Inflammation of the bowel
  • Diarrhoea
  • Skin rashes

Trials are now looking at other ways of using ipilimumab for melanoma. Read more about these trials on the melanoma research page. And read more about  ipilimumab.

Pembrolizumab (Keytruda)

Pembrolizumab is a type of immunotherapy.

You have it into a vein as a drip every 3 weeks. You usually carry on having pembrolizumab for as long as it works, unless it causes bad side effects.

The side effects of pembrolizumab include

  • Tiredness and weakness
  • Skin reactions
  • Diarrhoea
  • Feeling or being sick

Read more about pembrolizumab

Nivolumab (Opdivo)

Nivolumab is a type of immunotherapy.

You have it into a vein as a drip every 2 weeks. You usually carry on having nivolumab for as long as it works, unless it causes bad side effects.

The side effects of nivolumab include

  • Tiredness and weakness
  • Diarrhoea
  • Feeling or being sick 
  • Skin reactions 
  • Mild changes to the liver or kidneys 
  • Loss of fertility

Nivolumab has been approved for NHS use in England and Wales by the National Institute for Health and Care Excellence (NICE). But it has not been recommended by the Scottish Medicines Consortium (SMC) for use by the NHS in Scotland. Your doctor can tell you more about whether it may be available for you. 

Research shows that nivolumab works well in combination with ipilimumab. So your doctor may suggest you have these drugs together. NICE is due to make a final decision about this drug combination in September 2016. 

Read more about nivolumab.

 

Newer biological therapies for melanoma

Doctors are looking at some new biological treatments for melanoma. These include

  • MEK inhibitors, such as trametinib and cobimetinib
  • Melanoma vaccines, such as  TVEC

These drugs have been licensed to treat melanoma. But they have not been approved by the National Institute for Health and Care Excellence (NICE). So they may not be available as treatments on the NHS. 

Read more about these new drugs in the section about research into melanoma.  And you can read more about melanoma vaccines.

 

Biological therapy to treat an arm or leg

Interferon is sometimes used in combination with chemotherapy in regional chemotherapy. Regional treatment is a way of giving drug treatment into an arm or leg. It is usually used for melanoma that has come back in a limb. Another type of biological therapy called Tumour Necrosis Factor (TNF) has also been used in this way. We need more clinical trials before we know how useful biological therapy into an arm or leg will be.

Read more about regional chemotherapy.

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Updated: 22 January 2016