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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. They don't cure the melanoma but can control it for a time. The drugs include vemurafenib, ipilimumab, interferon, and interleukin 2.

Vemurafenib (Zelboraf)

Vemurafenib (Zelboraf) can shrink melanoma in people who have a change in a gene called BRAF V600. About half the people with melanoma of the skin have this gene change. You take vemurafenib as tablets. The side effects include joint pain, tiredness, a rash, skin sensitivity to light, feeling sick, hair loss and itching. Some people develop squamous cell skin cancers.

Dabrafenib (Tafinlar)

This drug is for people with melanoma that has a change in a gene called BRAF V600. You take dabrafenib as a tablet twice a day. The side effects include a skin rash, itchiness, headaches, fever, feeling sick, diarrhoea, loss of appetite and tiredness. Some people develop squamous skin cancers, which can easily be treated.  

Ipilimumab (Yervoy)

A monoclonal antibody called ipilimumab (Yervoy) can help some people with advanced melanoma to live longer. You have it into a vein by drip. The side effects include a mild effect on the liver, inflammation of the bowel, diarrhoea and a skin rash.

Interferon 

You have interferon as an injection under the skin 3 times a week. Some treatment plans include interferon given daily for the first few weeks. The treatment may continue for several years. In the first weeks of treatment, you are likely to have flu like symptoms such as headaches, a temperature or chills, tiredness, and aches and pains in your muscles and joints.

Interleukin 2

Interleukin 2 is also called aldesleukin (or IL2 or Proleukin). You are most likely to have it as an injection just under the skin (subcutaneously). But you may have it into a vein, either as an injection or through a drip.The side effects can include low immunity to infection, tiredness, flu like symptoms, low blood pressure, a skin rash, feeling sick, diarrhoea, and a poor appetite.

 

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What biological therapy is

Biological therapies are treatments that use substances made naturally by the body, or that change chemical processes in cancer cells. Some of these treatments are called immunotherapy because the drugs stimulate the immune system or occur naturally as part of the immune system.

Biological therapies can help some people with advanced melanoma. They don't cure the melanoma but can control it for a time.

 

Vemurafenib (Zelboraf)

Vemurafenib (Zelboraf) can shrink melanoma in people who have a change in a gene called BRAF V600. About half the people with melanoma of the skin have this gene change. Vemurafenib is called a BRAF inhibitor and you take it 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 taking vemurafenib develop squamous cell skin cancers. These a can easily be removed when found early. Tell your doctor if you notice any changes. 

The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) recommend that vemurafenib should be available as an option within the NHS  for people with advanced melanoma which is BRAF V600 positive. It is only available as part of the patient access scheme which means the manufacturer reduces the price of the drug for the NHS.

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 older treatments like chemotherapy. 

 

Dabrafenib (Tafinlar)

This is a treatment for melanoma that has spread or can't be removed with surgery. Dabrafenib helps to stop melanoma cells producing the BRAF protein which encourages the cells to grow and divide. It is only suitable for people who have a melanoma with a change in a gene called BRAF V600. 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

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). 

NICE recommends that dabrafenib should be available to people within the NHS in England and Wales for people with advanced melanoma who can't have surgery. They say that people should talk to their doctor about which treatment is best for them. The Scottish Medicines Consortium (SMC) is due to make a decision in early 2015. 

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.

 

Ipilimumab (Yervoy)

A monoclonal antibody called ipilimumab (Yervoy) can help some people with advanced melanoma to live longer. The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) have recommended it as a treatment option within the NHS in England, Wales and Scotland.

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. You can find information about these trials on the melanoma research page.

 

Interferon

The body naturally makes small amounts of interferon. It stimulates the immune system to attack cells that the body recognises as abnormal, such as cancer cells. You have a man made version of interferon as an injection under the skin 3 times a week. Some treatment plans include interferon given daily for the first few weeks. The treatment may continue for several months or years.

If you have this treatment over a long period of time, you or a relative can be taught to give the injections so that you don't have to keep going back to the hospital. Or a district nurse can give your injections if you don't like the idea of giving them yourself. You may find that having your injection in the evening before you go to bed reduces the side effects.

Side effects are most likely in the first few weeks of treatment and include

  • Flu like symptoms such as headaches, temperature or chills
  • Tiredness
  • Aches and pains in your muscles and joints
  • Feeling sick
  • Loss of appetite
  • Sadness or depression
 

Interleukin 2

Interleukin 2 is also called aldesleukin (or IL2 or Proleukin). You are most likely to have it as an injection just under the skin (subcutaneously). But you may have it into a vein, either as an injection or through a drip.

The side effects can include

  • Low immunity to infection
  • Tiredness
  • Flu like symptoms
  • Low blood pressure
  • A skin rash
  • Feeling sick
  • Diarrhoea
  • Poor appetite
 

Newer biological therapies for melanoma

Bevacizumab (Avastin) is a type of monoclonal antibody. Monoclonal antibodies are drugs designed to recognise and find specific abnormal proteins on cancer cells. When the antibody attaches to the cell it blocks particular processes that make the cell grow. So this can stop the cancer growing or may shrink it in some people. Research trials are looking into whether bevacizumab can help to stop melanoma coming back after surgery but it is not a standard treatment and is only available as part of clinical trials. You have bevacizumab as a liquid into a vein. The most common side effects are high blood pressure, feeling sick, constipation, diarrhoea and tiredness.

Another type of biological therapy being studied to treat melanoma is treatment with vaccines. There is a lot of interest in this treatment and so we have put information about melanoma vaccines on a separate page under the treating melanoma section. This treatment is very experimental at the moment.

 

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.

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Updated: 23 January 2014