Biological therapy for melanoma

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.

Vemurafenib (Zelboraf) can shrink melanoma in people who have a change in a gene called BRAF V600. About half the people with melanoma 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 verumafenib develop squamous cell skin cancers. These are not harmful and can easily be removed.

The National Institute for Health and Clinical Excellence (NICE) have recommend that vemurafenib should be available as an option within the NHS in England and Wales 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. The Scottish Medicines Consortium (SMC) do not recommend it as a treatment option within the NHS in Scotland, saying the benefit does not outweigh the cost. 

A monoclonal antibody called ipilimumab (Yervoy) can help some people with advanced melanoma to live longer. It is licensed in the UK for the treatment of advanced melanoma in people who have already had other treatments. The National Institute for Health and Clinical Evidence (NICE) have recommended that ipilumumab should be a treatment option within the NHS in England and Wales for people with advanced melanoma who have already had other treatments. It is only available as part of the patient access scheme which means the manufacturer reduces the price of the drug for the NHS. The Scottish Medicines Consortium (SMC) have said that it should not be available within the NHS in Scotland because it is not cost effective. They are due to review it again in Spring 2013. 

You have it into a vein by drip every 4 weeks. You usually have 4 doses. So the whole course takes 12 weeks. 

The side effects of ipilimumab include

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

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 is a substance produced naturally by the body. It is made in tiny amounts and stimulates the immune system to attack cells that the body recognises as abnormal, such as cancer cells. 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 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

You can read detailed information about interferon for melanoma in our question and answer section.

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

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.

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.