Melanoma research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available as a treatment either in the NHS or in private health care.

Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials. Then select 'melanoma' from the dropdown menu and click 'find'. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for melanoma.

Most melanomas are preventable. If we can find a way to successfully teach people to protect their skin properly when they go out in the sun we could prevent most skin cancers. Research into this area includes

• National skin cancer prevention campaigns
• Training people to recognise melanoma skin cancer
• Melanotan and sun protection
• Using scanners to detect melanoma
• Genetics
• IMP-3 protein
• Preventing melanoma coming back after treatment

You can find detailed information on our clinical trials database. Pick 'melanoma' from the dropdown list of cancer types.

National skin cancer prevention campaigns

Cancer Research UK has worked with the Department of Health to develop a national skin cancer prevention awareness campaign. The campaign called SunSmart was launched in March 2003. You can find lots of information about how to protect your skin from the sun in the  about melanoma section. You can also get information on Cancer Research UK's SunSmart pages.

Training people to recognise melanoma skin cancer

There is a UK study looking at the skills people need to help them recognise melanoma skin cancer and to see if these skills could be improved. The trial aims to see if people can match up their skin change with a computer picture to help them decide if it could be melanoma. The researchers hope that this will help people to go to their doctor sooner.  

Melanotan and sun protection

An Australian company has been developing a new drug called afamelanotide, or Melanotan. They hope it will protect people from sunburn. The company are developing it as injections, or as a pellet that releases a drug into your system over about 30 days. The company say one dose could give you an all over tan lasting for months. The pellet is implanted just under your skin and is made of the same material used in dissolvable stitches. Most people don't have any side effects from this material.

This drug is still in early stages of development and we won't know how successful it really is in preventing sunburn for some time. Equally, we can't know how safe it is until it has been in use for some time. Early trials have shown no immediate side effects. But it hasn't been around long enough for us to know if it does any lasting harm. The makers claim this drug will not replace the staying safe in the sun message, but will add to it.

The Medicines and Healthcare Products Regulation Agency (MHRA) is the government agency which makes sure that drugs work well and are reasonably safe. They have advised people in the UK not to use Melanotan because it is unlicensed and we don't know enough yet about how safe it is. They issued this advice in November 2008, because Melanotan has been advertised in some gyms and tanning salons. It is illegal to supply or advertise Melanotan in the UK.

There is more information about Melanotan in the skin cancer questions and answers section.

Using scanners to detect melanoma

The MoleMate trial is checking whether a new type of hand held scanner can help GPs to tell the difference between normal moles and melanomas. The scanner is linked to a computer and takes pictures of the moles. The computer analyses the moles and gives a report on whether the mole could be a melanoma. If the scanner works well it will reduce the number of people who are unnecessarily referred to a specialist to have normal moles removed.

Another study is looking at a new system called a Skin Analyser that takes detailed pictures and shows the texture of abnormal areas of skin. Researchers are using the Skin Analyser to look at areas of abnormal skin, such as moles or skin blemishes, in people with and without suspected skin cancer. They will look at this information along with results from SIAscopy (hand held scanner test) and physical examination. They hope to use this information to develop a system that can spot suspected skin cancer as accurately as possible.

Genetics

Scientists now know that the ultraviolet light from the sun damages your DNA. These changes in your DNA can  increase the chance of normal skin cells to become cancerous. Scientists are using this information to develop new treatments for skin cancers.

A study is looking into the genetic changes that cause skin cancer. The researchers are collecting samples of tissue and blood from people diagnosed with melanoma and non melanoma skin cancer of the head and neck. They will use these samples to identify changes in genes that may have caused the cancer, and to identify how the body's immune system responds to the cancer.

A few people are more at risk of developing melanoma than other people, because they have inherited a high risk faulty gene from a relative. Scientists recently discovered one of these genes, called the p16 gene or CDKN2A. They have been running a long term study to find out more about how genes and your surroundings can affect your risk of developing melanoma.

It is not recommended that everyone has a test for gene faults. This is because the gene is rare and the advice offered to families with melanoma about prevention and regular screening for early signs is the same whether you have the gene or not.

IMP-3 protein

Studies are looking at using IMP-3 protein to detect melanoma. Scientists have found that melanoma cells produce a lot of this protein, while cells from ordinary moles do not. They hope that this will help them diagnose melanoma quicker in the future. This is still very early research.

Preventing melanoma coming back after treatment

There is a study looking into lifestyle factors, such as how people live, what they eat, and how much time they spend in the sun after they have been treated. Researchers want to see if any of these factors might increase the risk of the melanoma coming back. This study is also looking at the genes of people with melanoma, to find out if any of these affect the risk of recurrence.

When removing melanoma with surgery doctors sometimes remove the nearest lymph node (sentinel node) to see if the melanoma has spread there. This surgery is called sentinel node biopsy. One trial is looking at treatment after sentinel lymph node biopsy for melanoma. At the moment if tests show melanoma cells in the sentinel node the standard treatment is an operation to remove all the other lymph nodes in the area. This is because they may contain cancer cells too.

But lymph node dissection has side effects and doctors are not sure whether it is necessary to remove all the lymph nodes straight away. So in this trial some people will have their lymph nodes removed and some will have monitoring with regular ultrasound scans. The trial aims to find out whether people need to have all their lymph nodes removed straight away. 

The SUNMEL trial is checking whether ultrasound can find melanoma that has come back in the lymph nodes before it can be felt by hand.

Biological therapy is treatment with substances that are made naturally within the body. The types of biological therapies being researched for melanoma include

• Interferon
• Monoclonal antibodies
• BRAF inhibitors
• MEK inhibitors 
• Drugs that block cell growth
• Vaccines
• Gene therapy
• Tumour necrosis factor (TNF)

You can find out about biological therapy trials for melanoma on our clinical trials database. Go to the advanced search and choose 'melanoma' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

Interferon

For people with stage 2 or 3 melanoma, there is a risk that the melanoma will come back at some time after their surgery. Doctors have used interferon treatment to try to prevent this. Interferon is made naturally as part of the body's immune response. Trials so far have found that interferon only helps a few people and can cause side effects that lower people's quality of life. So it is not standard treatment. But doctors are trying to find out whether giving interferon in different ways can help. 

A trial is looking at giving interferon for one month compared to a year after surgery for melanoma. The trial aims to find out if giving interferon for 4 weeks works as well as carrying on giving it for a year.

Monoclonal antibodies

Some types of monoclonal antibody activate the immune system to seek out and destroy melanoma cells in the body. Trials have found that a monoclonal antibody called ipilimumab can help some people with advanced melanoma to live longer. The CA184024 study found that having ipilimumab with dacarbazine chemotherapy for stage 3 and 4 melanoma increased the length of time people lived after treatment. 

Trials are now looking at other ways of using ipilimumab for melanoma. There is a trial looking at whether ipilimumab can help to stop stage 3 melanoma coming back, after the melanoma has been completely removed by surgery. Doctors running this trial also want to find out more about the side effects of ipilimumab. 

Another monoclonal antibody is bevacizumab (Avastin). This is a treatment for advanced bowel cancer, and has also been used for other cancers. Doctors want to find out if giving it to people with high risk melanoma helps to stop the melanoma coming back, after it has been removed surgically. The AVAST-M trial is looking into using Avastin for people with stage 2B, 2C or 3 melanoma, which has been surgically removed. 

Another monoclonal antibody called CNTO 95 or intetumumab has been tried to see how well it works against advanced melanoma. A small international trial using intetumumab for advanced melanoma combined it with the chemotherapy drug dacarbazine (DTIC). The researchers found that it was safe to use and that it worked very slightly better for some people than dacarbazine on its own. They recommend further research to find out more about intetumumab.

BRAF inhibitors

Research has shown that a protein called BRAF is faulty in about half the people who have melanoma skin cancer. The BRAF fault (mutation) means that the cell receives too many signals to divide. So the melanoma cells divide too quickly and can grow rapidly. Researchers are looking into drugs that block the BRAF skin cancer protein. These groups of drugs are called BRAF inhibitors or pyridoimidazolones. 

Vemurafenib (Zelboraf) is a type of BRAF inhibitor. Recent research has found that it can shrink advanced melanoma for some people and help them to live longer. We have information about vemurafenib on the biological therapy for melanoma page in this section.

A trial is looking at dabrafenib and trametinib for advanced melanoma. Dabrafenib is a type of BRAF inhibitor. Trametinib is another type of biological therapy called a MEK inhibitor. Researchers want to compare dabrafenib and trametinib with dabrafenib on its own, to find out which is better at treating advanced melanoma with the BRAF mutation.

Another trial is comparing dabrafenib and trametinib with vemurafenib for advanced melanoma with the BRAF mutation.

MEK inhibitors

If the BRAF gene is faulty, it affects a protein called mitogen activated protein kinase (MEK). MEK sends signals to cells telling them to divide and grow. Doctors are looking at new types of drug that block the MEK protein and are called MEK inhibitors. Hyd-Sulfate (AZD6244) is a type of MEK inhibitor. A trial is looking at AZD6244 and dacarbazine for advanced melanoma in people with a BRAF gene fault. 

The DOC-MEK trial is looking at docetaxel (Taxotere) chemotherapy with or without AZD6244. The people taking part have advanced melanoma whose cells do not have a change in the BRAF gene. Doctors hope that using AZD6244 with docetaxel may work better than docetaxel alone.

There is a trial comparing the MEK inhibitor drug GSK1120212 with chemotherapy for melanoma that has spread. It is for people whose melanoma cells have a change in the BRAF gene. The trial wants to find out if GSK1120212 is better than dacarbazine (DTIC) or paclitaxel (Taxol) chemotherapy for advanced melanoma. Another trial is also looking at GSK1120212 with paclitaxel chemotherapy for advanced melanoma.

Drugs that block cell growth

Imatinib and nilotinib are 2 different types of biological therapy called tyrosine kinase inhibitors. This means they block chemicals (enzymes) called tyrosine kinases that a cancer needs in order to grow. Some melanomas have a receptor on the cell called CD117. When there is a lot of this receptor it is caused by a gene change (mutation). Doctors call these types of cells c-kit positive. In melanoma, c-kit positive cells are usually found in people with rarer types of melanoma that are found in the mucosal tissue (anus or vaginal). Or they are found in melanomas which are found on hands and feet (acral melanomas ).

Very early trials suggest that imatinib and nilotinib can help people with mucosal or acral melanomas that are c-kit positive. These drugs work best on c-kit positive cells. The NICAM trial is looking at nilotinib for people with advanced mucosal or acral melanoma with c-kit positive cells. The aim of the trial is to see how well the treatment works for this group of people.

Vandetanib is another type of tyrosine kinase inhibitor. Doctors know that this drug can make cancer cells more sensitive to radiotherapy. The RADVAN trial is looking to see if using vandetanib with radiotherapy can improve treatment for melanoma that has spread to the brain. The researchers will also be looking at the side effects of having this drug with radiotherapy.

A phase 2 study is looking at whether bortezomib and an epilepsy drug could be a treatment for melanoma. Bortezomib (Velcade) is a type of biological therapy called a proteasome inhibitor. It blocks cancer cells from breaking down proteins that the cell doesn't need, so the cell dies. Researchers know that the anti epilepsy drug sodium valproate blocks enzymes called histone deacetylases, which cells need to grow and divide. Early research into using drugs like sodium valproate for cancer has shown promising results. This study is to find out how small doses of bortezomib (Velcade) and the epilepsy drug sodium valproate work in people with melanoma. 

Vaccines

Cancer vaccines are a fairly new area of research. Vaccines may help your immune system to kill the cancer cells. The phase 3 trials that have been done so far have had disappointing results. But research into different types of vaccines is continuing.

One trial is looking at a treatment called OncoVEX GM-CSF for people with advanced melanoma that cannot be removed with surgery. The treatment uses a form of the cold sore virus that has been changed so that it is not harmful to normal cells but destroys cancer cells. GM-CSF is a growth factor that encourages the immune system to recognise and attack cancer cells. Doctors want to find out if the virus will kill cancer cells and if GM-CSF boosts the immune system to help fight cancer. 

The DERMA trial is looking at a type of vaccine called MAGE-A3 ASCI. Early trials showed that this vaccine slowed the growth of advanced melanoma. The researchers in the DERMA trial want to find out if it can delay or stop melanoma coming back after surgery. The vaccine teaches the immune system cells to recognise a protein called MAGE-A3 found on melanoma cells. This should help the immune system to find and kill any melanoma cells left after the surgery. The trial also aims to learn more about the side effects of the vaccine. 

The Ludwig study is looking at 2 new vaccines after surgery for melanoma. You have the vaccines as injections. Both of them use a protein called the NY-ESO-1 antigen, which is found on some cancer cells. The vaccines help the immune system to recognise this antigen and kill the cancer cells. In one injection, the protein is combined with something called ISCOMATRIX, which can stimulate the immune system. The other vaccine combines the protein with a virus that has been changed so that it can't cause disease. The trial aims to find out if these vaccines can stimulate an immune response and to learn more about how safe they are and what the side effects are.

There is a whole page about melanoma vaccines in this section.

Gene therapy

This is one of the newer approaches to cancer treatment and is in the very early stages of clinical trials in the USA and UK. It really is early days. We are a long way from having gene therapy treatment for melanoma. We don't yet know if it will work at all.

By studying how changes in genes make normal cells in the skin become cancerous, scientists aim to eventually develop gene therapy so that damaged genes in the cancer cells can be replaced with normal ones.

One example of gene therapy is with a drug called Augmerosen. It is also called oblimersen or Genasense. This drug can stop cells from making a protein found in many melanoma cells. The protein stops the melanoma cells dying off, as normal cells eventually would. An international phase 3 study has been looking at Augmerosen with a chemotherapy drug called dacarbazine (DTIC) for people with advanced melanoma. It will be a couple of years before the results are known. 

There is general information about gene therapy in the biological therapy section.

Tumour necrosis factor (TNF)

TNF is a type of biological therapy that has been tried, along with chemotherapy, in regional limb perfusion. Regional limb perfusion is a way of giving drug treatment to just one arm or leg that is affected by melanoma. It is usually used for melanoma that has come back in the same limb after it was first treated. More trials are needed before we know if it will help people with melanoma.

If melanoma spreads to the brain it can't be cured. But radiotherapy can sometimes help to shrink a melanoma tumour in the brain that is causing symptoms. Some people have surgery to remove the melanoma tumour. Or they may have stereotactic radiotherapy, which targets radiotherapy very precisely at the tumour. 

A trial is looking at giving radiotherapy to the whole brain (whole brain radiotherapy) after surgery or stereotactic radiotherapy. It wants to find out if having whole brain radiotherapy after surgery or stereotactic radiotherapy (or both) helps to delay the melanoma from coming back. It also wants to find out about the side effects of whole brain radiotherapy. Doctors don't know at the moment if this treatment is helpful or not.

Researchers are trying to find better ways of using chemotherapy for melanoma. Your doctors may suggest chemotherapy for melanoma

• If your melanoma has spread to other parts of the body
• If your melanoma is too advanced for surgery when it is diagnosed

Doctors have also used chemotherapy after surgery to try to lower the risk of the cancer coming back (adjuvant treatment). So far, there is no real evidence from research that adjuvant chemotherapy is helpful in stopping melanoma from coming back.

Dacarbazine (DTIC) has been tested more than any other chemotherapy drug for melanoma that has spread. It has had some success in controlling the melanoma for a time in some people. Dacarbazine (DTIC) is usually the first choice of doctors using chemotherapy to treat melanoma.

A newer chemotherapy drug called temozolomide (Temodal) has had some success in treating brain tumours. A trial called EORTC 18032 compared temozolomide with dacarbazine for advanced melanoma. But the trial found that having a higher dose of temozolomide more frequently than the standard dose was no better than dacarbazine.

Electrochemotherapy

In some countries doctors are looking at using bleomycin chemotherapy combined with an electrical current. This is called electrochemotherapy. The chemotherapy may be given into a vein or injected into the area of the melanoma. This treatment is very experimental at the moment and we don't know whether it will be helpful for melanoma. We don't know of any trials using this treatment in the UK.