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Immunotherapy for Melanoma

Immunotherapy is a form of medicine that targets specific immune system components to treat conditions like cancer. There are several ways to accomplish this:


stimulating or enhancing your immune system's natural defences to make it work harder or smarter to detect and destroy cancer cells

To repair or enhance the capacity of your immune system to detect and eliminate cancer cells, researchers are creating in the lab substances that are identical to immune system components.

Immunotherapy has grown in importance as a component of various cancer treatments during the past few decades. New immunotherapy therapies are being evaluated and approved, and the understanding of how the immune system functions are expanding quickly.





Some cancer types respond to immunotherapy more effectively than others. Some of these tumours are treated with it alone, but for others, it seems to function best when combined with other forms of therapy.



Immunotherapy refers to the use of drugs to enhance the ability of the body's immune system to recognise and eradicate cancer cells. To treat melanoma, a variety of immunotherapies can be used.


Immune checkpoint blockade


The immune system's capacity to restrain itself from attacking healthy bodily cells is a crucial component. In order to activate an immune response, "checkpoints," which are proteins on immune cells, must be turned on (or off). These checkpoints are sometimes used by melanoma cells to prevent immune system attacks. However, these medications work to restore the immune response against melanoma cells by targeting the checkpoint proteins.




PD-1 blockers


Drugs that target PD-1, a protein on immune system cells called T cells that typically aids in preventing these cells from attacking other cells in the body, including pembrolizumab (Keytruda) and nivolumab (Opdivo). These medications enhance the immune response against melanoma cells by inhibiting PD-1. This frequently causes tumours to shrink and lengthens life.


They are capable of treating melanomas:


Surgery cannot be used to eliminate that.


that has spread to different body parts



After surgery (as adjuvant therapy) for some stage II or stage III melanoma in an effort to reduce the chance of the tumour returning


Depending on the substance and the reason for administration, these medications are commonly administered intravenously (IV) infusions every 2 to 6 weeks.





PD-L1 blocker


A medication called atezolizumab (Tecentriq) targets PD-L1, a protein that is linked to PD-1 and is present in some immune and tumour cells. By preventing this protein, the immune system's reaction to melanoma cells can be strengthened.




When surgical removal of the tumour is not possible or it has spread to other parts of the body, this medication can be administered in combination with cobimetinib and vemurafenib in patients with melanoma that contains the BRAF gene mutation.




This medication is administered intravenously (IV) every two to four weeks.




CTLA-4 blocker


Another medication that stimulates the immune system is ipilimumab (Yervoy), however, it targets a different part of the body. Another protein on T cells called CTLA-4 that typically aids in controlling them, is blocked by it.




Melanomas that cannot be surgically removed or that have spread to other body parts can be treated with it. In some circumstances, it may also be applied to less advanced melanomas following surgery (as an adjuvant treatment) in an effort to reduce the likelihood of cancer returning.




Since it has more severe adverse effects than the PD-1 inhibitors and doesn't appear to reduce as many tumours when given alone, one of those other medications is typically utilised first. Combining this medication with one of the PD-1 inhibitors may be an additional choice in certain circumstances. This can potentially improve the likelihood of tumour shrinkage (a little more so than a PD-1 inhibitor alone), but it can also potentially raise the risk of adverse effects.




For four treatments, this medication is administered intravenously (IV), often once every three weeks (although it may be given for longer when used as an adjuvant treatment).





LAG-3 blocker

Relatlimab targets LAG-3, another immune cell-specific checkpoint protein that often aids in controlling the immune system.




With the PD-1 inhibitor nivolumab, this medication is administered (in a combination known as Opdualag). Melanomas that cannot be surgically removed or that have spread to other body parts can be treated with it.




An intravenous (IV) infusion of this medication is normally administered once every four weeks.




Immune checkpoint inhibitors' potential adverse effects:

These medications can have a number of adverse effects, but some of the most frequent ones are weakness, coughing, nausea, skin rashes, low appetite, constipation, joint pain, and diarrhoea.


Less frequently, other, more severe adverse effects develop.


Some individuals may experience an infusion response when receiving these medications. This might cause symptoms similar to an allergic reaction, such as a fever, chills, facial flushing, rash, itchy skin, feeling lightheaded, wheezing, and breathing difficulties. It's crucial to inform your doctor or nurse as soon as possible if you have any of these side effects while taking these medications.


Autoimmune reactions: These medications take away one of the body's immune system's defences. Sometimes the body's immune system reacts by attacking other organs or tissues, which can result in significant or even fatal issues with the kidneys, liver, lungs, intestines, liver, or other organs.




It's crucial to notify a member of your healthcare team right once of any new adverse symptoms. If major adverse effects do arise, therapy may need to be halted, and your immune system may be suppressed with large doses of corticosteroids.




Interleukin-2 (IL-2)


Proteins called interleukins are produced by specific cells in the body to enhance the immune system generally. Interleukin-2 (IL-2) derivatives created in laboratories are occasionally used to treat melanoma. At least initially, they are administered as intravenous (IV) infusions. It's possible for some patients or carers to learn how to administer injections under the skin at home.




When taken alone, IL-2 can occasionally cause advanced melanomas to shrink. Because immune checkpoint inhibitors are more likely to benefit patients and frequently have fewer adverse effects, it is not used as frequently as it once was. But if these medications stop working, IL-2 might be an alternative.




Flu-like symptoms like fever, chills, pains, extreme fatigue, sleepiness, and low blood cell counts are possible side effects of IL-2. In excessive doses, IL-2 can cause fluid to accumulate in the body, causing swelling and a sickly feeling. High-dose IL-2 is only administered in hospitals and other facilities with experience administering this kind of treatment due to this and other potentially serious side effects.




Even if it appears that all of cancer has been removed, some earlier-stage melanomas are more likely to recur in another area of the body if they have spread to the adjacent lymph nodes. To try to stop this, IL-2 can occasionally be administered directly into the tumours (a procedure called intralesional treatment). When IL-2 is administered directly into the tumour, the side effects are comparable but typically less severe.




Patients and their doctors must weigh the potential advantages and disadvantages of using IL-2 while making this decision.




Viral oncolytic treatment


A form of germ that may infect and kill cells is a virus. In the lab, certain viruses can be changed to primarily infect and kill cancer cells. These viruses have the name "oncolytic." The viruses can not only damage the cells directly but can also signal the immune system to target the cancer cells.




The oncolytic virus talimogene laherparepvec (Imlygic), often known as T-VEC, is used to treat melanomas in the skin or lymph nodes that cannot be surgically removed. Every two weeks on average, the virus is injected directly into the tumours. These tumours may occasionally become smaller with this treatment, as well as tumours in other areas of the body.




Flu-like symptoms and soreness at the injection site are possible side effects.




Vaccination against Bacille Calmette-Guerin (BCG)


A similar bacterium to the one that causes tuberculosis is BCG. In people, BCG does not lead to significant illness, although it does stimulate the immune system. Although it is rarely used, the BCG vaccine can be directly injected into tumours to help cure stage III melanomas.




Imitrex cream


Imiquimod (Zyclara) is a medication applied topically. The local immune system is triggered to fight skin cancer cells. Some doctors may prescribe imiquimod for extremely early (stage 0) melanomas in delicate parts of the face if surgery would be disfiguring. For some melanomas that have migrated across the skin, it might also be a possibility.




For about three months, the cream is typically administered 2 to 5 times per week. This medication might cause severe skin responses in some people. For melanomas that are further advanced, imiquimod is not used.




Newer therapies


In preliminary research, a few other kinds of immunotherapy have shown promise in the treatment of melanoma. Currently, further studies are examining the possibility of improving the effectiveness of immunotherapy by combining various forms of treatment. Please click here to see more.



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