Immunotherapy for melanoma skin cancer

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Some people with melanoma skin cancer have immunotherapy. If you have immunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Immunotherapy may be used along with other treatments. You may have immunotherapy to:

• lower the risk that the cancer will come back (recur) after surgery
• stop or control the growth and spread of cancer cells
• shrink metastatic melanoma

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think might be from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Different types of immunotherapy are used for melanoma.

Localized therapy means that the treatment is given directly into or put on the surface of tumours. The following immunotherapy drugs are used as localized therapy for melanoma.

Aldesleukin (Proleukin or interleukin-2, IL-2) is a type of immunotherapy drug called a cytokine. Cytokines stimulate the immune system to attack cancer cells. Aldesleukin may be used to help shrink and control the growth of cancer that has spread to nearby areas of the skin (called satellite tumours) or to lymph vessels (called in-transit metastasis) if it can't be removed by surgery. It may also be used to treat locally recurrent melanoma when there are many tumours that can't be removed by surgery. The drug is injected directly into a tumour (called intralesional treatment).

Topical diphenylcyclopropenone (DPCP) is an immunotherapy drug that stimulates an immune response from your body. DPCP is applied to the skin as a cream.

Imiquimod (Aldara, Zyclara) is a type of immunotherapy drug called an immune response modifier. It uses your immune system to help destroy cancer cells. It is applied to the skin as a cream and can be used with aldesleukin.

Aldesleukin may cause these side effects:

• flu-like symptoms, including fever, chills and aches
• fatigue
• loss of appetite
• diarrhea
• nausea and vomiting
• sore mouth and throat

Topical DPCP and imiquimod may cause these side effects:

• skin problems, including redness, itching, dry flaking skin and colour changes to the skin in the treated area
• swelling (edema)
• discharge from the wound

The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints. Checkpoints slow down or stop an immune system response. Sometimes melanoma cells can use these checkpoints to hide and avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so immune system cells (called T cells) can attack and kill the cancer cells.

Immune checkpoint inhibitors are monoclonal antibodies, which are substances that find and attach to a specific antigen on a cancer cell. They may be used alone or in combination with each other.

Nivolumab (Opdivo) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. It may be used after surgery that completely removes stage 2B, stage 2C or stage 3 melanoma to lower the risk that the cancer will come back (recur). Nivolumab is also used alone or in combination with ipilimumab to help shrink and control the growth of unresectable locoregional or metastatic melanoma. It can also be given after treatment with ipilimumab and targeted therapy. Nivolumab is given through a needle into a vein (called intravenous infusion).

Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. It may be used after surgery that completely removes stage 2B, stage 2C or stage 3 melanoma to lower the risk that the cancer will come back. Pembrolizumab is also used to help shrink and control the growth of unresectable locoregional or metastatic melanoma. It is given through a needle into a vein.

Nivolumab and relatlimab (Opdualag) may be used for unresectable locoregional or metastatic melanoma that hasn't been treated with systemic therapy. Relatlimab is an immune checkpoint inhibitor that targets both the PD-1 and LAG-3 checkpoint proteins. This treatment is given through a needle into a vein.

Ipilimumab (Yervoy) is an immune checkpoint inhibitor that targets the CTLA-4 checkpoint protein. It is used to help shrink and control the growth of unresectable locoregional or metastatic melanoma. It is given either alone or in combination with nivolumab. Ipilimumab is given through a needle into a vein.

Immune checkpoint inhibitors may cause these side effects:

• fatigue
• diarrhea
• skin problems, such as a rash
• headaches
• liver problems, such as yellow skin and eyes
• thyroid problems, which may cause changes in weight, body temperature, heart rate and blood pressure
• lung problems, such as cough and shortness of breath

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.