Immunotherapy for melanoma skin cancer

Some people with melanoma skin cancer have immunotherapy. Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy or targeted therapy depending on how it works.

You may have immunotherapy to:

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

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You will probably receive other treatments.

The following types of immunotherapy drugs are used to treat melanoma skin cancer.

Cytokines are proteins made by certain cells of the immune system. They can also be made in a lab and given as a drug. Cytokines act as chemical messengers so the immune system cells communicate with each other and help control the immune response. Interferons and interleukins are types of cytokines.

Interferon alfa-2b (Intron A) is a type of cytokine that may be used for early stage or locally advanced melanoma skin cancer. It is mainly used after surgery to lower the risk of the cancer coming back. High doses of the drug are given by injection several days each week for 1 year. Usually the injections are given into a vein (intravenous) for the first 4 weeks. Then the injections are given into the tissue under the skin (subcutaneous) for the rest of the year.

Interleukin-2 (aldesleukin, Proleukin) is also a type of cytokine that may be used to help shrink and control the growth of metastatic melanoma skin cancer. Many doses of the drug are injected 2 or 3 times per day for 1 to 2 weeks. Interleukin-2 may also be used to treat locally recurrent melanoma skin cancer when there are many tumours on the skin that can’t be removed with surgery. The drug is injected directly into a tumour (called intralesional treatment).

The immune system usually stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Melanoma skin cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are drugs that 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. Sometimes they are given along with chemotherapy.

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 metastatic or unresectable melanoma skin cancer. It is given through a needle into a vein (intravenous infusion) once every 3 weeks for a total of 4 doses.

Nivolumab (Opdivo) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. It may be used after surgery that completely removes stage 3 or stage 4 melanoma to lower the risk of the cancer coming back (recurring). Nivolumab is also used to help shrink and control the growth of metastatic or unresectable melanoma skin cancer. It can be given alone when there is a change (mutation) in the BRAF gene or given in combination with ipilimumab. It is given through a needle into a vein once every 2 or 3 weeks until the disease progresses or the side effects outweigh the benefits of having the treatment.

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 of cancer coming back. Pembrolizumab is also used to help shrink and control the growth of metastatic or unresectable melanoma skin cancer. It is given through a needle into a vein once every 3 or 6 weeks for 1 year, until the disease progresses or the side effects outweigh the benefits of having the treatment.

Side effects can happen with any type of treatment for melanoma skin cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects of immunotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. The following are some common side effects of immunotherapy drugs used for melanoma skin cancer.

Interferon alfa-2b or interleukin-2 (cytokines) may cause these side effects:

• flu-like symptoms, including fever, chills and aches
• fatigue
• loss of appetite (anorexia)
• diarrhea
• nausea and vomiting
• skin problems, such as a rash
• low blood cell counts
• depression (more often with high-dose interferon alfa-2b)
• swelling from a buildup of fluid in the body (more often with interleukin-2)

Ipilimumab, nivolumab or pembrolizumab (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 difficulty breathing

Be sure to report side effects to the healthcare team. Side effects can happen any time during, immediately after or a few days or weeks after immunotherapy. Sometimes late side effects develop months or years later. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Your healthcare team is there to help. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

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