NCCN Guidelines for Patients® | Melanoma - page 40

40
NCCN Guidelines for Patients
®
: Melanoma
Version 1.2013
Part 4: Overview of melanoma treatments
Ipilimumab is a more recent immunotherapy drug used
as systemic treatment for melanoma. It is a monoclonal
antibody—a type of immune system protein made in a
lab. It works by removing the “brakes” on the immune
system. This boosts the immune system’s response
against melanoma cells in the body.
Interferon alfa can also be used as local treatment.
In this case it is injected directly into the tumor with a
needle. BCG (
B
acillus
C
almette-
G
uérin) is also a local
treatment that is injected directly into the tumor. The
third immunotherapy drug used as local treatment for
melanoma is imiquimod cream, which is rubbed onto the
surface of the tumor.
Vaccine therapy
This treatment is being tested in clinical trials for
advanced melanoma. Vaccine therapy for melanoma
is similar to vaccines used to prevent other diseases,
such as polio, measles, and mumps. These vaccines
have a weak or dead virus that can’t cause disease but
activates the immune system. Since it is unknown how
well vaccine therapies work for melanoma, they are only
recommended as part of a clinical trial. (See page 42 for
details on clinical trials.)
Targeted therapy
Targeted therapy drugs are designed to specifically
target cancer cells. For melanoma, these drugs target
the activity of a specific or unique feature of melanoma
cancer cells. Vemurafenib (Zelboraf™) is a targeted
therapy that the FDA (
F
ood and
D
rug
A
dministration)
approved for melanoma in 2011. It targets tumors that
have a damaged
BRAF
gene, so it will only help if you
have this type of melanoma. Vemurafenib is given as
a pill that is swallowed. Imatinib mesylate (Gleevec
®
)
is another targeted therapy drug that may be used for
certain melanoma tumors. It targets tumors that have a
damaged
c-kit
gene. Imatinib mesylate is also given as
a pill that is swallowed. Cancer tissue may be removed
from your body to be tested for genetic markers before
you begin treatment with a targeted therapy drug.
4.3 Radiation and ablative therapy
Radiation therapy
Radiation therapy uses a beam of high-energy rays to
kill cancer cells. The rays damage a cell’s instructions
for creating and controlling cells. This either kills the
cancer cells or stops new cancer cells from being made.
For melanoma, radiation is often given using a machine
outside the body. This method is called EBRT (
e
xternal
b
eam
r
adiation
t
herapy).
Radiation therapy is almost never used to treat the
primary melanoma tumor. Instead, it may be used after
surgery to kill any cancer cells that might have been
left behind. Radiation therapy may also be used to treat
recurrent or metastatic melanoma or to relieve symptoms
caused by the cancer. Recurrent melanoma is melanoma
that has come back (recurred) after treatment. Metastatic
melanoma is melanoma that has spread to parts of the
body far away from the first tumor.
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