NCCN Guidelines for Patients
Part 6: A step-by-step treatment guide
Principles of systemic therapy
Ipilimumab is an immunotherapy drug used as systemic therapy for advanced melanoma. Immunotherapy
is treatment that activates the body’s natural defense against disease (immune system) to fight cancer cells.
However, ipilimumab can cause serious side effects involving the immune system. You should take part in
your treatment center’s REMS program while taking ipilimumab. A REMS program is a system for tracking and
treating side effects. Ipilimumab should be used with extreme caution, if at all, if you have a serious autoimmune
disorder—a health condition that causes the immune system to attack healthy tissue in the body.
Vemurafenib is a targeted therapy drug used as systemic therapy for certain advanced melanomas. Targeted
therapy drugs are designed to specifically target cancer cells. Vemurafenib treats melanoma tumors that have
gene. However, vemurafenib can cause serious side effects such as skin cancer, extreme
sensitivity to sunlight, and joint pain and swelling. You should have regularly scheduled skin exams with your doctor
while taking vemurafenib. You should also see a dermatologist if you have any symptoms. A dermatologist is a
doctor who’s an expert in diseases of the skin.
Biochemotherapy is combination treatment with immunotherapy and chemotherapy. You and your doctor may
consider biochemotherapy to control symptoms or so that you can receive other treatment. However, a special
warning is needed when treatment with high-dose interleukin-2 or biochemotherapy is being considered because
each can cause serious side effects. You should not take high-dose interleukin-2 if you have poor organ reserve,
poor performance status, or untreated or active brain metastases. High-dose interleukin-2 may be considered for
certain patients to treat small brain metastases without major swelling around the tumor. Biochemotherapy and
high-dose interleukin-2 should be given by medical staff experienced with these treatments.