NCCN Guidelines for Patients® | Melanoma - page 82

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
80
5.5
Treatment guide
Metastatic melanoma
Principles of systemic therapy
Ipilimumab
is an immunotherapy drug used as
systemic therapy for advanced and metastatic
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. Examples of autoimmune
disorders include ulcerative colitis and active
rheumatoid arthritis.
Vemurafenib, dabrafenib, and trametinib
are targeted therapy drugs used as systemic
therapy for certain advanced and metastatic
melanomas. Targeted therapy drugs are
designed to specifically target cancer cells.
These three targeted therapies treat melanoma
tumors that have a damaged
BRAF
gene.
Vemurafenib
can cause serious side effects
such as non-melanoma 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.
Dabrafenib
can also cause serious side effects
such as non-melanoma skin cancer and severe
fevers. Therefore, you should have regularly
scheduled skin exams with your doctor while
taking dabrafenib and see a dermatologist if
you have any skin symptoms. For severe or
frequent fevers, you should briefly stop treatment
with dabrafenib and take medicine to lower the
fever. You can take acetaminophen (Tylenol) or
a nonsteroidal anti-inflammatory drug such as
ibuprofen (Motrin).
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 IL-2
(
i
nter
l
eukin-2) or biochemotherapy is being
considered because each can cause serious
side effects. You should not take high-dose IL-2
if your organs aren’t working well, your overall
health isn’t good, or you have untreated or
active brain metastases. Biochemotherapy and
high-dose IL-2 should be given by medical staff
experienced with these treatments.
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