40 NCCN Guidelines for Patients ® : Melanoma, 2018 4 Overview of melanoma treatments Immunotherapy Immunotherapy The immune system is the body’s natural defense against infection and disease. The immune system has many chemicals and proteins that are made naturally in the body. These substances can also be made in a lab to use as immunotherapy. Immunotherapy (also called biological therapy) is treatment that increases the activity of your immune system. By doing so, immunotherapy drugs improve your body’s ability to find and destroy cancer cells. Immunotherapy may be used as adjuvant treatment after surgery. Or, it may be used as primary treatment for melanomas that can’t be removed by surgery. Depending on how the drugs are given, immunotherapy can be used as local therapy or as systemic therapy. Guide 3 lists the immunotherapy drugs used as systemic therapy for melanoma. Guide 4 lists the immunotherapy drugs that are used as local therapy for melanoma. Pembrolizumab and nivolumab Pembrolizumab and nivolumab are two newer immunotherapy drugs approved for melanoma. They are a type of immunotherapy called PD-1 ( p rogrammed d eath receptor-1) inhibitor. PD-1 is a protein found on immune system cells called T cells. PD-1 normally helps keep T cells from attacking other cells in the body. These drugs block the PD-1 protein and boost the immune system response against the melanoma cells. This helps the immune system find, attack, and kills melanoma cells. Pembrolizumab and nivolumab are used as systemic therapy for melanoma. Adjuvant treatment with PD-1 inhibitors may prevent recurrence following surgery in patients with lymph node involvement. They are given every few weeks as a liquid that is injected into a vein. Receiving treatment with drugs Cancer doctors use drugs to treat melanoma in different ways. Sometimes drugs are given to treat melanoma in a specific, small area of the body, such as the tumor and nearby area. This is called local therapy or regional therapy. Drugs can also be given to treat melanoma throughout the body. This is called systemic therapy. Doctors use systemic drugs to treat cancer cells that may have spread beyond the skin to distant sites. The types of drugs used for melanoma include immunotherapy, targeted therapy, vaccine therapy, and chemotherapy.