42 NCCN Guidelines for Patients ® : Melanoma, 2018 4 Overview of melanoma treatments Immunotherapy Ipilimumab can also be given in lower doses to treat melanoma that can’t be removed by surgery or has spread to distant sites and is also combined with anti-PD1 therapy to improve immune responses in patients with advanced melanoma. Side effects of ipilimumab The most common side effects of ipilimumab are fatigue, diarrhea, skin rash, and itching. Ipilimumab can also cause serious side effects such as severe inflammation and problems in the intestines, liver, nerves, skin, eyes, and hormone glands. Interferon alfa and IL-2 Two older immunotherapy drugs used as systemic therapy for melanoma are interferon alfa and IL-2 ( i nter l eukin- 2 ). Another name for IL-2 is aldesleukin. Interferon alpha and IL-2 are molecules called cytokines that stimulate immune cells. Cytokines exist naturally in your body as part of the immune system—the body’s natural defense against infection and disease. They can also be made in the lab and be used as drugs to treat melanoma. When used as a treatment, cytokines are given in much higher amounts than what the body naturally makes. High doses of these drugs may cause severe side effects. A side effect is an unplanned or unwanted physical or emotional condition caused by treatment. Doctors don’t completely agree about using interferon alfa as adjuvant treatment. This is because its benefits may not clearly outweigh the side effects. Talk with your doctor if you have any concerns about taking interferon alfa. Interferon alfa and IL-2 can also be used as local therapy. In this case, the drugs are injected directly into the tumor with a needle. Side effects of interferon alfa and IL-2 A side effect is an unhealthy or unpleasant physical or emotional condition caused by treatment. The side effects of immunotherapy depend on the drug, how it is given, the amount taken, the length of treatment, and the person. When given in high doses, some immunotherapy drugs can cause very serious side effects. Flu-like symptoms are a very common side effect of interferon alfa and IL-2. Such symptoms include fever, chills, tiredness, headache, and body aches. Some of the other most common side effects of interferon alfa are nausea, vomiting, not feeling hungry, depression, hair thinning, and liver damage. Other common side effects of IL-2 are low blood pressure, nausea, vomiting, shortness of breath, confusion, fluid buildup, heart damage, skin rash, and abnormal bloods tests suggesting liver or kidney problems. Not all side effects of immunotherapy drugs are listed here. Be sure to ask your treatment team for a complete list of common and rare side effects. If a side effect bothers you, tell your treatment team. There may be ways to help you feel better. There are also ways to prevent some side effects. T-VEC T-VEC ( t alimogene laherparep vec ) is one of the newer immunotherapy drugs approved for melanoma. It is a type of virus made in a lab to infect and kill mainly cancer cells. T-VEC is used as local therapy and is given as an injection into metastatic, but not primary, melanoma tumors. In addition to killing the cancer cells directly, T-VEC also triggers the immune system to find and attack the cancer cells nearby and sometimes elsewhere in the body. Side effects of T-VEC The most common side effects of T-VEC are fatigue, chills, fever, nausea, vomiting, and pain at the injection site. Flu-like symptoms are also a common side effect of T-VEC. Such symptoms include fever, chills, tiredness, headache, and body aches.