44 NCCN Guidelines for Patients ® : Melanoma, 2018 4 Overview of melanoma treatments Vaccine therapy | Chemotherapy Imatinib mesylate is a targeted therapy drug that may be used for certain melanoma tumors. It targets tumors that have a damaged c-kit gene, but this mutation is less common than a BRAF mutation in melanoma. Imatinib is also given as a pill that is swallowed. Cancer tissue may be removed from your body to be tested for specific gene mutations before you begin treatment with a targeted therapy drug. Side effects of targeted therapy A side effect is an unhealthy or unpleasant physical or emotional condition caused by treatment. Each treatment for melanoma can cause side effects. The reactions to treatment differ between people. Some people have many side effects. Others have few. Some side effects can be very serious while others can be unpleasant but not serious. Most side effects appear soon after treatment starts and will go away after treatment ends. But, other side effects are long- term and may appear years later. The side effects of targeted therapy depend on the drug and dose. Some of the side effects listed are caused by only one targeted drug. Others are caused by many targeted drugs but differ in how likely they are to occur. Some common side effects of targeted therapy drugs used for melanoma are tiredness, joint pain, muscle pain, swelling, headache, fever, nausea or vomiting, and diarrhea. These drugs may also cause low blood cell counts. Other common side effects are skin rash or itching, sun sensitivity, other skin cancer (not melanoma), and hair loss. Because so many of the side effects occur on the skin, most patients on targeted therapy are also followed by a dermatologist or provider experienced in the management of skin side effects of these drugs. Not all side effects of targeted therapy 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. Vaccine therapy This type of treatment is being tested in clinical trials for melanoma. A clinical trial is a type of research that studies the safety and effectiveness of a test or treatment. 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 that 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 48 for more details on clinical trials.) Chemotherapy Chemotherapy is a type of drug commonly used to treat cancer. Many people refer to this treatment as “chemo.” Chemotherapy drugs kill fast-growing cells, including cancer cells and normal cells. When only one drug is used, it is called a single agent. However, different types of chemotherapy drugs attack cancer cells in different ways. Therefore, more than one drug is often used. A combination regimen is the use of two or more chemotherapy drugs. Chemotherapy can be used as systemic therapy or regional therapy for melanoma, although it is not as effective as newer immunotherapies or targeted therapies. Thus, it is used less often. Chemotherapy may be given as a palliative treatment. The goal of palliative treatment would be to shrink or stabilize tumors when other treatment options are no longer working.