Consensus statement from the society for immunotherapy of cancer

This review examines the evidence regarding immunotherapy in the treatment of advanced melanoma.

While early detection and surgical treatments have significantly reduced mortality rates for early stage melanoma patients, survival rates for advanced melanoma patients remain relatively low. Recent advances based on immune modulating drugs (drugs which affect the activity of the immune system and its response to cancer cells) have recently been reported.  This review analyzed evidence regarding immunotherapies in an attempt to reach broad recommendations regarding their use in the management of advanced melanoma.

Expert recommendations based on this review of the evidence state that for patients with a high risk of recurrence after surgery (such as patients with cancer that spread to the lymph nodes, with tumors greater than 4mm or with skin ulcerations), treatment with interferon-α2b (Intron-A) is recommended. Interferon has been shown to lead to a 23% increase in the time to disease recurrence, though it has not been shown to offer any benefit in overall survival. Patients with stage 3 melanoma and ulcerations may benefit from treatment with a similar interferon based drug; pegylated-interferon-α2b.

For metastatic melanoma (melanoma that has spread to distant organs), surgical removal of the cancer, wherever it has spread to, should be performed if possible.  In addition, immunotherapy with high-dose interleukin-2 (IL-2) and ipilimumab (Yervoy) are recommended.  Studies have shown that response rates to IL-2 treatments (as measured by tumor shrinkage) are 16% to 17%. Ipilimumab has been shown to lead to a 4 month increase in the overall survival of metastatic melanoma patients.

For patients with a BRAF mutation (a mutation in the BRAF gene which may stimulate cancer cells to grow very rapidly), BRAF inhibitors such as vemurafenib (Zelburaf) are recommended to slow cancer growth and spread. Some studies have shown that vemurafenib may increase survival rates of BRAF mutated melanoma patients by up to 63%.

Immunotherapies may also lead to several adverse effects, such as immune damage to healthy organs. Interferon-α2b may often lead to depression, and patients who struggle with depression should be closely monitored or should consider other treatments.

This review concluded that immunotherapy is effective in the treatment of advanced melanoma patients.

Consult with your physician regarding the risks and benefits of immunotherapies in the treatment of melanoma.