These New Skin Cancer Treatments Unleash Your Immune System

Immunotherapy and the melanoma fight

After decades with little progress, cancer researchers have made major breakthroughs in the last few years in treating melanoma (the most serious type of skin cancer). The key to these advances? Immunotherapy is helping patients live longer.

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Chemotherapy — which is typically a first-line treatment — targets cancers directly. But immunotherapy spurs your immune system to attack cancer cells. This approach can offer new hope if you have melanoma.

Researcher and plastic surgeon Brian Gastman, MD, works with the latest advances in using immunotherapy to treat melanoma. He explains how they work.

Injections of modified herpes virus kill cancer cells

“One of the newest options is injecting a modified form of the herpes virus directly into the tumor,” Dr. Gastman says.

This modified virus is called talimogene laherparepvec, or T-VEC. Once doctors inject it, the virus replicates within the cancer cells and causes them to rupture and die.

Doctors use T-VEC to treat melanoma at the skin level, under the skin or in deep soft tissues, he says.

“One of the main reasons we give T-VEC is for what’s called in-transit metastases,” Dr. Gastman says.

He explains, “Let’s say someone had a melanoma in their foot. Typically, it would spread from the foot to the lymph nodes and from the lymph nodes all over the body.”

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But sometimes cancer cells get caught between the original site and the lymph nodes and cause “little satellite lesions,” he says. Those are in-transit metastases.

“If it’s on the arm or leg, you can inject the arm or leg with chemotherapy and it will kill the cancer, but it will also damage the arm or leg,” Dr. Gastman says.

T-VEC offers several advantages over chemotherapy in this situation:

  • It has few side effects
  • It won’t damage the surrounding tissue
  • It’s better for treating in-transit metastases in places such as the head, neck and back

Ipilimumab helps keep cancer from returning

Doctors still use ipilimumab, the first immunotherapy drug used to disrupt the growth and spread of cancer, for high-risk patients, but mostly as a help to other treatments. It’s sometimes used alongside or after the initial treatment, Dr. Gastman says.

In this case, patients receive a high dose of ipilimumab after surgery to help prevent the cancer from coming back. It’s significant because it is helping patients live longer, he says.

“This is the first time that an adjuvant (helper) therapy showed an improvement in survival rates over a placebo,” he says.

Exciting immunotherapy research

T-VEC and the new use for ipilimumab are the two major advances the FDA approved in recent years. There’s also a lot of exciting research happening, too, Dr. Gastman says.

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Now, another immunotherapy drug called Pembrolizumab is being used a lot, he says. “In 2016, there was data showing that 40 percent of stage IV melanoma patients treated only with pembrolizumab were alive in three years. That’s very exciting news.”

There’s also ongoing research that finds promise in a treatment that combines ipilimumab with another immunotherapy drug, nivolumab.

The study, which focuses on patients with advanced melanoma who received this combination, reported a two-year overall survival rate of 64 percent. Early results show that using the two drugs together is more effective than using either drug alone.

Dr. Gastman also notes that outcomes are improving as doctors learn more about how to prevent or better manage side effects from these drugs. The side effects, which are sometimes significant, may include:

  • Colitis
  • Skin reactions
  • Problems with pituitary and thyroid function
  • Other autoimmune disorders

“We’re much better now than we were five or six years ago at handling the toxic side effects,” he says.

Immunotherapies won’t completely replace other treatments like chemotherapy and surgery. But, they offer new and effective options for patients with melanoma. And ongoing research continues to make advances, Dr. Gastman says.

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