Ipilimumab For Advanced Melanoma
Ipilimumab can be effective for people with metastatic melanoma and stage III melanoma that cannot be removed completely with surgery. Ipilimumab works by blocking an immune molecule called CTLA-4.
In 2004, MSK patients were among the first in the world to receive ipilimumab treatment. MSK led the first clinical studies showing that ipilimumab could prolong the overall survival of people with metastatic melanoma. The US Food and Drug Administration approved the drug for general use in 2011. Clinical trials gave MSK patients the opportunity to receive ipilimumab years before the FDA approved it.
Giving Thanks And Giving Back
Fighting metastatic melanoma was a long, hard road, and I was extremely fortunate. But more than anything, I had an incredible team by my side, including:
- Thomas Froehlich, M.D. oncology, internal medicine
- Sheeba Cantanelli, P.A.-C.
- Stephanie Savory, M.D. melanoma, dermatology
- And countless nurses and other expert providers
I am convinced that I survived because Dr. Froehlich and my other doctors were always on the cutting edge of new treatments for this terrible disease. I always felt that I was getting the best and most innovative treatments. I never had any doubt we were proceeding correctly. I had, and continue to have, complete faith in the dedicated doctors and medical personnel at UT Southwestern who saved my life.
Since February 2018, Ive been feeling great and I continue to be cancer-free. I now find great joy in connecting with people who are going through experiences similar to mine. I am proud to be an original member of the patient family advisory board at UT Southwestern, which helps shape aspects of patient care.
I’ve also helped set up a partnership with Imerman Angels, an international program that enables one-on-one support among cancer fighters, survivors, and caregivers. Ive mentored many great people through this program and offered ideas and perspectives to stay mentally strong through treatment.
Different things work for different people. One of my mentees finds strength through meditation. You have to find what works for you.
Why Doesnt Immunotherapy Work For Everyone
In the last decade, immunotherapy has become a viable treatment option for many cancer patients. Unlike radiation and chemotherapy, immunotherapy does not target the cancer itself. Instead, it enables a patients own immune system to attack the disease. In most cases, immune-based treatments stimulate T cells, a specialized type of immune cell, to fight cancer.
Immunotherapy drugs called immune checkpoint inhibitors accomplish this by blocking checkpoint proteins that live on the surface of T cells and act as brakes to prevent the T cells from accidentally attacking healthy cells. Now a standard treatment for a growing list of cancers, checkpoint inhibitors have proven effective for treating several types of cancers, including melanoma, small cell lung cancer and non-small cell lung cancer, bladder cancer, kidney cancer, stomach cancer, liver cancer, head and neck cancers, and lymphoma.
The survival outlook for patients with metastatic bladder cancer used to be less than one year, but Im now seeing some of my patients coming back to the clinic over and over again, five years and longer, says Padmanee Sharma, M.D., Ph.D., co-leader of MD Andersons immunotherapy platform. Its very rewarding to see that stage IV cancer patients can have hope.
However, checkpoint inhibitors dont yet work for everyone. Certain cancers, including pancreatic cancer, prostate cancer and glioblastoma, have been especially resistant to this approach.
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Beating Melanoma Is A Marathon Not A Sprint
As told by Terry Hart
My melanoma story started in 1999 with the discovery of a tumor on my left bicep. I’m now a retired attorney, and I was fortunate that my law partner at the time suggested I go to UT Southwestern for treatment.
The doctors removed the tumor and nearby lymph nodes. I was sure I had beaten it and that I was good to go. And for 14 years, I was.
In 2013, another tumor popped up close to the location of the original melanoma. Thats when I met Dr. Froehlich. Under his guidance, the cancer team removed the tumor and I underwent radiation. Again, I thought that was that.
Less than a year later, I noticed a spot on my right arm. I had seen enough at that point to know it was skin cancer. But it was in an entirely different location, and I knew that was not good.
Melanoma can spread rapidly, progressing from the skin to deeper body tissues within a matter of weeks or months. Sure enough, we did a PET scan to look for tumors throughout my body. The scan lit up like a Christmas tree I had metastatic melanoma, which means the cancer had spread, depositing 12 to 15 tumors throughout my body.
Dr. Froehlich suggested immunotherapy.
The response was dramatic my tumors were shrinking. But our challenges were only beginning.
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What About Side Effects
Traditional chemotherapy can cause hair loss and blood problems. But immunotherapy drugs donât work in the same way.
When your immune system is on high alert, it may start to attack other body parts like your skin. If it does, you could get an itchy rash and loss of skin pigmentation. Infections may also occur. You might notice more serious side effects if your immune system goes into overdrive and starts to attack healthy tissues. This can lead to diabetes, and inflammation of your bowels, pancreas, and lungs. Rarely, there have been neurological problems such as Guillain-Barre syndrome and myasthenia gravis, and even fatal reactions from heart attack, lung toxicity, and liver injury.
If it affects your intestines, you might get diarrhea. The severity of side effects varies. Some people have mild to moderate symptoms, while others can have major problems. One popular treatment — a mix of two checkpoint inhibitors: ipilimumab and nivolumab — often causes severe fatigue and loss of appetite. This can seriously affect your quality of life.
Some treatments cause side effects so subtle that you barely know youâre having them. For example, the organs that make up your endocrine system, like the thyroid and pituitary, could get inflamed. Your doctor may not even know itâs happening unless they do a blood test.
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How Are They Treated
For most people, steroids can help manage the symptoms and not stop the drugs from working. Topical corticosteroid creams and oral antihistamines can often give quick relief for skin symptoms. Over-the-counter treatments should work for mild diarrhea as well.
High-test steroids like prednisolone or other drugs that suppress your immune system are also the choice to treat most other problems, which you may hear your doctor refer to as adverse events, or AEs.
In addition to steroids, you might have to take permanent hormone supplements after being on this type of treatment. If the symptoms are too severe, your doctor may pause your treatment for a while. But if you have a life-threatening reaction, youâll need to stop treatment.
No New Safety Concerns
Brain metastases can hinder brain function by destroying healthy brain cells and by causing swelling in the brain. Because immunotherapies can cause inflammation, there were concerns that these treatments might trigger brain swelling and more neurological issues, Dr. Tawbi explained.
However, only seven participants had a serious neurological side effect, such as swelling or bleeding in the brain. In total, 55% of participants had a serious adverse event related to the treatment, most commonly an immune response in the liver . One participant died from inflammation of the heart muscles , which was related to the treatment.
The safety profile in this population was consistent with that reported in studies involving patients without brain metastases, noted Drs. Turajlic and Larkin.
It appears theres no increased safety risk in patients with melanoma brain metastases, said Dr. Sharon. I think that was the most interesting finding.
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Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a procedure to test for the spread of cancer.
It may be offered to people with stage 1B to 2C melanoma. It’s done at the same time as surgical excision.
You’ll decide with your doctor whether to have a sentinel lymph node biopsy.
If you decide to have the procedure and the results show no spread to nearby lymph nodes, it’s unlikely you’ll have further problems with this melanoma.
If the results confirm melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required.
Additional surgery involves removing the remaining nodes, which is known as a lymph node dissection or completion lymphadenectomy.
Immunotherapy: What You Need To Know
- By Guru P. Sonpavde, MD, Contributor
Not all that long ago, chemotherapy was the only option to treat most advanced cancers. Because these drugs work by destroying rapidly dividing cells, they harm some healthy cells such as hair follicles as well as cancer cells. In the past two decades, cancer treatment has been transformed by targeted drugs and the emergence of immunotherapy. Targeted drugs are designed to home in on specific genes or proteins that are altered or overexpressed on cancer cells. Immunotherapy has been very successful for certain types of advanced cancers, such as lung, bladder, and skin cancers.
One form of immunotherapy is called an immune checkpoint inhibitor. It takes the brakes off immune cells, unlocking their ability to detect altered proteins on cancer cells in order to attack and kill these cells. These drugs include programmed death -inhibitors and PD-L1-inhibitors , and cytotoxic T-lymphocyte antigen -4 inhibitors .
The speed of FDA approvals for these drugs has outstripped the general understanding of their effects, and side effects, raising many questions for people who have cancer and even for many physicians. If youre receiving immune checkpoint inhibitors, or wondering about them as part of cancer therapy, here are some facts you should know.
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What Are The Signs That Immunotherapy Is Working
Immunotherapy is deemed effective when a tumor shrinks in size or at least stops growing. It is important to note that immunotherapy drugs may take longer to shrink tumors compared to traditional treatments like chemotherapy.
Rarely, the tumor may seem to enlarge on scans before getting smaller. This illusory enlargement is called pseudoprogression. It does not mean the immunotherapy treatment is not working. Rather, the immune cells penetrating and attacking the tumor make it look bigger. In a case when this happens, your care team may recommend waiting for 2 or 3 more treatment cycles to get a confirmatory scan.
Side effects such as inflammation can also confirm that immunotherapy treatment is impacting your immune system in one way or the other. In certain cancers, specific side effects point to the likelihood of treatment success. For example, melanoma patients who develop vitiligo are more likely to have success with their immunotherapy treatment.
Research is ongoing to see if there are ways to determine whether immunotherapy is working much earlier during treatment, or if certain aspects of the tumor make it more likely to respond to immunotherapy. This way, patients who may not benefit don’t have to experience side effects for long. They also will not have to delay trying other available therapies.
The Future Of Immunotherapy
Terry’s story shows the powerful effects, as well as the challenges, associated with immunotherapy. It is a relatively new treatment, and we continue to refine it and use it in new ways. Weve seen how it works against melanoma, as well as kidney cancer and lung cancer.
And while immunotoxicities are not what we want, there is some data to suggest that patients who get them are more likely to respond to the treatment. We dont know exactly why, and through clinical trials we are working to prevent side effects while continuing to reap the benefits of immunotherapy.
Clinical trials offer gold standard of care plus the newest available treatments, often at little to no cost to patients. These studies help us advance treatment options for more patients.
If you or a loved one is diagnosed with metastatic melanoma, ask your doctor about immunotherapy. Find an academic medical center that has teams of experts in place not only to manage your care, but also the potential side effects of treatment.
Weve only scratched the surface of what immunotherapy can offer cancer patients. But at UT Southwestern and Simmons Cancer Center we are determined to continue improving it to help more patients like Terry beat this disease and lead longer, healthier lives.
To find out whether you or a loved one might benefit from immunotherapy, call or request an appointment online.
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When You Might Have Targeted Cancer Drugs Or Immunotherapy
You might have targeted cancer drugs or immunotherapy for some stage 3 melanomas to help reduce the risk of the cancer coming back.
Stage 3 generally means that the melanoma has only spread to the nearby lymph nodes or to an area between the primary melanoma and the nearby lymph nodes. You might have targeted cancer drugs or immunotherapy:
- if melanoma cells are found in your lymph nodes after a sentinel lymph node biopsy
- after surgery to remove your lymph nodes or in-transit metastases
In-transit metastases are areas of cancer that have spread more than 2cm from where the melanoma started but not as far as the nearby lymph nodes.
Or you might have targeted cancer drugs or immunotherapy for melanoma that cant be removed with surgery . Or if it has spread to another part of the body .
What Are The Types Of Immunotherapy
Several types of immunotherapy are used to treat cancer. These include:
- Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.
-
Learn more about immune system modulators.
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How Often Do You Receive Immunotherapy
How often and how long you receive immunotherapy depends on:
- your type of cancer and how advanced it is
- the type of immunotherapy you get
- how your body reacts to treatment
You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to immunotherapy, and build new healthy cells.
How Does Immunotherapy Work Against Cancer
As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors dont contain them.
Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:
- Have genetic changes that make them less visible to the immune system.
- Have proteins on their surface that turn off immune cells.
- Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.
Immunotherapy helps the immune system to better act against cancer.
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Moffitts Approach To Melanoma Immunotherapy
The Cutaneous Oncology Program at Moffitt Cancer Center takes a multispecialty, coordinated approach to the treatment of skin cancers. Our melanoma team, for instance, comprises physicians from every treatment specialty medical oncology, radiation oncology, surgical oncology, dermatology and more all trained and experienced in the treatment of melanoma.
Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center, nationally renowned for its comprehensive treatment and supportive care, as well as its groundbreaking research and robust clinical trials program, which includes a wide range of immunotherapy options for melanoma and many other forms of cancer.
If youd like to consult with an oncologist specializing in immunotherapy treatment options for melanoma, call or fill out a new patient registration form online.
New Research Reveals Why Some Patients Do Not Benefit From Immunotherapy Treatments
Scientists are one step closer to understanding why immunotherapy is an effective treatment for some cancer patients but not for others.
Immunotherapy is a new type of treatment that is touted by some as a breakthrough in the fight against cancer. It uses the body’s own immune system to attack cancer cells. But the treatment is expensive, it has many side effects, and in some patients it has virtually no effect.
Now scientists have discovered how immunotherapy activates the immune system to recognise and destroy cancer cells in some patients but not in others. It seems that the immune system can only recognise cancer cells that have particular genetic mutations.
“It’s very big news, which gives us a much better understanding of how immunotherapy works,” says Marco Donia from the Centre for Cancer Immunotherapy at Herlev Hospital, Denmark, who was not involved in the new research.
“It’s certainly an exciting and important discovery. Immunotherapy is a very expensive treatment, which only has an effect on some patients. Its vital that we have the tools to see which patients will benefit from treatment and which ones wont,” says Professor Ulrik Lassen from the oncology department at the University of Copenhagen Hospital, Denmark. He was not involved in the new research.
The immune system recognises particular genetic mutations
Only then, can the body’s immune system recognise and attack the cancer when the patient is receiving immunotherapy.
Cancer tumours are like trees
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