This is a groundbreaking treatment for this dangerous skin cancer.
Unlike treatment for other types of skin cancer, metastatic melanoma may require something called adjuvant therapy—the supplementary treatment after surgical excision of the skin lesion that helps prevent melanoma recurrence. That’s because melanoma is more likely than other skin cancers to metastasize, or spread throughout the body.
Previously, adjuvant therapy for metastatic melanoma would use traditional options like chemotherapy or radiation therapy. These methods come with a number of harsh side effects and have unpredictable effectiveness.
Today, patients have better, less toxic, and more effective options for preventing and treating metastatic melanoma: immunotherapy and targeted therapy.
What Is Targeted Therapy?
Targeted therapy uses “oral drugs that are deliberately developed to target genetic changes in the melanoma,” says Jeffrey Weber, MD, PhD, medical oncologist and melanoma researcher at Perlmutter Cancer Center at NYU Langone Health. Not every person with metastatic melanoma may be eligible for targeted therapy. That’s because this type of adjuvant therapy targets specific gene mutations associated with melanoma—but not everyone with melanoma has those exact mutations.
Here’s how it works. As many as half of the people with melanoma have mutations in the BRAF gene, according to the American Cancer Society (ACS). “If those melanomas have the BRAF gene, it drives the growth and the spread of the tumor,” says Dr. Weber. “If you have a drug that can specifically block it, it will cause the tumor to shrink.”
For people with this BRAF mutation, a drug called a BRAF inhibitor can target that protein on the melanoma cell to help shrink the growth of tumors. Alternatively, some people with melanoma have mutations in the MEK or C-KIT genes. MEK inhibitors and C-KIT inhibitors can help treat melanoma for people with these mutations.
Often, doctors will combine a MEK inhibitor and a BRAF inhibitor. “You’ll have a cocktail of potential drugs, and based on the genetic profile of the individual patient’s tumor, you’ll decide which drugs to use,” says Dr. Weber.
Because targeted therapy attacks specific melanoma cells, it causes fewer side effects than chemotherapy and is much more effective for most people with metastatic melanoma.
For people with melanoma who have neither of these gene mutations, immunotherapy is the best option. Learn more here about immunotherapy for metastatic melanoma.
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In adjuvant melanoma therapy the drugs we
most commonly use fall in two categories.
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Either immunologic drugs or targeted
drugs, which generally are oral drugs
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that are deliberately developed to
target genetic changes in the melanoma.
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Not in the patient, but in the melanoma.
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About 40 to 50% of melanomas
have a genetic change or
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a mutation called BRAF or B-RAF, and
if those melanomas have the BRAF gene,
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it drives the growth and
the spread of the tumor.
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And if you have a drug that
can specifically block it,
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it will cause the tumor to shrink and
cause benefit for the patient.
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We will often use those oral drugs in
combinations, we call them the BRAF and
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MEK drugs, and there are three
combinations that are FDA-approved.
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You'll have a cocktail of potential drugs,
and based on the genetic profile
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of the individual patient's tumor,
you'll decide which drugs to use.
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And that tumor may evolve over time.
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Tumors are very clever and very carefully
avoiding the attentions of both
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the immune system and our targeted drugs.
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So they evolve.
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And so you'll be constantly having, it's
like a chess game, point counterpoint.
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You'll treat the tumor with drugs X and
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then six months later
they'll develop resistance.
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So you'll give them A and B.
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But that's what'll happen,
I predict by the time I retire,
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which I hope would be less
than ten years from now.
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I predict that we're doing
real precision medicine
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by doing a blood test at
intervals of three months,
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to assess whether the tumor now is no
longer sensitive to your treatment.
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And it'll anticipate the sensitivity
to the next treatment, and
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you'll give the next treatment, and then
put the patient in remission for years.
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And then they'll eventually relapse and
you'll try something new and
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put them into remission again.
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But they'll live a long time.
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Adjuvant therapy for cutaneous melanoma. Waltham, UpToDate, 2019. (Accessed on March 5, 2019 at https://www.uptodate.com/contents/adjuvant-therapy-for-cutaneous-melanoma.)
Targeted therapy for melanoma skin cancer. Atlanta, GA: American Cancer Society. (Accessed on March 5, 2019 at https://www.cancer.org/cancer/melanoma-skin-cancer/treating/targeted-therapy.html.)