Chemoterapy
Chemotherapy: it ’s used on local melanoma recurrence and as a treatment in advanced melanoma. Therapy is given by mouth, injected into a vein and sometimes by regional limb perfusion. One of the best drugs is dacarbazine (DTIC) sometimes combined with cisplatin or vinblastine or temozolamide ortamoxifen. In some trials have been used temozolamide. Side effects: low blood cells, fatigue, diarrhea, loss or thinning hair, mouth ulcers, loss of fertility, nausea and vomiting, loss of appetite, an increased chance of infection. Hyperthermic isolated limb perfusionis is a method that allows drugs to remain confined to one limb without circulating in the body. It ’ s utilized in cases of melanoma of the limbs and is done under general anesthesia. It separates the circulation of the involved limb from the rest of the body and injects high doses of drugs into the artery feeding the limb. The blood can be heated to obtain better results. At the end the limb circulation is reconnected to the general circulation. Side effects are limited to mild pain, swelling and redness at the shoulder or groin, alopecia of the limb, rarely palmar o plantar vescicles. The drugs used are DTIC alone or with other chemotherapy drugs such as BCNU, and cisplatin. Dartmouth regimen: the combination of these three chemotherapy drugs, together with tamoxifen. Cisplatin,vinblastine, and DTIC is another chemotherapy combination. Temozolomide is a new drug that works like DTIC and can be get by mouth
Perfusione regionale
Immunotherapy: it is based on the principle that the host immune system is able to generate an immune response against tumor cells. The treatments currently available are limited by poor response. Interferon alpha is approved for the treatment of stage III melanoma with improved survival rates. Currently, immunotherapy is the choice treatment in metastatic melanoma. The use of interleukin-2 can help boost immunity in patients with melanoma. A study showed that out of 305 metastatic melanoma treated 4% had complete regression and 13% had a positive response. The occurrence of a “capillary leak” syndrome has limited use. Another drug used is the CTLA 4 that gave 17% of positive responses in patients with metastatic melanoma. Some patients develop severe enterocolitis and 10% pituitary disease.
Biochemotherapy: it consists in the combination of chemotherapy and interleukin 2, interferon or both. Temozolamide is often used
Ipilimumab is a monoclonal antibody studied by Bristol-Meyers Squibb and Medarex, which has its target in a molecule presented on T cells called CTLA-4 and has been used in clinical trials in cases of metastatic melanoma in combination with dacarbazine, it ’ s used in patients with advanced melanoma
Ipilimumab
Velmurafenib (Zelboraf): It improved rates of overall and progression-free survival in patients with previously untreated melanoma with the BRAF V600E mutation. It is a BRAF kinase inhibitor and it has shown response rates of more than 50% in patients with metastatic melanoma with the BRAF V600E mutation
Vemurafenib
OncoVEX: A new trial was undertaken by the Northern California Melanoma Center with OncoVEX which is injected into a virus that enters the tumor and kills malignant cells without affecting healthy cells, it is also capable of producing granulocyte macrophage colony stimulating factor that stimulates the immune response to cancer. Studies in phase 1 and 2 have produced encouraging results with fewer side effects than Interleukin 2
Immagine ripresa da: www.biovex.com/oncovex.html
Vaccines: are experimental therapies that are being tested in patients with stage III or stage IV melanoma, usually contain weakened or killed viruses. The vaccine stimulates the body ’s immune system to destroy melanoma cells. There is no really effective vaccine and limphocytes produced by the active antitumor immunization recognize with difficulty tumor cells.
Vaccini
Adoptive cell transfer: autologous lymphocytes with antitumor activity are identified, later they are stimulated in the laboratory and then increased in number, and then reinfused into patients. The results are encouraging, but cases where such therapy was used are limited
Gene therapy: two patients treated with genetically modified cells have obtained significant regression of metastatic melanoma. Trials are currently ongoing reporting positive responses in 30% of the cases.
Radiotherapy: is usually used inadvanced stages of the disease in patients whose melanoma come back, to alleviate pain or other symptoms. Is also used to reduce the tumor mass or in the case of bone metastases.
Radioterapia