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Melanoma Treatment Options After Surgery

After Your Melanoma Lesions Are Removed, What's Next?

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Updated October 03, 2009

The standard treatment for melanoma is to surgically remove the lesions -- a procedure called "wide area excision." Depending on the stage of your tumor, your doctor may then recommend an adjuvant (after-surgery) treatment in order to lessen the chance that the melanoma will come back (recur). For example, if the melanoma has spread to one or more of your lymph nodes, there is an estimated 70% to 80% chance that the melanoma will come back within the next 3 to 5 years. If it does recur, the disease is much more dangerous. While adjuvant treatment options are currently very limited (the only approved choice is interferon alfa-2b; the others are in clinical trials), be sure to discuss the following options with your doctor.

Interferon alfa-2b

Interferon alfa-2b, or IFN, is approved for patients who are currently free of melanoma but are at a high risk for recurrence, such as those with stage IIB, IIC or III disease. However, the value of IFN is controversial among doctors and patients. Some doctors recommend it to all stage III melanoma patients after surgery. However, a substantial number of doctors feel that the limited benefit of IFN treatment does not justify its significant side effects, such as flu-like symptoms, fatigue, muscle pain, depression and liver problems. You need to carefully weigh the pros and cons of IFN with your doctor before embarking on this treatment.

Granulocyte-Macrophage Colony-Stimulating Factor

Granulocyte-macrophage colony-stimulating factor (also known by the more manageable name of GM-CSF or sargramostim), stimulates your immune system. It is not yet approved as an adjuvant treatment for melanoma, but a few early studies have shown significant benefit. In one clinical trial, patients with high-risk (stage IIIB, IIIC, or IV) melanoma who received sargramostim treatment survived 37.5 months, which far exceeded the average survival time of 12.2 months in those who did not take sargramostim. Although these results are promising, more research is needed before sargramostim is approved as an adjuvant treatment for melanoma.

Ipilimumab

Ipilimumab activates your body's immune system by blocking a molecule called CTLA-4. CTLA-4 suppresses your immune system's response to disease, so blocking its activity helps your body fight off melanoma. While ipilimumab has shown to be significantly more effective than chemotherapy in patients with metastatic melanoma, it is still being investigated for use as an adjuvant treatment. Several clinical trials are researching ipilimumab both alone and in combination with interferon alfa-2b and sargramostim. The hope is that by using multiple drugs at once, different parts of the immune system may be stimulated to fight melanoma.

Other Options

Several other adjuvant therapies have been tested, with some coming up short and others showing promise:
  • Several vaccines for melanoma have been researched, but no positive effect has been found so far. In fact, several of the vaccines produced a worse outcome!
  • The use of adjuvant chemotherapy (for example, dacarbazine) for melanoma has been tested in multiple trials but has shown no benefit.
  • Adoptive cell transfer is a new technique that has shown some exciting preliminary results.
  • Several "targeted" drugs are also being investigated as adjuvant treatment for melanoma, including sorafenib, dasatinib, imatinib, and sunitinib.

The available options for post-surgery treatment of melanoma are slim. However, this is a very active area of research, so be sure to ask your doctor if any of the available clinical trials are right for you. Without volunteers for these studies, progress fighting this devastating disease simply will not happen.

Sources:

Fecher LA, Flaherty KT. Where are we with adjuvant therapy of stage III and IV melanoma in 2009? J Natl Compr Canc Netw. 2009 Mar;7(3):295-304. 27 September 2009.

Spitler LE, Weber RW, Allen RE, et al. Recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF, sargramostim) administered for 3 years as adjuvant therapy of stages II(T4), III, and IV melanoma. J Immunother. 2009 Jul-Aug;32(6):632-7. 27 September 2009.

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