Stage III Melanoma

Immunotherapy

Immunotherapies are drug treatments that aim to enhance your own body’s immune system so that it can recognise and destroy cancer cells more effectively.  By enhancing the immune system, it is very common for healthy parts of the body to be affected too.  There are now a number of immunotherapy drugs available that may be offered to you. They are given via an intravenous drip, usually in hospital.  Immunotherapies can be given as a single agent or as a combination of two of these drugs: Nivolumab and Ipilimumab.  All of these treatments have been assessed and have been approved for use in the UK.

SINGLE AGENTS

Single agent refers to drugs that are administered to patients as individual treatments, as opposed to combinations of more than one drug.

NIVOLUMAB OR PEMBROLIZUMAB

  • Nivolumab is given intravenously via a drip every two or four weeks.
  • Pembrolizumab is given intravenously via a drip every three or six weeks.
    • For stage III adjuvant melanoma, single-agent nivolumab or pembrolizumab is given for 1 year or sooner, if the side effects are unacceptable to you.
    • For unresectable stage III or stage IV melanoma, single-agent nivolumab or pembrolizumab is usually given for as long as it is working and the side effects remain acceptable to you. However, if you are in remission after 2 years of treatment, you may be offered to discontinue your treatment.  In such cases, treatment may be restarted at a future timepoint.

Your doctor will discuss with you the probabilities of treatments working and the potential side effects.

Risks and side effects

All cancer drug therapies are associated with some side effects that may impact on daily life to a lesser or greater extent.  As immunotherapy treatment affects the immune system, this may cause inflammation in different parts of the body which can cause serious side effects. They could happen during treatment, or some months after treatment has finished. In some people, these side effects could be life-long and can occasionally be life-threatening.  You may be affected by one or more side-effect.  Generally, many side effects can be dealt with if treated promptly.  Below includes some of the common side effects of these drugs:

  • Nivolumab and pembrolizumab – tiredness, skin changes, cough, breathlessness, muscle pain, decreased appetite, feeling or being sick, diarrhoea (contact your doctor or nurse straight away if you have any signs of diarrhoea or you open your bowels more often than usual), weakness, fever, abdominal pain, chest pain, joint pain, and effects on the hormone producing glands and nervous system.  Please contact the hospital if you develop any chest symptoms such as shortness of breath, cough or chest pain.  More information on Nivolumab, including potential side effects, can be found here and on pembrolizumab here.

Values you may wish to consider during treatment

    • Is the most important thing to you having treatment that gives you the best chance of curing your melanoma?
    • How prepared are you to have a treatment that has a potential risk of causing serious side effects or complications?
    • How prepared are you to have a year of treatment?
    • Is it important to you whether you have oral treatment or treatment in hospital?
    • How much time are you prepared to spend in hospital having treatment?
    • How much do you want to avoid having a visible scar after treatment?
    • How important is it to you to know everything about your risk of future melanoma?
    • How important is it to you to maintain living an active lifestyle, taking into account your daily activities and hobbies?