Melanoma Treatment – Systemic Targeted Therapy

There are a number of drug treatments available to manage the spread of melanoma. Prior to beginning a drug treatment your melanoma will be tested to determine its genetic type. This will help determine which drugs are most appropriate in treating your melanoma. Drug therapies vary from taking daily tablets to attending hospital periodically for an intravenous infusion. Your consultant will discuss the different drug therapies available and the specific information associated with the drug i.e. how it is given, side effects and how we expect it to work. Systemic therapy may be given alone, or combined with surgery/radiotherapy. (If you are started on a systemic therapy you will be given an in depth information folder to explain your treatment).

Targeted Therapy – BRAF/MEK Inhibitors

Sometimes, changes occur within the DNA of melanoma cells. These changes are called ‘mutations’. Multiple gene mutations can play a role in the progression of melanoma.  Everyone has the BRAF gene, but in some people this gene is mutated. This means the tumour sends continuous signals, causing cells to grow and divide too fast.

Excerpt from British Association of Dermatologists information leaflet

“If your melanoma is shown to have a BRAF mutation when it is sent for genetic testing, then targeted therapy with a BRAF inhibitor drug will be suitable for you and works by inhibiting the growth of the melanoma cells. These are tablets or capsules which are taken twice a day. This treatment is not a cure but may help to shrink down or slow the growth of the melanoma cells. BRAF inhibitor drugs do not work unless you have a BRAF mutation. Side effects of these drugs include rashes, joint pain, high temperature (fever), liver strain, and ECG changes, BRAF inhibitor drug are usually given in combination with a MEK inhibitor drug. The combination treatments have been shown to produce longer responses than the single BRAF inhibitor agents alone in the clinical studies done so far. MEK inhibitors may cause high blood pressure, changes in eyesight, and weakness of the heart muscle. You will generally carry on taking targeted treatment for as long as it is working.”

Patients at the Norfolk & Norwich University Hospital  have access to BRAF testing to guide their melanoma treatment. However, it is not necessary to do this for everyone except when they have stage III or IV melanoma or a positive sentinel lymph node biopsy result. Please ask your specialist nurse or doctor if you unsure of the BRAF mutation status of your melanoma.

Video courtesy of Melanoma Research Alliance

How is targeted therapy given?

Targeted therapy is given as a tablet on a daily basis.

What are the side-effects of targeted therapy?

The most common side effects seen with targeted therapies are diarrhea and liver problems, such as hepatitis and elevated liver enzymes. Other side effects seen with targeted therapies include:

  • Skin problems (acneiform rash, dry skin, nail changes, hair depigmentation)
  • Problems with blood clotting and wound healing
  • High blood pressure
  • Gastrointestinal perforation (a rare side effect of some targeted therapies)
Advantages and disadvantages of treatment

Many people are frightened at the idea of having treatment for cancer, because of the side effects that can occur. Some people ask what would happen if they did not have any treatment. Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

You can talk about your treatment options with your medical team and think about what feels right for you. It can be helpful to make a list of any questions you’d like to ask at your appointments. A friend or relative could also come with you for support.

If you have concerns about your treatment plan, you could get a second medical opinion. Ask your GP or specialist about how to do this.