Patient education and resources

Immunotherapy for melanoma has changed the way cancer is treated.

Melanoma is a very aggressive skin cancer with highest incidence in western countries where exposure to sunlight and UV Radiation is high. Approximately 290,000 people are diagnosed with the disease each year, in addition to about 61,000 deaths.

Picture of skin malignant melanoma

Melanoma is aggressive cancer and very few therapeutic options were available in past.  Five year survival rates for stage I and II malignant melanoma is 90 percent. Survival rate for stage 4 and stage 3 is poor, because chemotherapy and other targeted drugs do not work for malignant except few e.g., vemurafenib and dabrafenib.

In 2015 data was published which showed that 20 t0 30 percent of patients treated with check point inhibitors were alive at 3 years.

Different studies showed that 30% to 40% of patients were alive at 5 years.

Such a dramatic improvement in survival was never seen before and now immunotherapy has become the standard of care. We are seeing more and more patients survive longer.

The Food and Drug Administration (FDA) has approved three types of checkpoint inhibitors for treating melanoma:

ipilimumab (Yervoy), which blocks the checkpoint protein CTL4-A

pembrolizumab (Keytruda), which blocks the checkpoint protein PD-1

nivolumab (Opdivo), which also blocks PD-1

Your doctor may prescribe one or more checkpoint inhibitors if you have stage 3 or stage 4 melanoma that can’t be removed with surgery. In other cases, they may prescribe checkpoint inhibitors in combination with surgery.

Cytokine therapy

Treatment with cytokines may help boost your immune system and strengthen its response against cancer.

The FDA has approved three types of cytokines for the treatment of melanoma:

interferon alfa-2b (Intron A)

pegylated interferon alfa-2b (Sylatron)

interleukin-2 (aldesleukin, Proleukin)

Interferon alfa-2b or pegylated interferon alfa-2b is generally prescribed after melanoma has been removed with surgery. This is known as adjuvant treatment. It may help lower the chances of the cancer returning.

Proleukin is most often used to treat stage 3 or stage 4 melanoma that has spread.

Oncolytic virus therapy

Oncolytic viruses are viruses that have been modified to infect and kill cancer cells. They may also trigger your immune system to attack cancer cells in your body.

 

Talimogene laherparepvec (Imlygic) is an oncolytic virus that’s been approved to treat melanoma. It’s also known as T-VEC.

 

Success rates of immunotherapy in melanoma are phenomenal with the majority of patients surviving beyond 5 years

Excellent response to immunotherapy

Cost of immunotherapy

The out-of-pocket cost of immunotherapy varies, depending in large part on:

1, The type and dose of immunotherapy you receive

2, Whether or not you have health insurance coverage for the treatment

3, Whether or not you’re eligible for patient assistance programs for the treatment

4, Whether you receive the treatment as part of a clinical trial

 

When to stop?

We do not stop immunotherapy for stage 4 malignant melanoma patients. We want to keep disease in control and do not allow it to grow because if it  becomes resistant  then  few options are available

Newer treatments

Some other types of immunotherapy have shown promise in treating melanoma in early studies. Other studies are now looking at combining different types of immunotherapy

Research

https://www.cureus.com/articles/17222-harnessing-the-immunomodulatory-effects-of-radiation-in-urinary-bladder-cancer#:~:text=Extensive%20preclinical%20data%20supports%20the,the%20systemic%20anti%2Dtumor%20effect.

https://www.ojionline.org/article.asp?issn=2589-1871;year=2020;volume=4;issue=3;spage=110;epage=114;aulast=Patil

https://ijmio.com/cardiotoxicity-in-patients-on-trastuzumab-in-her2-positive-breast-cancer-a-retrospective-analysis-from-a-center-in-north-india/

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

https://www.researchgate.net/publication/343512692_Predictors_of_Occult_Neck_Metastasis_and_Extra_Capsular_Spread_in_Early_Oral_Cancers

https://pubmed.ncbi.nlm.nih.gov/30050778/

https://pubmed.ncbi.nlm.nih.gov/31607695/

https://pubmed.ncbi.nlm.nih.gov/31807489/

https://www.proquest.com/openview/d26bb79fb4948a5db6724295f88156a5/1.pdf?pq-origsite=gscholar&cbl=226512

https://pubmed.ncbi.nlm.nih.gov/31489291/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498714/

https://www.journalofcurrentoncology.org/article.asp?issn=2589-8892;year=2018;volume=1;issue=2;spage=97;epage=100;aulast=Patil

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348784/

https://www.researchgate.net/publication/334632035_Cancer_Awareness_amongst_Nurses_in_a_Tertiary_Care_Hospital_in_North_Delhi_India

https://www.crstonline.com/article.asp?issn=2590-3233;year=2021;volume=4;issue=1;spage=55;epage=60;aulast=Abbas

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

 

Dr. Waseem Abbas

Director research @MAX institute of cancer care.

Senior consultant medical and Hemato-oncology @MAX cance centre shalimarbagh.

Clinical lead in Medical oncology from MAX cancer centre shalimarbagh.

This has encouraged dr Abbas to dedicate himself to research in the field of immunotherapy. He has treated so far 500 patients with immunotherapy and has published research in International and National journals. Apart from that dr Abbas has done some breakthrough research in this field. Dr abbas have dedicated his life to immunotherapy research and are the pioneer of immunotherapy in India.