A medical oncologist is a doctor who specialises in drug therapy and will plan and monitor you during your treatment. Drug therapy can be neoadjuvant (before surgery) or adjuvant (after surgery) with the treatment option best for you determined by your disease stage and other health factors.
Currently, there are two main types of drug therapy used to treat melanoma – targeted therapy and immunotherapy:
Targeted therapies are drugs that block the growth of cancer by interfering with speciﬁc gene mutations in melanoma cells that allow melanoma to grow and spread. This is different to non-speciﬁc treatments, like chemotherapy, that simply aim to kill rapidly dividing cells. It is suitable for you if your melanoma has a speciﬁc gene mutation.
Researchers have identiﬁed a key genetic mutation that drives the growth of melanoma in approximately 40% of patients. It is known as BRAF (“BEEraff”). Another type of gene, called MEK, works together with the BRAF gene to drive melanoma growth.
There is a targeted therapy combination that is available on the PBS for patients with a BRAF-mutation. This regimen combines a drug that targets the BRAF gene mutation (BRAF inhibitor called dabrafenib) with a drug that blocks the MEK gene (MEK inhibitor called trametinib). This combination targeted therapy has been found to be more effective for shrinking melanoma tumours than using either type of drug on its own.
More gene mutations in melanoma cells are continuing to be discovered and new treatments speciﬁc to these mutations are in development and being tested in clinical trials.
Your healthcare team will discuss with you whether targeted therapy may be relevant to you.
Immunotherapy (also known as immune therapy) works by activating the body’s own immune system to seek out and ﬁght melanoma cells. Immunotherapy can be effective in shrinking melanoma metastases in advanced melanoma patients and reducing the risk of melanoma recurrence, regardless of your genetic mutation test result.
One type of immunotherapy currently available to treat Stage III and IV melanoma are checkpoint inhibitors. These drugs block proteins on the surface of immune cells that usually stop the body’s immune system from identifying and killing the cancer cells. When these proteins are blocked, your immune system’s ability to kill the cancer cells is increased.
Other immunotherapies are being tested in clinical trials involving advanced and early stage melanoma patients. Speak with your healthcare team to ﬁnd out about any new advances in immunotherapy that may be relevant to you.
Radiation therapy uses x-rays to target and kill cancer cells by damaging their DNA. Normal cells can repair damage to their DNA, but cancer cells are less able to do this and therefore die when affected by radiation therapy. The dead cancer cells are then broken down and eliminated by the body’s natural processes.
Since radiation therapy damages normal cells as well as cancer cells, treatment must be carefully planned to allow the normal cells to repair themselves and minimise side effects.
A radiation oncologist is a doctor who specialises in radiation therapy and will plan and monitor your treatment. The total dose of radiation and the number of treatments you need will depend on the size and location of your melanoma, your general health and other medical treatments you’re receiving.
Radiation therapy may be given on its own, after surgery or in combination with another drug therapy.