Treatment for advanced melanoma

You will usually have immunotherapy as an outpatient, which means you visit a treatment centre for the day. In most cases, the immunotherapy drugs are given into a vein (intravenously).

You may have treatment every 2–6 weeks in a repeating cycle for up to two years, but this depends on how the melanoma responds to the drugs and any side effects you may have.

Immunotherapy using checkpoint inhibitors has worked well for some people with melanoma, but it does not help everyone.

While most people treated with checkpoint inhibitors have had advanced cancer, immunotherapy is now available for some people with earlier stage melanoma.

Other immunotherapy treatments are being tested in clinical trials. Talk to your doctor about whether immunotherapy is an option for you.

Checkpoint inhibitors can take weeks or months to start working, depending on how your immune system and the cancer respond. Sometimes their effects keep working long after treatment stops, but this varies from person to person.

Other times cancer cells can become resistant to the treatment even if it works at first.

The side effects of immunotherapy drugs will vary depending on which drugs you are given and can be unpredictable.

Immunotherapy can cause inflammation in any of the organs in the body, which can lead to side effects such as tiredness, joint pain, diarrhoea, and an itchy rash or other skin problems.

The inflammation can lead to more serious side effects in some people, and in rare cases, this can be life threatening, but these side effects will be monitored closely and managed quickly.

You may have side effects within days of starting immunotherapy, but more often they occur many weeks or months later. It is important to discuss any side effects with your treatment team as soon as they appear so they can be managed appropriately.

When side effects are treated early, they are likely to be less severe and last for a shorter time. Delaying or stopping treatment for a side effect does not mean immunotherapy will stop working.

Many patients stop treatment after only one or a few treatments and their melanoma remains controlled years later without further treatment.

The side effects of targeted therapy will vary depending on which drugs you are given. Common side effects include fever, tiredness, joint pain, rash and other skin problems, loss of appetite, nausea and diarrhoea.

Ask your treatment team how you can deal with any side effects.

Before starting treatment, you will have a CT or MRI scan at a planning appointment. The radiation therapist may make some small permanent or temporary marks (tattoos) on your skin so that the same area is targeted during each treatment session.

If you are having radiation therapy to the brain, a plastic mask will be custom-made to fit you. It helps keep your head still so that the radiation is targeted at the same area each session.

Each treatment session takes about 30 minutes and is usually given daily for 1–4 weeks. For the treatment, you will lie on a table under a machine that aims radiation at the affected part of your body.

In some cases, you may be offered a specialised type of radiation therapy that delivers extremely precise, tightly focused beams of high-dose radiation onto the tumour from many different angles.

This is called stereotactic radiosurgery (SRS) when used on the brain, and stereotactic body radiation therapy (SBRT) when used on other parts of the body. SBRT usually involves 3–5 treatment sessions over 1–2 weeks.

The side effects that you experience will depend on the part of the body that receives radiation therapy, the dose of radiation you receive and how long you have treatment. Many people will have temporary side effects, which may build up over time.

Common side effects during or immediately after radiation therapy include tiredness, and the skin in the treatment area becoming red and sore. Ask your treatment team for advice about dealing with any side effects.