Adjuvant Therapy in Melanoma: What Is It and Is It Right for Me?

This article is for people who have melanoma, or their care partner, as well as others who want to learn more about treatments for melanoma. The goal is to give you confidence in discussing adjuvant therapy in melanoma with your healthcare provider.

You will learn:

• What adjuvant therapy in melanoma is

• Who adjuvant therapy is recommended for

• The potential benefits of adjuvant therapy

• About side effects of adjuvant therapy

• Questions to ask your provider about adjuvant therapy

• Primary treatment for melanoma (usually surgery) may not be enough to get rid of the cancer

• Sometimes after primary treatment for melanoma, cancer cells remain and they can't be seen on tests

• Adjuvant therapy in melanoma is a treatment given after primary treatment to kill the cancer cells left behind and decrease the chances of the cancer coming back

• Adjuvant therapy is not for everyone with melanoma

• Adjuvant therapy may be given to people with stage 3 melanoma (melanoma that has either not spread from the skin beyond the regional lymph nodes)

• Adjuvant therapy may reduce the risk of melanoma from coming back after the primary treatment

• If you are interested in adjuvant therapy, ask your provider if adjuvant therapy is right for you

If adjuvant therapy is right for you, there are several medicines that your healthcare provider may recommend. Three medicines are approved for adjuvant therapy for melanoma:

• Nivolumab (Opdivo^®)

• Ipilimumab (Yervoy^®)

• Dabrafenib + trametib (Tafinlar^® + Mekinist^®)

• Pembrolizumab (Keytruda^®; FDA approved February 2019)

Nivolumab and ipilimumab are medicines that fight cancer by boosting the immune system, or immunotherapies. Although approved for adjuvant therapy, ipilimumab is rarely used for this type of treatment.

Nivolumab is an immunotherapy, also called a checkpoint inhibitor. Side effects of nivolumab are different from chemotherapy side effect. For example, nivolumab does not cause hair loss.

The most common side effect is tiredness that does not go away when you rest. Other common side effects are nausea, poor appetite, rash or itching, constipation or diarrhea, and joint pain.

Nivolumab can also cause your immune system to attack your organs, such as lungs, intestines, liver, or kidneys. These side effects are serious and can cause death if not treated early.

Contact your healthcare provider right away if you notice any changes in how you feel or look.

Dabrafenib and trametib are targeted therapies. These medicines are not as well tolerated as immunotherapies because their side effects are the ones traditionally associated with cancer therapy, like fever, rash, headache, chills, joint aches, and cough. These side effects can usually be managed with advice from your healthcare provider.

Many people with melanoma can benefit from adjuvant therapy. It may right for you if you:

• Don't have other serious health problems

• Would like more treatment to reduce the chances that your melanoma will come back

• Understand the potential benefit (less chance of tumor coming back) and risks (potential for serious side effects)

Discuss the potential benefits and side effects of medicines for adjuvant therapy with your provider. Tell her or him what information matters to you and how much detail you'd like.

• Do you recommend adjuvant therapy for me (why/why not)?

• If yes, which medicine for adjuvant therapy do you recommend for me?

• How might the medicine affect my overall health?

• What is the chance I'll stay melanoma-free if I take this medicine?

• What are the side effects of this medicine?

• Will I be able to work or go to school while taking adjuvant therapy?

• How long will I need to take the medicine?

• What kind of follow-up care will I need?

• Is the medicine covered by my health insurance?

• What is my cost of this medicine to me?

• Is there a clinical trial that might be right for me?

Congratulations!

You have successfully completed the program: Adjuvant Therapy in Melanoma: What Is It and Is It Right for Me?