What to Know About Combination Immunotherapy for Metastatic Melanoma

This article is for people who are living with metastatic melanoma and their care partners or for anyone who wants to learn more about metastatic melanoma. The goal of this activity is to help you work with your doctor and your healthcare team to make a treatment plan for your metastatic melanoma and to understand the potential role for combination immunotherapy.

You will learn about:

• What metastatic melanoma is

• Ways to help manage metastatic melanoma

• What immunotherapy medicines are and how they are combined to help treat metastatic melanoma

• Working with your doctor and your healthcare team to make a treatment plan

• Questions to ask your doctor about combination immunotherapy

Certain medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for metastatic melanoma but are recommended by the National Comprehensive Cancer Network (NCCN).

Melanoma is the most serious type of skin cancer because of how fast it can grow and spread. Melanoma that spreads to other parts of your body is known as metastatic melanoma. It's also called stage IV melanoma or advanced melanoma.

Metastatic tumors (metastases) can occur in other places on your skin or in your organs. Common sites of metastatic melanoma include the lungs, liver, bones, and brain. It's important to understand that metastatic melanoma is still skin cancer, even when it's found somewhere else.

Metastatic melanoma is hard to cure, but many treatments exist to help control its growth and manage symptoms. People living with metastatic melanoma often need more than 1 kind of treatment.

Your doctor may recommend surgery to remove the main melanoma tumor from your skin, along with any lymph nodes (small bean-shaped organs) believed to contain melanoma cells. The surgeon may also remove as much metastatic melanoma as possible.

If you can't have surgery or it's likely you still have some melanoma cells after surgery, your doctor may recommend radiation therapy or medicines.

There are 3 main types of medicines used to help treat metastatic melanoma:

• Chemotherapy ("chemo") directly attacks cancer cells to try to slow their growth or kill them

• Immunotherapy makes it easier for your immune system -- your body's natural defense system -- to find and kill cancer cells

• Targeted therapy blocks a protein or gene that helps your cancer cells grow and survive

Each type of therapy includes many medicines, and each fights cancer in its own way. Your healthcare team can explain more about how they work.

Your immune system is made up of many parts that work as a team to protect you from certain illnesses. Your T cells are like the team leaders. When they learn there may be something harmful in your body, like a virus or a cancer cell, they spring into action and launch an immune attack.

Your body uses checkpoint proteins to prevent T cells from accidentally attacking your normal cells and to shut T cells down once the threat is gone. Cancer cells have learned to use the same checkpoint proteins to fool your T cells into thinking the cancer cells are normal cells and to weaken immune attacks against them.

Immune checkpoint inhibitors (ICIs) are medicines that block checkpoint proteins. Some ICIs block checkpoint proteins that melanoma cells use to hide from T cells. Others block checkpoint proteins that slow or stop T-cell attacks.

ICIs are the most common type of immunotherapy used to treat metastatic melanoma. Because each ICI can block only 1 checkpoint protein, doctors usually combine 2 ICIs to target different checkpoint proteins.

Combining ICIs helps T cells find melanoma cells anywhere in your body and prevents checkpoint proteins from shutting down an immune response. As cancer cells die, your tumors may shrink or even disappear.

Combination immunotherapy rarely cures metastatic melanoma, but it may help you live longer or lessen your symptoms.

All medicines have side effects, including ICIs. Different ICIs can cause different side effects, so it's important to ask your doctor or healthcare team about possible side effects of the ICIs you're taking.

Because combination immunotherapy affects everyone differently, your doctor may not be able to tell you exactly which side effects you'll get. But they can tell you what symptoms to watch for and how to report them. They can also work with you to try to prevent and manage common side effects, such as tiredness, cough, nausea, joint pain, diarrhea, and trouble pooping (constipation).

Sudden or severe side effects are possible with combination immunotherapy even after you stop treatment. You may want to carry a card that lists your immunotherapy medicines in case of an emergency.

Your doctor and healthcare team will work with you to make a treatment plan. Your options for treatment depend on many things, including:

• Your overall health and melanoma symptoms

• Size of the main tumor

• Number of metastases, their sizes, and where they are in your body

• What you want or don't want from treatment (your preferences and goals)

Don't be afraid to ask questions. Understanding how each treatment works, its possible side effects, how it's given (for example, by mouth at home or by vein at a doctor's office), and what tests you might need before and after treatment can help you with your choices.

Questions you can ask your doctor and healthcare team about combination immunotherapy for metastatic melanoma include:

• What are my options for combination immunotherapy, and what are their possible side effects?

• How does combination immunotherapy work?

• How are these medicines taken?

• How will we know if treatment is working?

• What happens if treatment stops working?

• Will I need to take any other medicines?

• Where can I find more information about combination immunotherapy?

Congratulations!

You have successfully completed the program What to Know About Combination Immunotherapy for Metastatic Melanoma.

View Additional Materials on this topic that you may find useful:

Melanoma Treatment

Immune Checkpoint Inhibitors

Immunotherapy to Treat Cancer

What Is Skin Cancer?

Skin Cancer (Including Melanoma)

Advanced Cancer