Biological therapy for melanoma

Biological therapies are treatments that use substances made naturally by the body. Some of these treatments are called immunotherapy because the drugs stimulate the immune system or occur naturally as part of the immune system.

The most common immunotherapy used to treat melanoma is interferon. Interferon is a substance produced naturally by the body. It is made in tiny amounts and helps the body fight infection. It stimulates the immune system to attack cells that the body recognises as abnormal - for example, cancer cells. Interferon can be made in the laboratory in large quantities and used as a cancer treatment.

Interferon treatment has been tested in melanoma for some years. But it is still an experimental treatment. Researchers need to find out more about

• The best dose to use
• Why the treatment helps some people and not others
• Whether interferon works best in combination with other treatments such as chemotherapy

Interferon is sometimes given to try to stop melanoma that has spread to the lymph nodes from coming back. This type of treatment does not cure melanoma but it may control it for a time. It should only be offered to you as part of a clinical trial.

The treatment is usually given as an injection under the skin (subcutaneous injection). You have the injections three times a week. Some treatment plans include interferon given daily for the first few weeks. You may have daily injections into a vein (intravenous injection) rather than under the skin. Interferon treatment may continue for several years.

If you have this treatment over a long period of time, you or a relative can be taught to give the injections so that you don't have to keep going back to the hospital. Or a district nurse can give your injections if you do not like the idea of giving them yourself. You may find that having your injection in the evening before you go to bed reduces the side effects.

In the first weeks of your treatment, you are likely to have flu like symptoms such as

• Headaches
• A temperature or chills
• Aches and pains in joints and muscles
• Tiredness

These side effects usually lessen as you get used to the interferon. But this depends on the dose you have. You may find you get a temperature and shivering for a short time after each injection. If this happens, tell your doctor. You will probably be advised to take paracetamol before you have each injection.

We have a specific page with information about interferon side effects in the section on side effects of individual cancer drugs.

Monoclonal antibodies are drugs designed to recognise and find specific abnormal proteins on cancer cells. Each monoclonal antibody recognises one particular protein. When the antibody attaches to the cell it blocks particular processes that make the cell grow. So this can stop the cancer growing or may shrink it in some people.

A monoclonal antibody called ipilimumab (Yervoy) can help some people with advanced melanoma to live longer. It is approved in the UK for the treatment of advanced melanoma in people who have already had other treatments. You have it into a vein by drip every 4 weeks. You usually have 4 doses. So the whole course takes 12 weeks. The side effects of ipilimumab include a mild effect on the liver, inflammation of the bowel, diarrhoea and a skin rash. Trials are now looking at other ways of using ipilimumab for melanoma. You can find information about these trials on the melanoma research page.

Bevacizumab (Avastin) is another type of monoclonal antibody. Research trials are looking into whether bevacizumab can help to stop melanoma coming back after surgery but it is not a standard treatment and is only available as part of clinical trials. You have bevacizumab as a liquid into a vein. The most common side effects are high blood pressure, feeling sick, constipation, diarrhoea and tiredness.

Interferon is sometimes used in combination with chemotherapy in regional limb perfusion. Regional limb perfusion is a way of giving drug treatment into an arm or leg affected by melanoma. It is usually used for melanoma that has come back in a limb. Another immunotherapy called Tumour Necrosis Factor or TNF has also been used in this way. We need more clinical trials before we know how useful it will be.

Another type of biological therapy being studied to treat melanoma is treatment with vaccines. There is a lot of interest in this treatment and so we have put information about melanoma vaccines on a separate page under the treating melanoma section.