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Chemotherapy for melanoma
Chemotherapy is commonly used to treat advanced melanoma.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is usually a systemic therapysystemic therapyTreatment that travels through the bloodstream to reach cells all over the body. that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour. Chemotherapy may also be a regional therapy, given to specific areas of the body.
Chemotherapy can help to control or slow down melanoma. Chemotherapy may be used to:
- treat a local recurrence
- treat advanced melanoma that has spread
- relieve pain or to control the symptoms of advanced melanoma (palliative chemotherapy)
Drugs, doses and schedules vary from person to person.
The most common chemotherapy drugs used to treat melanoma are:
- dacarbazine (DTIC)
- carboplatin (Paraplatin, Paraplatin AQ)
- temozolomide (Temodal)
- used to treat brain metastasis
- cisplatin (Platinol AQ)
These drugs may be used in combination, but it is not clear if using chemotherapy combinations is helpful to treat melanoma. Chemotherapy may also be combined with biological therapy (biochemotherapy or chemoimmunotherapy) to treat melanoma.
For more detailed information on specific drugs, go to sources of drug information.
Regional chemotherapy, given directly into the blood vessels of an arm or leg, allows higher concentrations of drugs to be given. Regional chemotherapy may be used for people with local lymph node metastases, in-transit metastases or multiple recurrences on an arm or leg.
A number of techniques may be used to give regional chemotherapy. These are usually done under a general anesthetic and can involve a hospital stay of 7–10 days. These techniques are only performed at specialized centres.
Isolated limb perfusion
A tourniquet is applied to the limb to stop the flow of blood to the rest of the body. The tourniquet keeps the drug in the limb and prevents it from circulating throughout the body. The blood of the limb is oxygenated with a bypass machine.
The surgeon makes a small incision in the thigh or groin (if the melanoma involves the leg) or in the armpit (if the melanoma involves the arm).
Catheters are inserted into the blood vessels to transfer the blood flow from the limb to a pump, and then back to the limb.
Chemotherapy drugs are given into the blood through the pump, which then enter the limb.
The drugs circulate in the limb for about an hour and then the limb is flushed to get rid of any remaining drug.
Isolated limb perfusion allows extremely high doses of chemotherapy (15–20 times higher than systemic doses) to be infused into the tumour.
After the procedure is done, the blood flow from the limb is reconnected to the rest of the body and the tourniquet is removed.
Isolated limb infusion
The flow of blood to and from the limb is temporarily stopped with a tourniquet.
Catheters are surgically inserted into the axial artery and vein of the limb. The catheters are connected to a 3-way tap and joined in a circuit.
Chemotherapy is given by the arterial catheter.
The chemotherapy is circulated using a syringe and the 3-way tap.
The drugs circulate in the limb for about 30 minutes.
The limb is then flushed to get rid of any remaining drug.
Because heat can make chemotherapy more effective, sometimes the blood containing the drugs is warmed slightly before it is returned to the limb or a heating blanket is placed around the limb. This is called hyperthermia or hyperthermic isolated limb perfusion or infusion.
The most common chemotherapy drug used in regional chemotherapy to treat melanoma is melphalan (Alkeran, L-PAM).