Chemotherapy for melanoma is commonly used to treat common forms of the disease. This method involves the use of anticancer therapy (cytostatic) drugs to combat oncology. As a general rule, carried out systemic therapy, drugs which affect the entire body, circulate through the bloodstream and destroy cancer cells, including secondary foci. There is also a regional form of treatment, the effect of which is directed to a specific region of the body.
Chemotherapy for melanoma helps control the symptoms or slow the progression of the disease. The indications for it are:
- treatment of local recurrence;
- therapy for advanced melanoma;
- pain relief or control of symptoms (palliative chemotherapy).
Selection of medication and dosage schemes depending on the individual characteristics of the disease and the health of each patient.
chemotherapy drugs for melanoma
The most common drugs that are prescribed to treat melanoma include:
- dacarbazine (DTIC);
- carboplatin (Paraplatin);
- temozolomide (Temodal);
- cisplatin (Platinol AQ) (for the treatment of brain metastases).
These medicines may be used in certain combinations, but clearly it is not clear which one is most effective therapy for the purpose of the particular disease. Chemotherapy with melanoma and in some cases is combined with a biological therapy (biochemotherapy).
Regional chemotherapy in melanoma Assuta
Drugs in this type of treatment received directly into the blood vessels in the arm or leg, providing a higher concentration of drugs. Regional chemotherapy prescribed for metastases in the lymph nodes of multiple tumors in the arm or leg.
It is carried out in several stages, typically under general anesthesia. In addition, the intended stay in the hospital for 7-10 days. These procedures are performed only in specialized centers.
Isolated limb perfusion
Perfusion involves surgery and involves the following steps:
- The finiteness of the over-tighten a tourniquet to stop the blood flow to the rest of the body. Thanks to him, the drug is only inside the limbs and not distributed throughout the body. Roller bionasos applied, the thermostat, the oxygenator.
- The surgeon makes a small incision in the thigh or groin (if hit by foot) or in the armpit (if melanoma is on the hand).
- The catheters are inserted into blood vessels to pass blood flow from the extremities to the pump and then back.
- Chemotherapy drugs enter the bloodstream via the pump.
- Drugs circulate in the limb for about an hour, and then it is purified to get rid of the remnants of drugs.
- Isolated limb perfusion provide very high doses of chemotherapy directly to the tumor melanoma (15-20 times higher than with systemic therapy).
- After the procedure, a tourniquet is removed and the blood flow is reduced.
Isolated limb infusion
This procedure involves carrying out the following steps:
- Blood flow - to and - from the limb is temporarily stopped with the harness.
- Catheters are inserted into the axial artery and vein in the limb. Connect them with a tee for infusion system (three-way valve), by which change the direction of flow or stop infusion.
- Chemotherapy drugs act via the arterial catheter.
- Introduction of regulated using a syringe and a tee.
- Cytostatics circulate inside the limb for about 30 minutes.
- It is then washed to get rid of drug residues.
Since heat can make melanoma chemotherapy more effective, sometimes blood containing drugs, slightly heated before returning to the limb or limb warmed using blankets. This procedure is called hyperthermic isolated limb perfusion or infusion.
The most common medications used in regional chemotherapy for the treatment of melanoma in Israel, is melphalan (Alkeran, L-PAM).
Side effects of chemotherapy for melanoma
The negative effects of treatment occur while taking all chemotherapeutic agents. They acquire pronounced at higher doses and increase in the course of treatment.
Common side effects include anemia, depression, diarrhea, fatigue, nausea and vomiting, temporary loss of hair, loss of weight.
Serious short and long term complications can occur and vary depending on the particular drug. These include the following:
- Abnormal blood clotting (thrombocytopenia).
- An allergic reaction.
- The increase in the risk of infection, because cytotoxic drugs suppress the immune system.
- Liver and kidney damage.
- Menstrual irregularities and infertility in women.
- Neutropenia - an abnormally low number of neutrophils in the blood.
- Problems with concentration, memory and motor function, may acquire long-term.
- Secondary cancers such as leukemia - in rare cases.
Treatment side effects of chemotherapy for melanoma
Drugs known as serotonin antagonists, especially ondansetron (Zofran), are able to relieve nausea and vomiting in almost all patients treated with mild drugs, and the majority of patients who were given more powerful dose.
Erythropoietin stimulates the production of red blood cells and may reduce or prevent the development of anemia induced by chemotherapy. It is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp). Aranesp is present in the bloodstream longer than epoetin alfa, requiring fewer injections.