When to Stop Immunotherapy for Melanoma: Essential Guidance for Continued Care

Immunotherapy is a cutting-edge treatment that uses the body’s own immune system to fight off illnesses, particularly cancer. It works by boosting or restoring the immune system’s ability to tackle diseases. This approach dates back to the late 1800s, when doctors first started tapping into the immune system’s power. Today, immunotherapy includes treatments like checkpoint inhibitors, monoclonal antibodies, and cancer vaccines.

Immunotherapy has been very effective in many medical cases. For instance, the Keynote-006 study showed that pembrolizumab (Keytruda®) worked well for advanced melanoma, helping many patients stay cancer-free for a long time. This success has made immunotherapy a key player in treating various cancers, including melanoma.

What is Melanoma?

Melanoma is a serious type of skin cancer that starts in the cells that give our skin its color. According to the American Cancer Society, about 100,640 new cases of melanoma are expected in the United States in 2024.

Symptoms of Melanoma

Signs of melanoma include:

• Moles that change size, shape, or color
• New spots on the skin that look different from others
• Sores that don’t heal
• Itching, tenderness, or pain in a mole

Melanoma can be hard to treat because it spreads quickly if not caught early. Traditional treatments like surgery, chemotherapy, and radiation don’t always work well, especially for advanced cases.

Immunotherapy for Melanoma

Immunotherapy helps by boosting the immune system to better recognize and fight melanoma cells. This can reduce symptoms and improve treatment results, giving hope where other treatments might not work.

How Melanoma is Treated with Immunotherapy

Immunotherapy is a powerful way to treat melanoma by boosting the immune system to fight cancer. Here are the main methods used:

1. Checkpoint Inhibitors

Checkpoint inhibitors are immunotherapy drugs that help treat cancers like melanoma. They block certain proteins on cancer cells or immune cells, called checkpoints, which normally prevent the immune system from attacking normal cells. By blocking these checkpoints, the drugs “release the brakes” on the immune system, allowing them to attack cancer cells more effectively. Common checkpoint inhibitors target proteins like PD-1, PD-L1, and CTLA-4.

• Ipilimumab (Yervoy®): Helps T cells attack cancer by blocking a protein that limits their activity.
• Nivolumab (Opdivo®): Blocks a protein (PD-1) that stops T cells from attacking cancer cells.
• Pembrolizumab (Keytruda®): Similar to Nivolumab, it blocks PD-1 to boost T cell activity.

2. Monoclonal Antibodies

Monoclonal antibodies are targeted cancer therapies made in labs. They attach to specific proteins on the surface of cancer cells. Some mark cancer cells for the immune system to destroy, while others block signals the cancer needs to grow or kill the cancer cells directly. Some even deliver toxic substances to cancer cells. These treatments can be effective with fewer side effects than traditional chemotherapy.

3. Cancer Vaccines

Cancer vaccines help the immune system recognize and fight cancer cells. Unlike traditional vaccines that prevent diseases, most cancer vaccines treat existing cancers. They introduce proteins from cancer cells into the body, teaching the immune system to see these proteins as threats and attack the cancer cells. Examples include preventive vaccines like the HPV vaccine and therapeutic vaccines for cancers such as melanoma. This emerging field shows promise for new cancer treatments with fewer side effects.

These drugs work by taking the brakes off the immune system, allowing T cells to find and kill melanoma cells more effectively. They focus the immune response on cancer cells without harming normal cells.

Efficiency of Immunotherapy

Immunotherapy has been shown to be very effective in treating melanoma, especially when other treatments don’t work. According to a study presented at the annual meeting of the American Association for Cancer Research, more than one-third of patients with advanced melanoma who started treatment with Opdivo (Nivolumab) were still alive five years later—double the average survival rate for the disease.

Signs of Improvement

When immunotherapy works, you might notice:

• Tumors getting smaller or staying the same size
• No new melanoma spots showing up
• Feeling better overall and having more energy

Doctors use regular scans and check-ups to see how well the treatment is working and to track your progress.

The End of Immunotherapy: When and Why to Stop Treatment

Immunotherapy can be a great way to treat melanoma, but it isn’t meant to be used forever. One reason is the potential for serious side effects, which can become worse and harder to handle over time. Additionally, some patients may stop responding to the treatment as their bodies develop resistance, making it less effective. Continuous treatment can also impact a patient’s quality of life due to frequent doctor visits and dealing with side effects.

When to Stop Immunotherapy for Melanoma

The decision to stop immunotherapy should be made by the patient and their doctor. Here are some common reasons to stop:

• Complete Response: If scans show no cancer for a long time, doctors might decide to stop the treatment.
• Stable Disease: If the cancer is not growing or spreading, doctors might choose to stop treatment and just keep an eye on things.
• Severe Side Effects: If the side effects are very bad or dangerous, stopping treatment might be necessary to protect the patient’s health.

Why Stopping is Needed

Stopping immunotherapy helps balance the benefits of treatment with the risks and side effects. Continuing treatment when it’s no longer needed can cause unnecessary problems and lower the patient’s quality of life. By monitoring the patient’s condition and adjusting the treatment plan, doctors aim to provide the best care while minimizing harm.

What to Do When Melanoma Treatment Ceases

When you stop melanoma treatment with immunotherapy, it’s important not to get discouraged. There are still many effective ways to manage your health. Having a plan for ongoing care is crucial. Here’s what you can do:

• Regular Check-Ups: Keep scheduling regular follow-up appointments with your healthcare team to monitor your health and catch any signs of recurrence early.
• Scans and Tests: Continue getting scans and tests as recommended by your doctor to make sure the cancer hasn’t returned or spread.
• Symptom Management: Watch for any new symptoms or changes in your health and report them to your doctor right away.
• Support Systems: Join support groups or talk to counselors to help manage the emotional side of stopping treatment.

Coupling Treatment with a Healthy Lifestyle

Even if you stop immunotherapy, there are other ways to manage melanoma and stay healthy. Adopting a healthy lifestyle can make a big difference. Eat a balanced diet with plenty of fruits, vegetables, and whole grains. Stay active with regular exercise and manage stress with activities like meditation or yoga. Avoid smoking and limit alcohol to support better health outcomes. Combining these healthy habits with regular medical care can help keep your immune system strong and support your overall well-being.