Medical Therapy for Melanoma
The Johns Hopkins Melanoma Program offers a broad range of expertise in using medications to manage melanoma at all stages. In addition to offering standard therapies, our Melanoma Program specialists collaborate with other Johns Hopkins scientists, national cooperative groups and the National Cancer Institute in developing and conducting studies of experimental therapies. Read more about this work in our Research section and our Clinical Trials section.
William Sharfman, M.D.
Some patients who have had melanoma removed by surgery have no evidence of residual disease, but are at significant risk for relapse. For these patients, options include careful observation, or treatment with interferon or experimental therapies.
Interferon is an FDA-approved therapy for patients with melanoma whose tumors have been surgically removed. Johns Hopkins oncologists are experts in administering the approximately yearlong therapy, which requires careful monitoring, dose adjustments, and attention to therapy-associated symptoms.
Our melanoma specialists also lead and participate in clinical trials of experimental medications, such as vaccines and other investigational therapies. Please see our clinical trials section for more information.
Treatments for Advanced Melanoma
Patients with melanoma that cannot be removed by surgery (stage IV, some stage III) have a variety of treatment options available. These treatments fall into 3 broad categories: immunotherapy, targeted therapy and chemotherapy.
Immunotherapies are drugs that activate the body’s immune system to fight cancer. Each of the treatments listed below is administered by our team of experts to ensure safety and maximum efficacy.
Interleukin 2 (IL-2) activates the body’s immune cells to fight cancer. It is administered to patients as a five-day inpatient treatment, which may be repeated for several cycles depending on the tumor’s response. In a small percentage of patients treated with IL-2, tumors may stop growing or disappear completely for several years. Because IL-2 can cause side effects such as nausea, vomiting, rash, liver and kidney complications, high heart rate and low blood pressure, it is generally administered to younger patients without brain metastases who have good heart and lung function.
Johns Hopkins is among a select few Comprehensive Cancer Centers in the Mid-Atlantic region equipped to give IL-2 therapy. Johns Hopkins patients are treated in private rooms in our well-equipped Cancer Center, under the watchful eye of expert physicians and specially trained oncology nurses.
Ipilimumab (Yervoy) is administered intravenously once every three weeks for a total of four doses. In some cases, ipilimumab causes tumors to shrink and helps patients live longer. In some patients, the immune system is activated to attack normal parts of the body, which causes side effects such as diarrhea, rash and kidney or liver damage. The expert team at Johns Hopkins are highly experienced at managing the potential side effects of Yervoy, which is critical for the safe and effective use of the drug.
Investigators at Johns Hopkins have led the way in developing novel drugs to restore the immune system’s ability to spot and attack cancer cells. Clinical trials of the investigational medication nivolumab (anti-PD-1) have demonstrated reductions in tumor size in about 1/3 of patients, and, in some cases, long-lasting remissions.
The drug, now in Phase 3 clinical trials, has also shown activity in patients with advanced lung and kidney cancers. Read more in our anti-PD-1 section.
Some melanomas contain genetic mutations that lead to tumor growth. The most common of these mutations – BRAF, cKIT and NRAS – can be targeted with specific medications. The Johns Hopkins team brings expertise in the comprehensive testing of melanoma tumors and the administration and management of appropriate therapies.
These drugs include vemurafenib (Zelboraf), dabrafenib (Taflinar), and trametinib (Mekinist) and are administered as pills.
Chemotherapy is offered to select patients at Johns Hopkins by our expert team of medical oncologists. These medications include:
- Dacarbazine (DTIC), an intravenous drug administered every three weeks in an outpatient clinic
- Temozolomide (Temodar), an oral chemotherapy taken daily for five days each month
- Carboplatin and Taxol, two intravenous drugs administered weekly in an outpatient clinic