Combination Therapy for Advanced Melanoma
- The combination of immunotherapy and targeted therapy is helping to treat some forms of advanced melanoma, the deadliest form of skin cancer.
- Atezolizumab (Tecentriq) in combination with cobimetinib (Cotellic) and vemurafenib (Zelboraf) is approved for people with the V600 BRAF mutation who have melanoma that can’t be surgically removed or that has spread to other areas of the body.
- Clinical studies found patients who received the combination therapy were able to live for more than 15 months without their disease worsening. This is compared to 10.6 months with other forms of therapy.
“Ten years ago, or maybe 12 years ago, melanoma was regarded as this hopeless cancer, ” Dr. Jeffrey Weber, NYU Langone Health oncologist and melanoma specialist, tells SurvivorNet. “George Canellos, who was the physician in chief (at) Dana-Farber… said once that melanoma was the tumor that gives oncology a bad name. And I sat next to him at a dinner perhaps 15 years ago and asked him, “Did you really say that?” And he said, ‘Absolutely.'”Read More
How Atezolizumab (Tecentriq) Is Changing Treatment
Atezolizumab in combination with cobimetinib (Cotellic) and vemurafenib (Zelboraf) is approved for people with the V600 BRAF mutation who have melanoma that can’t be surgically removed (unresectable) or that has spread to other areas of the body (metastatic). About 50% of advanced unresectable or metastatic melanomas have a mutation in the BRAFgene, with V600E being the most common mutation. National Comprehensive Cancer Network guidelines specify that BRAF mutation testing should be performed on metastatic lesions.
Clinical studies found those with advanced melanoma who received the combination therapy were able to “live for more than 15 months without their disease worsening,” Weber says. This is compared to 10.6 months in the placebo arm.
Atezolizumab is an immunotherapy that helps the body’s natural defenses fight cancer. Cobimetinib and vermurafenib target two key proteins that cause cells to duplicate uncontrollably.
When combined together, the treatment helps a person’s immune system recognize, target and slow the growth of melanoma cells. Atezolizumab is also approved to treat other types of cancers such as non-small cell lung cancer, liver cancer and advanced stage bladder cancer.
Atezolizumab is administered through an IV once every three weeks. The first treatment takes 60 minutes, and thereafter, treatments may shift to 30 minutes if tolerated. Cotellic and Zelboraf are taken orally. The combination therapy is given in 28-day cycles.
Other NCCN-approved options for the treatment of patients with BRAF V600 include dabrafenib/trametinib and encorafenib/binimetinib.
Side effects of Atezolizumab (Tecentriq)
As with any drug, there are side effects to consider. Among those people most frequently experienced when using atezolizumab in combination with cobimetinib and vemurafenib include:
- Skin rash
- Joint, muscle, or bone pain
- Feeling tired or weak
- Liver injury
- Swelling of legs or arms
- Mouth swelling (sometimes with sores)
- Low thyroid hormone levels
- Sunburn or sun sensitivity
Makers of the drug caution that Tecentriq can cause a person’s immune system to attack various organs in the body, causing life-threatening conditions. They stress the importance of monitoring symptoms and consulting your healthcare provider right away if you experience problems with your lungs, intestines, liver, hormone glands, kidney, skin or anywhere else. They also note that Tecentriq may also cause fertility problems in females.
The Battle Against Melanoma Continues
Even with advanced treatments, melanoma is still a deadly disease. Dr. Weber says while we’ve made good progress, there’s much more room for improvement.
“Anyone who thinks that we’ve cured all melanoma is crazy,” Dr. Weber told SurvivorNet.
According to the American Cancer Society, approximately 99,780 new melanomas will be diagnosed in 2022. About 7,650 are expected to die from it this year.
Risk factors for melanoma include ultraviolet light exposure, moles, a family history of skin cancer, age and having fair skin or a weakened immune system.
The best tool in the fight against melanoma and other skin cancers is early detection. Dr. Cecilia Larocca, a dermatologist at Dana-Farber Cancer Institute, recommends monthly self skin checks using the acronym ABCDE as a checklist:
Asymmetrical moles: if you drew a line straight down the center of the mole, would the sides match?
Borders: irregular, jagged, not smooth; can also stand for bleeding
Colors: multiple distinct colors in the mole
Diameter: larger than 6mm, about the size of a pencil head eraser
Evolution: This may be the most important thing that changes over time, such as gaining color, losing color, pain, itching, hurting, changing shape, etc.
What to Ask Your Doctor
- Has genetic testing been conducted on my cancer?
- Do I have the BRAF V600 mutation?
- Am I eligible to try the atezolizumab combination treatment?
- How does the atezolizumab combination work?
- How will we be able to monitor if the drug combination is working for me?
- Are there other alternative treatments?