Is your treatment what more than 1,100 Oncologists recommend?
The information provided below is meant to help you understand the role of your melanoma biology in treatment decisions, as well as the role of other tools used in determining your ability to receive chemotherapy or targeted therapy (precision medicine).
In 2016, there are 76,380 new cases of melanoma in the United States (CA Cancer J Clin 2016; 66(1):7-30) and its incidence has increased three times over the last two decades. Melanoma can occur in any ethnic group and 1/37 men (1/56 women) will be diagnosed with melanoma in their lifetime.
In melanoma, the stage when you first diagnosed predicts outcome. Information such as tumor thickness in mm, number of positive lymph nodes and mitotic index (measure of cell growth) help predict survival in affected individuals. Melanoma lesions in extremities can have better outcome than those of trunks and head.
Three different approaches to treating melanoma are available.
This website is designed to outline in detail your targeted therapy options and offer you personalized information about the best options to yield optimal survival and quality of life. Multiple factors affect your treatment options including:
Stages in melanoma
Exciting new targeted therapies for advanced melanoma treatment are available since 2011.Your tumor is used to test for these markers.
BRAF inhibitors drugs
BRAF gene mutations (V600) are seen in 50-60% of melanoma and produces B-Raf protein (transmit chemical signals for abnormal cell growth). The BRAF inhibitor drugs such as Vemurafenib or Dabrafenib are used if your melanoma expresses mutated BRAF. These drugs have more than 50% chance for response.
MEK inhibitor drugs
Despite an initial excellent response, half of the patients experience progression eventually on BRAF inhibitor drugs. MEK pathway is a chain of proteins that communicate signals from the surface to the nucleus of the cells. When patients with mutated BRAF no longer respond to BRAF inhibitors drugs (Vemurafenib or dabrafenib), MEK inhibitor pathway drugs (Trametinib, Cobimetinib) can control tumor.
Combination of both BRAF and MEK inhibitors have even higher response rate about 70% of tumor control. Two combinations are currently available trametinib/dabrafenib and cobimetinib/vemurafenib. The combination approach is now used as the front line therapy in patients who harbor BRAF mutation.
Immunotherapy is used to unleash your own immune system to fight tumor and has resulted in significant improvement in survival in advanced melanoma.
Chemotherapy has limited response in melanoma. The chemotherapy drugs are dacarbazine, temozolamide, carboplatin/paclitaxel that can be used in advanced melanoma.
This website gives you about 80-85% of straight forward melanoma treatment plans. All melanoma treatment are recommended based on expertise ‘s opinions from multiple national guidelines (NCCN, ASCO, ESMO, ASTRO). For recurrent advanced melanoma, the website will give you the best recommended treatment plans.
Even though the standard of treatment is outlined, your individual tolerability to each treatment will depend on your overall health, i.e. whether you have other illness (diabetes, heart disease, liver disease, arthritis, or kidney disease). Another assessment that your treating physicians may use to determine the optimal melanoma treatment plan and prognosis for you is called ECOG performance status as described below.
ECOG PERFORMANCE STATUS
Grade 0: Fully active, able to carry on all activity
Grade 1: Restricted in physically strenuous activity but ambulatory and able to carry out light house work, office work
Grade 2: Ambulatory and capable of all self-care but unable to carry out any work activities
Grade 3: Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
Grade 4: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair
(Am J Clin Oncol 1982: 5: 649-655)
Finally, chemotherapy and targeted therapies can result in unpleasant side effects such as hair loss, numbness of fingers or toes, cardiac toxicity, nausea, vomiting, diarrhea, abnormal liver function or low white blood cell count that could cause infection, and fatigue. However, advances in the oncology field have led to numerous supportive measures, such as white blood cell growth support (i.e. Neulasta) or anti-nausea medications (such as Zofran), that help to control most side effects when used as prescribed.
The best time to use this service (based on more than 1,100 cancer experts) is after you have learned the details of your cancer and treatment plan from your treating physicians, and would like to clarify and confirm that your treatment is the best option for your cancer. This questionnaire is used mainly for drug treatment in medical oncology.