Chemotherapy for Melanoma Skin Cancer

Chemotherapy (chemo) uses drugs that kill cancer cells. The drugs are usually given though an IV into a vein or taken by mouth as a pill. They travel through the bloodstream to all parts of the body and attack cancer cells that have already spread beyond the skin.

When might chemo be used?

Chemo might be used to treat advanced melanoma after other treatments have been tried. It’s not often used as the first treatment because newer forms of immunotherapy and targeted drugs are typically more effective. Chemo can shrink tumors in some people, although it’s not clear if it can help people live longer.

Which chemo drugs are used to treat melanoma?

Several chemo drugs can be used to treat melanoma, including:

• Dacarbazine (DTIC)
• Temozolomide
• Nab-paclitaxel
• Paclitaxel
• Cisplatin
• Carboplatin

Some of these drugs are given alone, while others are more often combined (such as carboplatin and paclitaxel). It’s not clear if using combinations of drugs is more helpful than using a single drug, but it can add to the side effects.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks.

How is chemo given?

For melanoma that has spread to other parts of the body, chemo is usually given as an infusion into a vein (IV). Some chemo drugs, such as temozolomide, can be taken by mouth as capsules.

Isolated limb perfusion (ILP) and isolated limb infusion (ILI): These are ways of giving chemo that are sometimes used to treat melanoma that is confined to an arm or leg but that can’t be removed with surgery. The idea with this approach is to keep the chemo in the limb and not allow it to reach other parts of the body, where it could cause more side effects.

This is done during a surgical procedure. The blood flow of the arm or leg is cut off from the rest of the body, and a high dose of chemotherapy is circulated through the limb for a short time. This lets doctors give high doses to the area of the tumor without exposing other parts of the body to these doses.

To do this, a tube is placed into the artery that feeds blood into the limb, and a second tube is placed into the vein that drains blood from it.

• For ILP, the artery and vein are first surgically separated from the circulation to the rest of the body, and are then hooked up to tubes going to a special machine in the operating room.
• For ILI, long tubes (catheters) are inserted through the skin and into the artery and vein. This method is less complex and takes less time, and it might not require general anesthesia (where you are in a deep sleep).

In either approach, a tourniquet is tied around the limb to help make sure the chemo doesn’t enter the rest of the body. Chemotherapy (usually with a drug called melphalan) is then infused into the blood in the limb through the artery. (This is done by the machine in ILP, and by using a syringe in ILI.) During the treatment session, the blood exits the limb through the tube in the vein, the chemo is added, and then the blood is returned back to the limb through the tube in the artery. (During ILP, the drug can also be heated by the machine to help the chemo work better.)

By the end of the treatment the drug is washed out of the limb, and the tubes are removed (and for ILP the blood vessels are stitched back together) so that the circulation is returned to normal.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are used. The side effects of chemo can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased risk of infection (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects usually go away once treatment is finished. There are often ways to lessen side effects. For example, drugs can help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about drugs to help reduce side effects.

Some chemo drugs can have other side effects. For example, some drugs can damage nerves, which can lead to symptoms (mainly in the hands and feet), such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This condition is called peripheral neuropathy. It usually goes away once treatment is stopped, but for some people it can last a long time.

Be sure to talk with your cancer care team about what to expect in terms of side effects. While you are getting chemo, report any side effects to your medical team so that they can be treated promptly. In some cases, the doses of chemo may need to be reduced or treatment may need to be delayed or stopped to prevent side effects from getting worse.