Medications

Melanoma

When is medication used to treat melanoma?

Medications are used to treat melanoma when it:

  • Cannot be removed with surgery (unresectable) or
  • Has spread to distant parts of the body (metastasized).

Medications also can be used as adjuvant treatment for stage III melanoma. Adjuvant therapy is an additional cancer treatment given after the primary (main) treatment, such as surgery. It can help lower the risk that the cancer comes back.

What medications are used to treat melanoma?

Medications for metastatic melanoma include targeted therapies and immunotherapies. Medication selection depends on several factors, including:

Targeted therapy for melanoma. Targeted therapies block molecules that send signals that for cancer cell growth and division. Genetic mutations cause abnormal changes in these signals. Targeted therapies aim at the features that make cancer cells different.1

    Targeted therapies that treat melanoma with BRAF mutations are:

  • Tafinlar® (dabrafenib), possibly in combination with Mekinist® (trametinib), a MEK inhibitor
  • Zelboraf® (vemurafenib), possibly in combination with Cotellic® (cobimetinib), another MEK inhibitor

Gleevec® (imatinib) is a targeted therapy used for advanced melanoma with c-KIT mutation.

Immunotherapy for melanoma. Immunotherapies turn your immune system against the cancer.2 Some immunotherapies help your immune system identify cancer cells. Some give your immune system a general boost, and others create an immune response at the tumor.

Drugs called immune checkpoint inhibitors prevent melanoma cells from hiding from your immune system. These medications are:

Cytokines. Cytokines are general immune system boosters.2 They rally your immune system’s defenses to fight cancer cells. The cytokines used to treat skin cancer are:

  • Interleukin-2
  • Interferon-alfa
  • Peginterferon

Talimogene laherparepvec. Immunotherapy drugs can be injected directly into the tumor. This is called intralesional injection. Talimogene laherparepvec is an “oncolytic virus” that is injected into tumors. The virus kills tumor cells directly, which leads to the release of antigens.3 This triggers an immune response. The virus also causes the cells to make a protein, called GM-CSF, that causes a general immune response.

Intralesional Bacillus Calmette-Guerin (BCG) vaccine. The BCG vaccine is used infrequently for melanoma now. However, this intralesional immunotherapy was used for 4 decades to treat melanoma by creating a general immune response in the area where the tumor is located.4,5

Chemotherapy. Chemotherapy is not as effective as immunotherapy and targeted therapy for melanoma.6 Today, it is not used often to treat melanoma. However, it remains an option in some circumstances.

Basal cell carcinoma

What medications are used to treat low-risk basal cell carcinoma?

Topical medications can be used to treat basal cell carcinoma if surgery, curettage and electrodessication, or radiation therapy are not possible.7 Topical medications are medications that are applied to the skin.

Approved options for thin basal cell carcinomas include:

  • Fluorouracil (5% concentration)
  • Imiquimod (5% concentration)

Topical medications are only used for basal cell carcinoma that is unlikely to return (recur). For higher-risk basal cell carcinoma, more effective treatments are available.7

What medications are used to treat advanced basal cell carcinoma?

Advanced basal cell carcinoma is rare. Less than 1% of cases are locally advanced. Only 0.04% of cases are metastatic (spread throughout the body).8 However, locally advanced basal cell carcinoma can cause substantial damage to tissue, cartilage and bone.7

Two targeted therapies are available to treat advanced basal cell carcinoma. Both are taken by mouth. They are:

These medications are called SMO inhibitors. SMO is short for “Smoothened.” SMO is a receptor in the Hedgehog pathway. Mutations cause an overactive Hedgehog pathway in about 40% of basal cell carcinomas.9

Squamous cell carcinoma

Medications do not have a significant role in the treatment of squamous cell carcinoma.

What medications are used to treat low-risk squamous cell carcinoma?

Squamous cell carcinoma in situ (Bowen’s disease) may be treated with topical medications, according to national cancer guidelines.10 Squamous cell carcinoma in situ is an early form of SCC. At this stage of disease, the cancer cells are only in the top layer of skin (epidermis). The two medications which may be suggested for early squamous cell carcinoma are:10

  • Fluorouracil
  • Imiquimod

Neither medication is approved by the US Food and Drug Administration for this use. Topical medications have lower cure rates than surgical treatments for squamous cell carcinoma in situ.

What medications are used to treat high-risk squamous cell carcinoma?

Chemotherapy may be used together with radiation therapy for squamous cell carcinoma that is likely to return (recur).10 This treatment is only used if surgery is not an option. Chemotherapy plus radiation therapy is also an option for squamous cell carcinoma that has spread to the lymph nodes.10

Actinic keratosis

How are medications used to treat actinic keratosis?

Topical medications are a common way of treating actinic keratosis. Topical medications are useful for people who have multiple lesions. Medications approved for actinic keratosis are:

  • Fluorouracil
  • Imiquimod
  • Diclofenac
  • Ingenol mebutate

Rare skin cancers

How are medications used to treat Merkel cell carcinoma?

The first drug approved specifically for Merkel cell carcinoma is an immunotherapy called Bavencio® (avelumab). Bavencio is an immune checkpoint inhibitor.11 It prevents melanoma cells from hiding from your immune system. It also attracts your body’s defense cells to destroy the cancer cells.

Chemotherapy has been used to shrink or slow the spread of MCC tumors.12

How are medications used to treat Kaposi sarcoma?

Chemotherapy is a standard treatment for Kaposi sarcoma. If there are only a few lesions, the drug may be injected directly into them. If the cancer is widespread, chemotherapy may be used systemically.13

Liposomal doxorubicin is the main chemotherapy drug for Kaposi sarcoma. The doxorubicin is attached to tiny fat particles (liposomes). The liposomes prefer Kaposi sarcoma tissue over normal tissue. This directs the drug to the tumor and spares some healthy tissue.13

Written by: Sarah O'Brien | Last reviewed: May 2017.
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