Melanoma: Chemotherapy

Chemotherapy is a treatment for cancer that is done with medicine. It attacks cells that divide quickly, such as cancer cells. Chemotherapy can be used to treat some advanced melanomas. It is not used as often as some newer treatments such as immunotherapy and targeted therapy.

Types of chemotherapy medicine

The chemotherapy medicines most often used for melanoma include:

  • Nab-paclitaxel

  • Carmustine

  • Dacarbazine

  • Carboplatin

  • Cisplatin

  • Paclitaxel

  • Temozolomide

  • Vinblastine

For melanoma, you may get more than one medicine. This is called combination therapy. This may lower the chance that the cancer will become resistant to one medicine. Combination therapy can include several days of treatment given every 3 to 4 weeks. The schedule varies for each person. Which medicines you take and how often you take them depend on many factors, such as your general health.

If you are having chemotherapy, you may have it along with immunotherapy medicine. This is sometimes called biochemotherapy.

How chemotherapy is done

Chemotherapy medicine is most often given through an IV. It may also be taken by mouth as a pill, or as an injection. The treatment may be done as an outpatient visit to a hospital, and you go home the same day. Or it may be at your doctor’s office, a chemotherapy clinic, or at home. In some cases, you may stay in the hospital during treatment.

You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:

  • Killing more cancer cells. The medicine can kill more cancer cells over time, because cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.

  • Giving your body a rest. Treatment is hard on other cells of the body that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects, such as sores and nausea. Between cycles, your body can get a rest from the chemotherapy.

  • Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

Chemotherapy side effects

Side effects of chemotherapy depend on the type and amount of medicines you’re taking. They vary from person to person.

Some common temporary side effects from chemotherapy include:

  • Loss of appetite, nausea, and vomiting

  • Infections from low white blood cell counts

  • Easy bruising or bleeding from low blood platelet counts

  • Fatigue from low red blood cell counts

  • Numbness or tingling in the hands or feet (peripheral neuropathy)

  • Constipation or diarrhea

  • Hair loss

  • Mouth sores 

  • Skin changes

Most of side effects will go away or get better between treatments and a few weeks after treatment ends. You may also be able to help control some of these side effects. Tell your health care providers about any side effects you have. They can help you cope with the side effects.

A more serious possible side effect of some chemotherapy medicines is organ damage. This can include damage to the kidneys, liver, testicles, ovaries, brain, heart, or lungs. You may have blood tests while you’re getting chemotherapy. This is to make sure you aren’t having harmful reactions to the medicine.

Working with your health care team

It's important to know which medicines you're taking. Write your medicines down, ask your health care team how they work, and what side effects they might have. Keep a written diary of your treatment schedule and any signs or symptoms you have.

Talk with your health care providers about what signs to look for, and when to call them. Chemotherapy can make you more likely to get infections. Your doctor will likely want you to call if you have signs of infection, such as:

  • Burning during urination

  • Fever

  • New cough or shortness of breath

  • Redness, swelling, and warmth at the site of an injury

  • Shaking chills

  • Sore throat

Chemotherapy through isolated limb perfusion (ILP)

If the melanoma is on a leg or arm, you may also get the medicine by isolated limb perfusion (ILP).  This procedure may shrink the tumor and help prevent amputation. It may also relieve symptoms, such as pain and swelling.

How ILP is done

ILP combines surgery and medicine. First, the surgeon temporarily stops the blood circulation to the affected arm or leg. Isolating the blood supply of the limb stops high doses of chemotherapy medicine from traveling around the body and affecting other organs.

Then, two small tubes called catheters are put into the limb. One is put in an artery and one is put in a vein. Blood from the vein goes into a machine called a pump-oxygenator. This machine is like the one used in heart bypass surgery. There, the blood is mixed with oxygen and chemotherapy medicine. Melphalan is the most common medicine used for this. The blood is then returned to the limb through the artery. 

Chemotherapy medicine moves through the limb for up to 90 minutes. During this time, blankets keep the limb warm. The medicines are also warmed as they move through the pump-oxygenator. This may help the chemotherapy work better. At the end of the procedure, the medicines are flushed out of the limb. Normal circulation is resumed. The entire procedure takes about 2 to 3 hours.

How ILP may help

The main advantage of ILP is that it allows high doses of chemotherapy medicine to be given to the affected limb, but spares the rest of the body from the medicine’s side effects. Side effects are mostly limited to the limb, such as limb swelling.

But ILP also has a few drawbacks. For one, it is major surgery. Also, it does not affect any cancer that has spread beyond the limb. And while this procedure can often shrink tumors, it may not improve long-term survival better than other treatments.

Doctors continue to look for ways to improve ILP. One method that is being tested is called isolated limb infusion (ILI). In ILI, a high dose of chemotherapy medicine is injected into an artery or vein of the affected limb while the blood is temporarily stopped with a tourniquet. It is believed that this type of infusion may kill more cancer cells and cause less damage to healthy tissue. This procedure is still being researched.