Systemic (full body) treatment
Systemic therapies can be divided into two groups; those that are given in addition to the primary treatment to help increase the patient’s chances of survival (adjuvant), and those that are used to improve symptoms (palliative) or control the tumours (curative intent) once the cancer has spread.
Most conjunctival melanoma patients will receive a local adjuvant therapy at the time of their initial treatment, such as cryotherapy, radiation therapy or topical chemotherapy. There is currently no systemic adjuvant therapy suitable for conjunctival melanoma patients.
Traditionally Dacarbazine (or DTIC) given as an IV infusion has been used to treat all kinds of metastatic melanoma patients. Because of the rarity of conjunctival melanoma, it is unknown how many patients respond to this sort of drug.
A relatively new area of cancer treatment is targeted therapies. These are drugs, or other substances, that block or inhibit certain cancer molecules.
Around half of conjunctival melanoma patients may have mutations in the BRAF gene, which is related to increased growth of the cancerous cells.
If you have developed metastases and are found to be “BRAF Positive”, your medical/clinical oncologist may suggest a course of Dabrafenib (brand name “Tafinlar”) or Vemurafenib (brand name “Zelboraf”).
These drugs have been found to help around half of all melanoma patients with the BRAF mutation. Due to the rarity of conjunctival melanoma, it is unknown how many conjunctival melanoma patients have benefited.
Immunotherapy is an emerging area of cancer research. Treatment uses parts of the patient’s own immune system to fight the cancer, either by stimulating the immune system to work more effectively, or by adding engineered components.
If you take immunotherapy drugs you should also be aware of the potentially lethal side effects, although with close supervision from your medical/clinical oncologist, and being aware yourself of the issues, these are generally well managed.
Ipilimumab (brand name “Yervoy”) is available on the NHS, through your medical/clinical oncologist. The treatment works by stimulating the body’s own immune system. It is a form of Anti-CTLA-4.
CTLA-4 is a molecule found on the surface of the T-Cells in the immune system. CTLA-4 is responsible for “switching off” the T-Cells’ response to avoid the immune system over-working and causing autoimmune disease. Ipilimumab reverses this process, forcing the T-Cells to remain “on” to fight the cancer.
Ipilimumab’s effectiveness in conjunctival melanoma is not yet fully understood, so your medical/clinical oncologist will be able to advise you.
PEMBROLIZUMAB AND NIVOLUMAB
Pembrolizumab (brand name “Keytruda”) and Nivolumab (brand name “Opdivo”) are both Anti-PD-1 drugs.
PD-1 is a protein found on the surface of a tumour cell that, along with PD-L1, protects tumour cells from being destroyed by the immune system. Anti-PD-1 blocks this action, allowing the immune system to attack the tumour cells.
Pembrolizumab is currently available on the NHS for patients who have already had Ipilumumab. Nivolumab is currently available on the NHS as a “first-line” treatment (i.e. no pre-treatment required). Your medical/clinical oncologist will be able to tell you more.
The National Institute for Health and Care Excellence (NICE) are continually monitoring these relatively new drugs. In particular, doctors are looking at combining Pembrolizumab with Ipilimumab, a combination which has shown promise in cutaneous melanoma (skin cancer).