Schneck Medical Center

SUM 2015

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1 9 w w w. s p i r i t o f w o m e n . c o m S U M M E R 2 015 S P I R I T O F W O M E N Food and Drug Administration approval and hit the market as the first immunotherapy drug for skin cancer treatment. Since the approval of Yervoy, Keytruda (pembrolizumab) and Opdivo (nivolumab) have also received FDA approval and are now commercially available. "These drugs are known as checkpoint inhibitors," says Dr. Rosemary Fiore, an oncologist affiliated with Monmouth Medical Center, Long Branch, N.J. "Checkpoint inhibitors basically inhibit the immune system from turning off. There are different ways each drug works, but all of these drugs inhibit the 'stop' signal for the immune system, so the body continues to fight the cancer." RISK VS. REWARD Immunotherapy treatments are currently being used for metastatic melanoma; surgery is still the first treatment doctors generally explore for localized melanomas that haven't metastasized. Medical professionals caution, however, that immunotherapy is a relatively new area and not a fail-safe treatment when other methods are ineffective. "You can use Yervoy on all melanoma patients, but it only seems to help 20 percent of those who try it," says Dr. Fiore. "One of the goals researchers have is to figure out why it only seems to help 20 percent and get that number to improve." One reason immunotherapy is already gaining traction, though, is its lessened toxicity compared with chemotherapy. While chemotherapy can cause severe side effects including nausea and extreme fatigue, immunotherapy treatments have a much less adverse effect on a patient's quality of life. "There might be some nausea, but generally it's not as severe," says Kate Kennedy, a nurse practitioner in oncology at Pardee Hospital, Hendersonville, N.C. "The most common side effects include fatigue, and perhaps rashes." INFLAMMATION CONCERNS Inflammation is the biggest area of concern with immunotherapy drugs. The drugs prevent the immune system from powering down, which can lead to internal inflammation that has to be managed with medication. "With these types of drugs, it's not just targeting the tumors, it's revving up your entire immune system," says Dr. Fiore. "And when you do that, there's always a potential for side effects." In cases of excessive inflammation, doctors often try to balance the immunotherapy drugs with anti-inflammatory and immunosuppressive medications, including steroids. "It can be a balancing act to find the right combination SHUTTERSTOCK • Never use a tanning bed or sun lamp. • Wear sunscreen (water-resistant with SPF 30 or higher) and lip balm every day. • Wear clothes that protect you from ultraviolet (UV) rays, such as those made from material that you can't easily see through. Or, add a UV protectant to your clothes when you wash them. • Wear sunglasses that offer UV protection daily. • Avoid spending time outdoors between 10 a.m. and 2 p.m. whenever possible. Source: American Academy of Dermatology 5 ways of the drug to treat the cancer and the medication used to manage the inflammation," Kennedy says. "The big thing is that if you notice any changes or any new symptoms, you talk to your doctor right away, because you might need an adjustment in the levels of the medications you're taking." GET INFORMED As with any treatment regimen, the effectiveness of immunotherapy can hinge on a variety of factors. Before considering immunotherapy treatment options, it's important to talk with your healthcare professional about how advanced your skin cancer is and any other possible complicating issues. "Know as much as you can about the advancement of the disease," says Dr. Fiore. "And ask your doctor to test your tumors for certain mutations that might make your disease a candidate for genetically targeted treatments, which could also come into play." Age is another variable that can affect treatment options, but Dr. Fiore explains that the real issue is overall health, not age alone. "We do have some additional concerns with older patients," she says. "Having said that, I've had patients in their 80s who have responded well to immunotherapy treatments. It really depends on each person's situation." As research and development continues to advance, scientists predict that one day immunotherapy drugs could be part of comprehensive cancer treatments that attack the disease on multiple fronts. "An individual drug might not be the answer specifically, but we could see treatments composed of a combination of immunotherapy, genetically targeted therapy and other courses of treatment, leading to an overall clinical benefit," according to Dr. Fiore. "The years of research are starting to pay off." • to help prevent skin cancer

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