Melanoma therapies and the skin

March 21, 2019
Ilya Petrou, MD

Dermatology Times, Dermatology Times, June 2019 (Vol. 40, No. 6), Volume 40, Issue 6

The cutaneous side effects of targeted therapies and immunotherapy for melanoma can complicate treatment and become a burden to patients. Dermatologists must aggressively address these side effects for a more ideal management and better quality of life for their melanoma patients.

Continued research has borne an array of different therapeutic drugs for the treatment of unresectable or metastatic melanoma, each agent achieving varying degrees of efficacy. What remains constant, however, is that these new and innovative targeted and immunotherapies have side effects, many of which are cutaneous. A number of these patients will receive lifelong or long-term therapy with these agents, and the new challenge that must be met head-on in this new age of targeted and immunotherapies are the cutaneous side effects that many melanoma patients experience. Dermatologists must be able to quickly recognize, treat and manage the melanoma drug-specific symptoms seen in this growing patient population.

Melanoma therapies have had many advantages over the last several years with the emergence and success of immunotherapy and targeted therapies. The use of systemic medications has now expanded and is effectively used in adjuvant therapy and other settings. Although many patients are doing well and surviving longer, experts agree that these same patients are now met with different challenges, which include a number of cutaneous side effects from the treatments that are helping them with their previously untreatable disease.

“It is a more promising time for melanoma patients as there now exist better therapeutic options to treat advanced disease, but there is a relatively high incidence of cutaneous adverse events with these novel therapies, including with immunotherapies. As such, we as dermatologists have a critical role to play in trying to best manage the cutaneous side effects in this patient population so that there is no limitation if possible for them to receive these very effective targeted and immunotherapy drugs,” says Bernice Y. Kwong, M.D., F.A.A.D., clinical associate professor of dermatology, director of the supportive dermato-oncology program, and director of the inpatient dermatology consult service, department of dermatology, Stanford University School of Medicine, Stanford, Calif.

Even before immunotherapies and targeted therapies became available for melanoma treatment, skin toxicities were already a common issue with other cancer therapies. According to Dr. Kwong, the lessons learned from the side effects of cancer therapy management from other cancer drugs have been helpful in treating patients with melanoma.

“It is such an exciting time with increasing and ongoing research and understanding of genetic changes in melanoma, and the development of targeted therapies and immune therapies not only for melanoma but for many other cancers as well. There is a newer field of dermatology called supportive oncodermatology, where there continues to be rapid change and still so much to learn. As such, it is important that our management strategies adapt and change in this very dynamic field,” Dr. Kwong says.

Recognizing the growing need for a standardized optimal care framework for the side effects of melanoma immunotherapy treatment, as with the guidelines put forth on how to optimally treat melanoma, Dr. Kwong says that the National Comprehensive Cancer Network (NCCN) has now also put forth helpful guidelines on how clinicians can best manage immunotherapy toxicities, including skin toxicities.

Dr. Kwong also notes that when patients develop advanced or metastatic melanoma and chemotherapy comes in to play, there is still a very important role for dermatologists to have in the care for these patients. Dermatologists are equipped through their training and diagnostic expertise with the knowhow and formidable treatment modalities to help them successfully address and manage the skin issues they encounter in their immunotherapy melanoma patients.

“The cutaneous eruptions that we are seeing often rely so much on us as dermatologists to use our expertise in skin morphology and skin disease to understand what is happening there on a clinical, morphologic and histological level. This expertise allows us to bring great management strategies to our patients. If we better understand what is happening in the skin and what is happening histologically, we can oftentimes find better, more optimal, specific, and effective treatment and management strategies for our patients,” Dr. Kwong concludes.

Disclosures: Genentech, Inc. – C(Fees);

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