How the Drugs Are Given For targeted therapy, you will be taking capsules/tablets twice a day as long as you are tolerating the combination and the melanoma doesn’t progress. Pembrolizumab is given as an IV infusion into your arm, typically at your oncologist’s office. The drug is usually given every three weeks (but can be given every six weeks) and will be continued for as long as you tolerate it, and the melanoma doesn’t progress. The infusion lasts for 30 minutes. Nivolumab is given as an intravenous (IV) infusion into your arm, typically at your oncologist’s office. The drug is usually given every two weeks (but can be given every four weeks) and will be continued for as long as you tolerate it, and the melanoma doesn’t progress. The infusion lasts for 30 minutes. When nivolumab and ipilimumab are given in combination, both drugs are given by IV. Nivolumab is given over a 30-minute period. Ipilimumab is given over 90 minutes. They will be given every three weeks for a total of four doses. After that, nivolumab is usually given alone every two or four weeks. The therapy is usually given for as long as you tolerate it, and the melanoma doesn’t progress for a maximal treatment time of two years. For vemurafenib + cobimetinib + atezolizumab, the administration includes a period with just the targeted therapies (which is capsules/tablets twice a day) for 28 days. This is followed by the triple combination approach, which includes 28 days with targeted therapy along with atezolizumab every two, three, or four weeks given as an intravenous infusion into your arm (over a 60-minute period for the first dose and, if tolerated, over 30 minutes thereafter), typically at the oncologist’s office. The triple drug combination will be continued for as long as you tolerate it, and the melanoma doesn’t progress. As mentioned, IL-2 is given in the hospital and requires hospital stays of five to seven days per course, most often in an intensive care or bone marrow transplant setting. The infusion itself is given by an intravenous line for a treatment course of two cycles, each given three times per day for five days. So you take a two-week break before the second cycle. A month after the second cycle, the scans are done to see if the cancer is shrinking. If it is working you can receive up to a total of six cycles of IL-2. T-VEC is injected directly into the tumor in the physician’s office or clinic. As mentioned, T-VEC is made with a herpes virus so you will need to be careful with dressing changes and potential exposure to your loved ones, particularly those who are immunocompromised or pregnant. The injections are at the initial visit, then three weeks later, and then every two weeks while you have the tumor to inject. You can be treated for six or more months.
Stage IV Melanoma Treatment Options • Making the Decision That’s Right for You Copyright © 2022 AIM at Melanoma Foundation and Terranova Medica, LLC. All Rights Reserved. Document Released January 26, 2022.
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