What to Do When Immunotherapy Stops Working

Immunotherapy works by harnessing the power of your body’s own immune system. It attacks metastatic melanoma in a way that can extend lives for months or years -- and in some cases actually get rid of the disease.

But it doesn’t always work for everyone.

Doctors generally know fairly quickly if you’re responding to immunotherapy. They’ll use either CT (computerized tomography) scans, a type of X-ray, or PET (positron emission tomography) scans, which use a radioactive substance to look for disease in the body.

They’ll compare scans taken before treatment with those taken after 3 months. They can see what’s happened to your cancer: Is it bigger, smaller, or the same size? And more important, are there any new signs of melanoma?

How Your Doctor Reads Your Scans

If the scans show a clear response, meaning the existing disease is getting smaller and there aren’t any new spots, you’ll continue treatment and repeat the scans in 3 more months. The same is true if there’s a partial response, like a growth of existing lesions but no sign of new disease. You may be rescanned at 2 months instead to provide an earlier snapshot of how the treatment is working.

Things get tricky if your scan shows clear growth of existing lesions and the start of new ones.  Doctors don’t want to give up too soon -- many people don’t show improvement until after 4 to 6 months, so the doctor may keep you on your meds -- especially if they aren’t causing severe side effects. So, often they will wait another 2 to 3 months and repeat the scans. 

Is It Time to Try a Clinical Trial?

If the new scans show the disease is progressing, the best option is to enroll in a clinical trial. This is a research program that lets people who have melanoma help test a new treatment, drug, or device. All new treatments start in the lab. They’re carefully studied in test tubes and laboratory animals. Only those most likely to work make it to the next step, where they’re tested in a small group of humans. After that comes a larger clinical trial.

The good news about clinical trials is that because researchers are trying to figure out why some people respond to immunotherapy and others don’t, many are now specifically geared toward people with treatment-resistant metastatic melanoma.

Continued

Can Surgery or Radiation Help?

Depending on where the melanoma has spread, these treatments can help ease symptoms. If it’s in your bones, radiation -- which uses high-energy rays to destroy cancer cells -- can help relieve pain and prevent the cancer from growing and further destroying the bone. But neither option can cure the disease.

What to Do When Nothing Works

Despite all the progress that’s been made with immunotherapy in treating advanced melanoma, it doesn’t help everyone. When nothing works, the question for doctors becomes, “Am I going to do this patient more harm than good by continuing to treat them?”

If the answer is yes, the doctor will talk to you and your family about hospice. This type of care focuses on managing a seriously or terminally ill person’s pain and symptoms, while also tending to their emotional and spiritual needs.

One way of thinking about end-of-life care: Instead of getting up every day to fight cancer, choose not to worry about how many days are left. Focus on making sure every day has the best quality of life as possible.

These discussions are never easy, but they are honest. And it may be possible to have both quality of life and quantity of life. One study showed that people who receive hospice care live longer than those who pursue aggressive treatment.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on December 12, 2018

Sources

SOURCES:

Rodabe Amaria, MD, assistant professor, melanoma medical oncology, University of Texas MD Anderson Cancer Center.

Skin Cancer Foundation: “Treatment of Metastatic Melanoma: A New World Opens.”

Memorial Sloan Kettering Cancer Center: “New Findings Clarify How Immunotherapy Works -- and Why, In Some People, It Doesn’t.”

American Cancer Society: “Tests for melanoma skin cancer.”

National Cancer Institute: “Immunotherapy.”

UpToDate: “Immunotherapy of advanced melanoma with immune checkpoint inhibition,” “Patient education: Melanoma treatment; advanced or metastatic melanoma (Beyond the Basics).”

Melanoma Research Foundation: “Treating Melanoma Through Clinical Trials.”

Family Practice Management: "Discussing End-of-Life Care With Your Patients.”

© 2018 WebMD, LLC. All rights reserved.

Pagination