Immunotherapy: Open Access
Open Access

Melanoma Immunotherapy: The Therapeutic Approach of Immune System in Treating Melanoma

Peter Kunst^{* *}Correspondence: Peter Kunst, Department of Immunology, University of Cuito Cuanavale, Menongue, Angola, Email:

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Description

Melanoma, a potentially deadly skin cancer, has seen remarkable treatment advancements over the past decade, primarily due to the development of immunotherapy. This therapeutic approach harms the body's immune system to identify and combat cancer cells, offering patients with advanced melanoma, where traditional treatments often fall short.

Melanoma and its side effects

Melanoma arises from melanocytes, the cells responsible for producing melanin, the pigment that colors our skin. While it accounts for a small percentage of skin cancer cases, it causes the majority of skin cancer deaths due to its high potential to spread (metastasize) to other parts of the body. Early-stage melanoma is often treatable with surgical excision, but once it metastasizes, the prognosis significantly worsens. Historically, treatments for metastatic melanoma included chemotherapy and radiation, which had limited efficacy and considerable side effects.

The emergence of immunotherapy

Immunotherapy represents a paradigm shift in the treatment of melanoma. Unlike conventional treatments that directly target cancer cells, immunotherapy aims to boost the patient’s own immune response to fight the cancer. Two main types of immunotherapy have shown significant assurance in treating melanoma: checkpoint inhibitors and adoptive cell transfer.

Inhibitors of the immune system

Checkpoint inhibitors are drugs that block certain proteins used by cancer cells to evade detection by the immune system. The most notable checkpoints are CTLA-4 and PD-1/PD-L1.

Cytotoxic T-Lymphocyte Associated Protein (CTLA-4) inhibitors: Ipilimumab, an anti- CTLA-4 antibody, was the first checkpoint inhibitor approved for melanoma. By inhibiting CTLA-4, ipilimumab enhances T-cell activity, leading to a more robust immune response against melanoma cells.

Programmed Cell Death Ligand 1 (PD-1/PD-L1) inhibitors: Drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) target the PD-1 pathway, another mechanism melanoma cells use to avoid immune attack. Blocking PD-1 or its ligand PD-L1 allows T-cells to recognize and kill melanoma cells more effectively.

Clinical trials have shown these inhibitors can significantly prolong survival in patients with advanced melanoma. For instance, the combination of nivolumab and ipilimumab has demonstrated higher efficacy compared to either drug alone, although this combination also increases the risk of severe immune-related side effects.

Adoptive cell transfer: engineering a response

Adoptive Cell Transfer (ACT) involves extracting T-cells from the patient, genetically modifying or selecting those with the highest tumor-fighting potential and reintroducing them into the patient. The most prominent form of ACT is Tumor Infiltrating Lymphocytes (TIL) therapy, where T-cells extracted from the tumor are expanded in the laboratory and then infused back into the patient. This personalized approach has shown assurancing results, with some patients achieving complete remission.

Challenges and future directions

While immunotherapy has revolutionized melanoma treatment, it is not without challenges. Not all patients respond to these therapies and some develop resistance after an initial response. Moreover, the side effects, often termed immune related Adverse Events (irAEs), can be severe and require careful management. These include inflammation of healthy organs such as the intestines, liver, endocrine glands and skin.

Ongoing studies aims to overcome these challenges. Biomarkers that predict response to immunotherapy are under investigation, which could help to made treatments to individual patients. Additionally, combining immunotherapy with other modalities such as targeted therapy, radiation or new agents is being explored to enhance efficacy and overcome resistance.

Immunotherapy has opened new avenues for treating melanoma, providing options for patients with advanced disease who previously had limited assurance. The success of checkpoint inhibitors and adoptive cell transfer highlights the potential of harnessing the immune system to fight cancer. As studies progresses, the hope is to further improve these therapies, making them more effective and accessible, ultimately transforming melanoma from a fatal disease to a manageable condition. The journey of immunotherapy in melanoma treatment exemplifies the power of innovative science in rewriting the narratives of cancer care.