Treatment of metastatic melanoma of the skin

Metastatic melanoma (stage III) is operable, then the main method of treatment is surgery in combination with adjuvant radiation and drug therapy, which is the prevention of the spread of metastases.

Inoperable metastatic melanoma is treated symptomatically, combining mainly drug treatment with cytoreductive surgery as indicated. There is currently no single treatment regimen for patients with a high risk of subsequent recurrence.

Chemotherapy for metastatic melanoma has not proven effective, however, it is used alone or in combination with other methods in palliative care schemes. In addition, treatment with cytostatics is the most accessible form, although many researchers note that the toxic effect of chemotherapy is very high and it often kills the patient faster than the tumor itself.

The most well-known and widely used cytostatic agent for melanoma is Dacarbazine. This drug inhibits cell division, both of the malignant tumor and of all others, however, like other cytostatics. It disrupts the stability of cellular deoxyribonucleases, and, being a purine analogue, suppresses their synthesis. However, prolonged use of Dacarbazine has a detrimental effect not only on the growth of the malignant tumor, but also has a systemic toxic effect on the entire body. A side effect of its long-term use is the growth of new malignant tumors. Manufacturers estimate the effectiveness at 20-22%, although real studies often cite lower figures at 15-20%, and some - only 5.5%.

In diffuse melanoma, polychemotherapy is more often used. Other cytostatics are also included in the treatment regimen. For example, the following treatment regimens have been created based on Dacarbazine:

• CVD regimen – every three weeks, intravenous infusions of Cisplatin are combined at a dose of 20 mg per 1 m² of the patient’s body surface from the first to the fourth day; Vinblastine 1.5 mg/m² with the same frequency and on the first day of the treatment cycle – Dacarbazine 800 mg/m²;
• The Dartmouth regimen is a combination of the cytostatics Dacarbazine (220 mg/m²) and Cisplatin (25 mg/m²), which the patient receives from the first to the third day every three weeks; twice as often (every six weeks) and only on the first day, the cytostatic Carmustine is added at a dose of 150 mg/m²; while the patient also receives Tamoxifen at a daily dose of 20-40 mg (a drug that suppresses estrogen activity and is used in the treatment of hormone-dependent breast cancer);
• BOLD regimen – every three weeks the patient receives three drugs: on the first and fourth days, 15 mg of the glycopeptide antibiotic Bleomycin, which has antitumor activity; on the first and fifth days, Vincristine at a dose of 1 mg/m²; from the first to the fifth day, 200 mg/m² of Dacarbazine; the patient receives the drug Lomustine at a dose of 80 mg/m² on the first day, but through a cycle, that is, with an interval of six weeks.

The benefits of polychemotherapy have not yet been proven, and there is much controversy regarding the choice of more effective treatment tactics.

A newer cytostatic of similar action, Temozolomide, is also used, the effectiveness of which is recognized as higher. In monotherapy, it is currently considered a first-line drug. In addition, the combination of Temozolomide with recombinant interferon is recognized as quite effective.

Palliative treatment aims not to cure, but to improve the quality of life and its duration. Its main characteristics are moderate toxicity and convenience for the patient. Systemic therapy (intravenous infusions, taking tablets) and regional therapy can be performed - infusions are made into the arteries that feed the primary or metastatic tumors (used when the tumor and metastases are concentrated in the area of one limb). This allows concentrating the action of antitumor drugs in high doses directly into the affected area, without affecting organs in other places.

Chemotherapy is contraindicated for pregnant women, patients with terminal cancer, severe liver, kidney, respiratory and heart failure, advanced stages of endocrine pathologies, hematopoiesis disorders (hemoglobin level ˂ 60 g/l; leukocytes ˂ 3×10⁹/l; platelets ˂ 100×10⁹/l); in cases of severe sensitization to the drug.

Side effects of antitumor drugs include temporary baldness, severe immunosuppression, nausea, vomiting, constant malaise, and spontaneous appearance of hematomas on the surface of the skin.

Immunotherapy is also used. In metastatic inoperable melanoma, it is carried out with high doses of recombinant interferon-α (IFN-A), which have a pronounced antiproliferative effect, but also pronounced side effects - flu-like symptoms (fever, muscle and joint pain, loss of appetite, cognitive, neurological and mental disorders). Therapy with medium and low doses of the drug can also be prescribed. The latest developments in semi-synthetic recombinant interferon-α-2b in a form including a polyethylene glycol molecule have reduced the toxicity of the drug and improved its tolerability by patients. Studies have generally shown improved survival outcomes for patients with advanced cases of melanoma.

Immunostimulation is carried out using interleukin-2 (IL-2). Tumor necrosis factor is also used. However, immunotherapy is not yet a panacea, although there are individual cases of complete recovery with short-term assistance.

In inoperable stages of melanoma, a new direction in treatment is biotherapy: the use of placental drugs synthesized on the basis of embryonic peptides and glycoproteins is being studied; vaccination with antigens of the patient's own tumor melanocytes is used.

To alleviate the condition of patients with an unfavorable prognosis, combinations of various treatment methods are also used: biochemotherapy, a combination of immunotherapy with the use of antitumor vaccines, and others.

Scientists have high hopes for treatment with drugs that stimulate the body's own antitumor response by activating T-lymphocytes (targeted therapy). The first registered drug of this type, Ipilimumab (Yervoy), is a human monoclonal antibody (it is produced by immune cells from a single cell by multiple division - a cell clone), and is designed to include the process of fighting modified melanocytes by interfering with the mechanism of interaction between the tumor and the immune system, both at the early and late stages of immune response formation. In randomized studies among patients receiving Ipilimumab monotherapy, very impressive results were obtained, although the drug cannot be called a panacea. There were also side effects that were relieved by glucocorticosteroids, and sometimes more complex therapy was required; nevertheless, there was an antitumor response to Ipilimumab therapy, and the median overall survival was almost a year (11.4 months), and the three-year survival rate reached almost 22%.

Later developed new drugs of this type, the so-called checkpoint inhibitors – Keytruda (pembrolizumab) and Opdivo (nivolumab) are used to treat unresectable melanomas in cases where other therapeutic methods, including Ipilimumab, are ineffective.

Immunotherapy with monoclonal antibodies has proven effective in treating melanoma metastasis to the brain. Repeated therapy with these drugs has resulted in partial regressions in some cases, or at least stabilization of the patient's condition. However, many questions remain about dosing and undesirable effects of treatment. Often, the patient develops resistance to targeted therapy - blocking one direction of tumor development often leads to the emergence of another.

Another new targeted drug Vemurafenib works only in cases of BRAF mutation in altered melanocytes. About 2/3 of tumors have this type of changes. Before prescribing this drug, the patient is tested for it. Compared with the standard course of chemotherapy, Vemurafenib showed almost nine times better results in clinical trials - a decrease in tumor size and regression of secondary formations were recorded in 48.4% of subjects. The response to therapy developed literally from the second week of treatment, the condition of patients improved, even at very advanced stages, however, this state of affairs lasted only a few months. Six months or a little later from the beginning of the treatment course, resistance to the drug develops, and a relapse of the underlying disease begins. In addition, the subjects developed new types of skin neoplasms. The most common complication was squamous cell carcinoma, benign keratoacanthoma of the epidermis was also diagnosed. The drug is not always effective and in some cases the growth of the tumor accelerates, which brings the death closer.

During the research it was found that a fairly rapid mutation of the BRAF signaling pathway kinase enzyme under the influence of Vemurafenib caused a paradoxical effect: tumor melanocytes began to synthesize mutant proteins in excess, against which the drug was planned to act. But it was also discovered that tumor cells not only become resistant to treatment, but they also develop a drug-like dependence on the drug. Without it, the growth and development of cancer cells stopped - they died. This observation was confirmed experimentally, which made it possible to develop a method of intermittent therapy - the drug is taken in short courses, taking breaks between them, during which the melanocytes of the neoplasm die in the absence of the "drug".

Although new drugs have been registered for use, they are still in the stage of study and refinement of treatment regimens. In addition, they are expensive - a course of treatment costs tens and hundreds of thousands of dollars. Although patients all over the world have the opportunity to participate in research of new drugs (then the treatment is free).

Radiation therapy is used as a palliative treatment and to prevent the spread of metastatic tumors, especially in cases of multiple lymph node lesions, secondary bone or brain tumors. In some cases, it prevents the spread of metastases, alleviates the symptoms of the disease, and helps control them. It is also often combined with drug therapy.

All currently known methods of treating metastatic melanoma have a number of serious drawbacks. None of them leads to a complete cure, all of them are very toxic. However, they still allow many patients to prolong their lives, in some, albeit rare, cases, quite significantly.

Folk remedies

The laboratories of the world's leading clinics are working on a solution to the problem of curing metastatic melanoma, and the results are still weak. Therefore, the idea that a patient can be cured using traditional methods is very doubtful. However, folk remedies have been used for a long time, and cases of cure are well-known, so they should not be neglected. Especially for patients who are contraindicated for chemotherapy due to health reasons. In addition, traditional medicine enhances the effects of medications used in traditional oncology, enriches the body with vitamins, flavonoids, micro- and macroelements, has antioxidant activity and is able to some extent to neutralize the toxic effects of drugs. The use of such complex therapy, especially approved by the attending physician, increases the chances of improving or stabilizing the condition.

Our article is about metastatic melanoma, when cancer has spread throughout the body, so we will look at options for the systemic use of folk remedies.

Juice therapy: many vegetables have antitumor properties – beets, carrots, white cabbage, potatoes.

Beetroot juice is drunk five times a day, 120 g at a time before meals at equal intervals (a total of 600 g per day). It turns out that four portions are drunk while awake, and to take the fifth, you will have to get up at night. The daily portion of juice is squeezed out once a day and stored in the refrigerator. Before the first intake, the juice should stand there for at least two hours. The portion is slightly warmed up before use.

It is recommended to combine beetroot juice with radiation therapy. In addition to antitumor, it has a beneficial effect on many processes in the body - hematopoiesis, digestion. It should be noted that beetroot juice reduces blood pressure, so hypotensive patients should be careful with this treatment. Beetroot, not only raw, but also boiled or baked, is generally recommended for cancer patients to eat more often.

For melanoma, it is recommended to drink carrot juice with pulp twice a day. It should be prepared immediately before use.

It is also recommended to drink a juice mix in the morning on an empty stomach, which consists of: two parts of beetroot and carrot juice and one part of cabbage and potato juice. Moreover, the beetroot component of the drink should be left to stand for two hours, then squeeze the juice out of the remaining vegetables, mix and drink immediately.

Juices are drunk on an empty stomach, so in order for them to be absorbed, you need to take a sip of vegetable oil or eat a teaspoon of sour cream before drinking a portion.

Figs or fig tree - fruits, leaves, roots and milk secreted from fresh broken young shoots and leaves are used to treat malignant neoplasms on the skin. Antitumor effect is provided by substances contained in figs. They promote the death of modified cells, increasing the permeability of cell membranes. Therefore, they are simply useful to eat. This is a southern plant, so in most regions dried or dried figs are used. You can make a decoction from them: chop several dried fruits, measure out two tablespoons of raw materials, pour 200 ml of water and boil for ten minutes, rub everything into a gruel, insist for an hour. This is the daily norm, it should be divided into three to four parts and consumed during the day.

Herbal treatment of melanoma is also possible. Antitumor activity is usually possessed by poisonous plants, therefore preparations from them should be taken strictly according to the scheme and under the supervision of a doctor.

Tincture of aconite rhizome (wrestler). Dug roots are cleaned from soil residues, dried and crushed. Take a container of dark glass, pour 10 g of the finished raw material into it and fill it with 70% alcohol in a volume of 400 ml. The alcohol should be free of foreign impurities, diluted only with distilled water (the composition is usually written on the pharmacy packaging). The tincture is kept in a dark cool place for 21 days, during which it should acquire a dark color.

It is drunk according to a certain scheme in combination with a decoction of herbs, which must be prepared daily. To prepare the decoction, a mixture of medicinal plants is made: two parts of black elderberry and duckweed flowers, one part of centaury, sweet clover, wintergreen, meadowsweet. Mix well. Take a tablespoon of the mixture, pour it into an enamel container, pour 200 ml of boiling water, put on the fire and cook for ten minutes. Set aside and let cool. Strain.

Scheme of administration: one hour before a meal, dilute one drop of aconite tincture in ½ glass of water and drink. Half an hour later, add 3 ml of tincture to a strained glass of herbal decoction and drink the entire portion.

The next day, dilute two drops of aconite root tincture in ½ glass of water, prepare the herbal decoction, mix and drink in exactly the same way.

Each subsequent day, the number of drops of tincture diluted in water should be increased by one. The maximum permissible amount is 20 drops (this is 20 days), after which the dose is gradually reduced - each day, dripping one drop less into the water. This is another 19 days. The recipe for herbal decoction remains unchanged.

After the course of treatment, a break of 14-21 days is taken. Then the course of treatment can be repeated.

You can replace or supplement the herbal decoction with aloe juice. It also enhances the effect of the tincture of aconite roots. Aloe leaves that are at least two years old are suitable for this. The juice is prepared immediately before taking. The leaf is crushed and the juice is squeezed through several layers of gauze. You need a teaspoon of juice per dose. On the days of taking the tincture, aloe juice is consumed three times a day.

Turmeric powder enhances the antitumor effect of aconite drops. It is recommended to dilute a teaspoon of turmeric in 100 ml of warmed fresh whey from cow's milk. During the course of taking the tincture, this drink is consumed three times daily.

Celandine is a well-known antitumor agent. Celandine infusion can be prepared from dry grass purchased at a pharmacy. Brew with boiling water in a glass or enamel container at the rate of 5 g of celandine per 300 ml of water, keep for a quarter of an hour in a water bath. Let it cool for 45 minutes, strain. Take two tablespoons before breakfast, lunch and dinner, a quarter of an hour after taking it you can already eat.

It is also recommended to infuse celandine roots in vodka, for which they are washed, dried, and crushed. Take 100 g of raw material per 500 ml of vodka, infuse away from light, in a warm place for 14 days. Strain the finished tincture through several layers of gauze. Take as follows - drip a few (5-7 drops) onto a piece of refined sugar and dissolve under the tongue three times a day.

Dry flowers of common thistle are infused in vodka in the following proportions: one part of plant material to five parts of vodka. The container with the tincture is kept for ten days in a place protected from light and quite warm, then filtered and taken half an hour before breakfast, lunch and dinner, one teaspoon at a time.

Externally, for application to the skin affected by melanoma and its metastases, as well as the lymph nodes, you can use an oil extract prepared from plant materials. Take equal parts of dry bay leaf, lupine seeds, soapwort roots, and thistle flowers ground into powder and mix well. For a glass of plant mixture, you will need a liter of refined sunflower or olive oil. This mixture is simmered in a water bath for half an hour and infused at room temperature for another three quarters of an hour. The finished extract is filtered and applied to the affected skin surface several times a day (without restrictions).

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Homeopathy

In the fight against such a serious disease and the consequences of chemotherapy, all means are good. Homeopathy should not be neglected, and treatment should be carried out under the supervision of a doctor. Not every homeopath will undertake to treat a cancer patient. However, there are doctors who have experience in such work. Treatment with homeopathic preparations is aimed at activating the patient's own antitumor defense. Both homeopathic granules and the patient's autonosode (autovaccine) are used, for example, his own urine can be used as biological material.

Depending on the stage of melanoma, different treatment tactics can be chosen. In cases of widespread metastases, palliative treatment is suggested, aimed at slowing down the tumor process, reducing its aggressiveness, transferring it to a less severe chronic form, prolonging the patient's life and improving its quality.

Sometimes this tactic is quite successful, the patient's condition stabilizes, and the doctor moves on to actively counteracting the growth of primary and secondary tumors. As a result, it often becomes possible to transfer inoperable patients to a group of less severe patients and perform anticancer treatment, tumor resection, and adjuvant therapy, which was previously considered inappropriate.

With the help of modern homeopathic medicines, it is possible to prepare a patient for surgery, chemotherapy, radiation therapy, and to accompany various treatment methods, which will help to mitigate toxic effects and speed up recovery, as well as avoid many possible complications and prevent relapses of the disease.

Homeopathic preparations should be prescribed by a homeopathic oncologist, treatment is usually complex, different means are used, sometimes several at the same time. Symptoms are removed layer by layer. Treatment is individual.

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Surgical treatment

Metastatic melanoma is often inoperable. Even if tomograms or other studies reveal only one or two metastases in distal organs, defeating melanoma metastases by surgical intervention is highly questionable. There is a high probability of the presence of other micrometastases, the size of which does not allow them to be detected yet. Nevertheless, surgical intervention is often performed to remove the primary and detected secondary tumors, the purpose of which is to establish control over melanoma. Palliative surgical care is provided to alleviate symptoms. Of course, they try to remove the tumor tissue as completely as possible and improve the patient's condition; sometimes the removal of a small number of metastases allows to significantly increase life expectancy and its quality.

At the third stage of melanoma, the primary tumor and the nearest nodes in which modified melanocytes are found are removed. At this stage, distant metastases are not yet determined, and after adjuvant therapy there is hope for a long relapse-free period.

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