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 medical forms of treatment with cytoreductive surgery according to indications. A single treatment regimen for patients who are at high risk of subsequent recurrence does not currently exist.

Chemotherapy for melanoma with metastases has not proven to be 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 often it kills the patient faster than the tumor itself.

The cytostatic most well-known and widely used for melanoma is Dacarbazine. This drug inhibits cell division, as a malignant tumor, and all others, however, like other cytostatics. It violates the stability of cellular deoxoribonucleases, and, being a purine analogue, inhibits their synthesis. However, prolonged use of Dacarbazine detrimental effect not only on the growth of a malignant tumor, but also has a systemic toxic effect on the entire body. A side effect of its prolonged use is the growth of new malignant tumors. Manufacturers estimate efficiency at 20–22%, although actual research often cites lower numbers at 15–20%, and some, only 5.5%.

In diffuse melanomas, polychemotherapy is often used. Other cytostatics are included in the treatment regimen. On the basis of Dacarbazine created, for example, the following treatment regimens:

• CVD regimen - every three weeks combined intravenous infusions of Cisplatin at a dose of 20 mg per 1 m² of 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;
• Dartmud regimen - a combination of Dacarbazine cytostatics (220mg / m²) and Cisplatin (25mg / m²), which the patient receives from the first to the third day every three weeks; twice as rarely (every six weeks) and only on the first day is added the cytostatic agent Carmustine at a dose of 150 mg / m²; at the same time, the patient also receives Tamoxifen in a daily dose of 20–40 mg (medication, estrogen inhibitory activity and 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, 15mg of the glycopeptide antibiotic Bleomycin, which has antitumor activity; on the first and fifth days of Vincristine at a dose of 1 mg / m²; from the first to the fifth day at 200mg / m² Dacarbazine; Lomustine at a dose of 80mg / m² the patient receives on the first day, but after a cycle, that is, with an interval of six weeks.

The advantages of chemotherapy have not yet been proven, and there are many differences on the choice of a more effective treatment strategy.

A newer cytostatic agent with a similar effect, Temozolomide, is also used, the effectiveness of which is considered higher. With monotherapy, he is currently considered the first-line drug. In addition, the combination of Temozolomide with recombinant interferon was found to be 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 can be performed (intravenous infusions, taking pills), regional - infusions are made into the arteries feeding the primary or metastatic tumors (used when the tumor and metastasis are concentrated in the area of one limb). This allows you to focus the action of anticancer drugs in high doses directly into the affected area, without hurting the organs in other places.

Chemotherapy is contraindicated in women carrying a child, patients with end-stage cancer, with severe hepatic, renal, respiratory and heart failure, with advanced stages of endocrine pathologies, hematopoietic disorders (hemoglobin level ˂ 60g / l; leukocytes 3 × 10⁹ / l; platelets 100 × 10⁹ / L); in cases of severe sensitization to the drug.

Side effects of anticancer drugs are temporary baldness, severe immunosuppression, nausea, vomiting, constant indisposition, spontaneous appearance of hematomas on the surface of the skin.

Immunotherapy is also used. In metastatic inoperable melanoma, it is performed with high doses of recombinant interferon-α (IFN-A), which have a pronounced antiproliferative effect, however, and pronounced side effects - flu-like symptoms (fever, muscle and joint pain, lack of appetite, cognitive, neurological and mental disorders ). May also be prescribed therapy with medium and small doses of the drug. Recent developments of semi-synthetic recombinant interferon-α-2b in the form, including the molecule of polyethylene glycol, have reduced the toxicity of the drug and improve its tolerability by patients. Research has generally shown improved survival rates for patients with advanced melanoma cases.

Immunostimulation is performed using interleukin-2 (IL-2). Used and tumor necrosis factor. However, while immunotherapy is also not a panacea, although there are isolated cases of even complete cure against the background of short-term relief.

In the inoperable stages of melanoma, biotherapy is a new direction in treatment: the use of placental preparations synthesized on the basis of embryonic peptides and glycoproteins is being studied; Vaccination with antigens of own tumor melanocytes is applied.

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

Scientists have high hopes for treatment with drugs that stimulate the body’s own antitumor response by activating T-lymphocytes (targeted or targeted therapy). The first registered drug of this type, Ipilimumab (Yervoy), which is a human monoclonal antibody (produced by single-cell immunocytes by the multiple division method, a cell clone), is intended to include the process of dealing with mutated melanocytes, interfering with the mechanism of interaction between the tumor and the immune system, and early and late in the formation of the immune response. In randomized studies among patients who received monotherapy with Ipilimumab, very impressive results were obtained, although it is still impossible to call the drug a panacea. Also, it was not without its side effects, which were stopped by glucocorticosteroids, sometimes more complicated therapy was required, however, the antitumor response to Ipilimumab therapy took place, and the median overall survival was almost a year (11.4 months), and a three-year one reached almost 22%.

Later developed new drugs of this type, the so-called control points inhibitors - Keitrud (pembrolizumab) and Opdivo (nivolumab) are used to treat unresectable melanomas in cases of ineffectiveness of other therapeutic methods, including Ipilimumab.

Immunotherapy with monoclonal antibodies has been shown to be effective in metastatic melanoma to the brain. Repeated therapy with these drugs gave partial regressions in some cases, or at least the patient's condition stabilized. Nevertheless, there are still a lot of questions on dosing and undesirable effects of treatment. Often, the patient develops resistance to the target therapy — blocking one direction of tumor development often leads to the appearance of another.

Another new targeted drug, Vemurafenib, works only in cases of BRAF mutations in modified melanocytes. About 2/3 of the tumors have this type of change. Before prescribing this drug, the patient is tested for its presence. Compared with the standard course of chemotherapy, Vemurafenib in clinical trials showed almost nine times better results - a reduction in the size of the tumor and the regression of secondary formations were registered in 48.4% of subjects. The response to therapy developed literally from the second week of treatment, the patients' condition improved, even at very advanced stages, however, this state of affairs remained only a few months. Six months or later from the start of the course of treatment, resistance develops and the relapse of the underlying disease begins. In addition, a new type of skin neoplasm appeared in the subjects. The most frequent complication was scaly cell carcinoma, and benign keratoacanthoma of the epidermis was also diagnosed. The drug is not always effective and in some cases, growth of the neoplasm is accelerated, which approximates the lethal outcome.

In the course of the research, it turned out that the fairly rapid mutation of the enzyme kinase of the BRAF signaling pathway under the action of Vemurafenib caused a paradoxical effect: tumor melanocytes began to be synthesized in an excess amount of mutant proteins, against which it was planned to direct the effect of the drug. But it was also found that tumor cells become not only resistant to treatment, but they are dependent on the type of drug 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 in the absence of a “drug” die.

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

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

In all methods of treatment of metastatic melanoma, which are currently known, there are a number of serious disadvantages. None of them leads to complete recovery, they are all very toxic. However, they still make it possible to extend the life of many patients, in some, however, rare cases, quite significantly.

Alternative treatment

The laboratories of the world's leading clinics are working on solving the problem of treating metastatic melanoma, and the results are still weak. Therefore, the idea that the patient can be cured with the help of healers is very doubtful. Nevertheless, alternative means have been used for a long time, and there are cases of cure by ear, so they should not be neglected. Especially patients who are chemotherapy contraindicated for health reasons. In addition, the means of alternative medicine reinforce the effects of drugs used in traditional oncology, enrich the body with vitamins, flavonoids, micro- and macroelements, have antioxidant activity and are capable of alleviating the toxic effects of drugs to some extent. The use of such complex therapy, especially approved by the attending physician, increases the chances of improving or stabilizing the condition.

In our article we are talking about metastatic melanoma, when the cancer has spread throughout the body, so we will consider options for the systemic use of alternative means.

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

Beet juice is drunk five times a day, 120 g at a time before meals at regular intervals (only 600 g per day). It turns out that four servings are drunk while awake, and for the reception of the fifth one will have to get up at night. A daily serving 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 reception of beet juice with radiation therapy. It has, in addition to the antitumor, a beneficial effect on many processes in the body - blood formation, digestion. It should be borne in mind that beet juice reduces blood pressure, so hypotonics should treat this treatment with caution. Beets, not only raw, but also boiled or baked, are generally recommended to be consumed more often by cancer patients.

Twice a day with melanoma, it is recommended to use carrot juice with pulp. It must be prepared immediately before use.

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

Juices are drunk on an empty stomach, therefore, in order to assimilate them, it is necessary to take a sip of vegetable oil before eating a portion or eat a teaspoon of sour cream.

Figs or figs - fruits, leaves, roots and milk, released from fresh, broken young shoots and leaves are used to treat malignant tumors on the skin. The antitumor effect of substances contained in the fruits of figs. They contribute to the death of modified cells, increasing the permeability of cell membranes. Therefore, they are simply useful to eat. This is a southern plant, so dried or dried figs are used in most regions. You can make a decoction of them: chop some dried fruits, measure two tablespoons of raw materials, pour 200 ml of water and cook for ten minutes, wipe everything in a mush, insist for an hour. This is the daily rate, it must be divided into three or four parts and consumed during the day.

Herbal melanoma is also possible. Usually poisonous plants possess antitumor activity, therefore preparations of them must be taken strictly according to the schedule and under the supervision of a physician.

Tincture of aconite rhizomes (fighter). Dug roots cleaned of soil residues, dried and crushed. They take a container of dark glass, pour 10 g of finished raw material there and pour 70% alcohol in a volume of 400 ml. Alcohol should be free of impurities, diluted only with distilled water (on the pharmaceutical packaging is usually written composition). The tincture is kept in a dark cool place for 21 days, during which time it should acquire a dark color.

It is drunk according to a certain pattern in combination with a decoction of herbs that you need to prepare daily. For the preparation of the broth is a mixture of medicinal plants: two parts of black elderberry flowers and marsh duckweed, one each - the thousandth, sweet clover, wintergreen, groundwort. Mix well. Take a tablespoon of the mixture, pour into an enamel container, pour 200 ml of boiling water, put on the fire and boil for ten minutes. Let go and allow to cool. Strain.

The regimen: an hour before a meal, dissolve one drop of aconitic tincture in ½ cup of water and drink. Half an hour after that, add 3 ml of tincture to a filtered glass of herbal broth and drink the entire batch.

The next day, two drops of tincture of aconite root are diluted in ½ cup of water, the herbal decoction is prepared, mixed and drunk in the same way.

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

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

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

Strengthens the antitumor effect of aconitic drops of turmeric powder, a teaspoon of which is recommended to be diluted in 100 ml of pre-warmed fresh cow milk whey. During the course of taking tinctures such a drink is consumed three times a day.

Celandine - known antitumor agent. Infusion of celandine can be prepared from dried herbs purchased at the pharmacy. Brewed with boiling water in a glass or enameled container at the rate of 5g celandine per 300ml of water, kept for a quarter of an hour in a water bath. Allow to cool for 45 minutes, strain off. Take two tablespoons before breakfast, lunch and dinner, a quarter of an hour after ingestion, you can already eat.

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

Insist on vodka dry flowers tartarnika ordinary in the proportions: one part of plant materials for five parts of vodka. Container with tincture is kept for ten days in a dark place protected from warm enough, then filtered and taken half an hour before breakfast, lunch and dinner, a teaspoon.

Outwardly for application to the skin affected by melanoma and its metastases, as well as lymph nodes, an oil extract prepared from plant materials can be used. Take the same parts of powdered dry bay leaves, lupine seeds, soapwort roots, tartar flowers, and mix well. In a glass of vegetable mixture need a liter of refined sunflower or olive oil. This mixture is boiled in a water bath for half an hour and at room temperature for another three-quarters of an hour. The finished extract is filtered and applied to the affected surface of the skin several times a day (without restrictions).

[1]

Homeopathy

In the fight against such a serious disease and the effects of chemotherapy, all means are good. Do not neglect and homeopathy, in addition, treatment should be under the supervision of a physician. Not every homeopath will undertake to treat a cancer patient. However, there are doctors who have experience of such work. Treatment with homeopathic medicines is aimed at activating its own antitumor protection. Both homeopathic grains and the autonosode (autovaccine) of the patient are used, for example, his own urine can be used as a biological material.

Depending on the stage of melanoma, different treatment tactics can be chosen. In cases of widespread metastases, palliative treatment is planned, aimed at inhibiting the tumor process, reducing its aggressiveness, converting to a less severe chronic form, prolonging the life of the patient and improving its quality.

Sometimes this tactic is very successful, the patient’s condition stabilizes, and the doctor proceeds to actively counteract 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 to perform anticarcinogenic treatment, tumor resection and adjuvant therapy, which was previously considered impractical.

With the help of modern homeopathic medicines, one can prepare a patient for surgical intervention, a course of chemotherapy, radiation treatment, accompanying various treatment methods, which will reduce toxic effects and speed recovery, as well as avoid many possible complications and prevent relapses of the disease.

Homeopathic remedies should be prescribed by the oncologist, the treatment is usually complex, different means are used, sometimes several at the same time. Symptoms are removed in layers. Individual treatment.

[2], [3], [4], [5], [6]

Surgery

Metastatic melanoma is often inoperable. Even if only one or two metastases to distal organs were found on tomograms or other studies, the victory over melanoma metastases through 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, surgery is often performed to remove 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 most fully and improve the patient's condition, sometimes removing a small number of metastases can significantly increase the life expectancy and its quality.

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

[7], [8], [9], [10], [11], [12]