Immunotherapy for melanoma in Germany
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Melanoma immunotherapy is an innovative method of systemic therapy that complements the conventional protocol at all stages of the disease and can significantly increase treatment success rates, survival rates and life expectancy. In German hospitals, doctors actively use this type of treatment in the early stages of melanoma to prevent a recurrence, and immunotherapy for metastatic melanoma makes it possible to restrain the progression of the disease and prolong the life of patients with advanced stages of the pathology. In Germany, more than five groups of immunotherapeutic drugs are used, each of which is prescribed strictly individually, taking into account the genetic characteristics of the tumor and the patient's condition.
Content
- Role of immunotherapy in the complex treatment of melanoma
- Types of immunotherapy for melanoma
- How immunotherapy for melanoma is carried out
- Benefits of immunotherapy for melanoma
- How to undergo immunotherapy for melanoma in Germany
Role of immunotherapy in the complex treatment of melanoma
Immunotherapy treatment for melanoma is part of the complex therapy of this type of oncology. At stages I and II, the tumor is removed surgically with the capture of 0.5 to 2.0 cm of healthy tissue. If the fingers or auricle are affected, then German surgeons perform modified operations in order to preserve the function of the hand or organ of hearing. After complete healing of the postoperative wound, a course of immunotherapy is prescribed. It is crucial to start treatment no later than nine weeks after surgery. The goal of immunotherapy in this clinical situation is to minimize the risk of cancer recurrence.
When given in the early stages of melanoma, immunotherapy (most often, this is a dendritic cell vaccine) forms a long-term anti-cancer memory. The human immune system stores information about the tumor; if a similar malignant neoplasm reappears in the body, it is quickly destroyed due to the activation of specific anti-cancer immunity.
In the III stage of melanoma, with the involvement of the lymph nodes, doctors additionally remove the lymph nodes, and immunotherapy begins no later than three months after that. At this stage of the disease, German oncologists prefer administering preparations of monoclonal antibodies and immune response checkpoint inhibitors. The goal of treatment is to destroy the remaining microscopic metastases and ensure complete recovery.
If the tumor is unresectable (this may be in stage III or IV), then melanoma immunotherapy can slow down the further progression of the disease, i.e., the spread of metastases and the destruction of the primary tumor. In this case, the patient receives immunotherapeutic drugs for a long time, and this is the primary type of treatment. Previously, doctors could offer such patients only chemotherapy, which had severe side effects.
Types of immunotherapy for melanoma
The overall goal of immunotherapy for melanoma is to make the human immune system learn to recognize and destroy malignant cells. In general, melanoma is a highly immunogenic tumor. This means that it has several unique surface antigens that can be a target for immune attacks. In medical practice, there are cases when small neoplasms disappear on their own, without surgery or other types of treatment, only due to the work of natural antitumor immunity. If this does not happen, then doctors use drugs for such groups:
- Cytokines, such as Interleukin-2 and Interferon alpha. In melanoma, Interleukin-2 preparations are mainly used since Interferon alpha is deactivated too quickly.
- Tyrosine kinase inhibitors. Such drugs are used in the detection of one of the mutations in the BRAF gene, namely the V600E mutation. Overall, mutations in the BRAF gene cause more than 80% of melanoma cases. Tyrosine kinase inhibitors suppress the activity of this gene.
- Monoclonal antibodies, such as immune checkpoint inhibitors. These are the most common drugs that are highly effective in people with advanced melanoma. Immune checkpoint inhibitors block the CTLA-4 and PD-1 receptors on the surface of lymphocytes and thereby remove the ability of the tumor to hide from anti-cancer immunity.
- Adaptive cellular immunotherapy: TIL-therapy and CAR T-cell therapy. In the first case, lymphocytes are isolated from the affected by melanoma tissues. Such lymphocytes have high anticancer activity. They are cultivated in the laboratory and reinfused in the patient. In the second case, doctors insert artificially synthesized receptors into the patient's lymphocytes, which will allow the cells of the immune system to see the tumor better. The method is extremely effective, but its application is limited by the high average cost of treatment.
- Vaccination: peptide and ganglioside vaccines, DNA vaccines, cellular vaccines (including dendritic cell vaccines).
Modern medicines for all groups are available in German clinics, and doctors have vast experience in their administration. It is imperative to choose the most effective immunotherapy regimen with minimal side effects.
How immunotherapy for melanoma is carried out
The main type of immunotherapy in the early stages of melanoma is vaccination with dendritic cells. The vaccine is manufactured individually, using the patient's leukocytes and particles of his own tumor. The process of making the vaccine can take up to 2-3 weeks, which must be taken into account during the treatment planning (as mentioned above, vaccination should be carried out no later than nine weeks after the surgical tumor removal). Depending on the results of the control examination, the patient receives several doses of the vaccine with an interval between injections of 2 to 8 weeks. The drug is administered on an outpatient basis in a day hospital.
The choice of immunotherapeutic drugs and schemes for their use in stage III or IV melanoma begins with an examination for mutations. In this case, the accuracy of the diagnostic stage significantly affects the treatment outcome since tumors with different mutations are sensitive to different drugs. The most clinically significant mutations are:
- V600E mutation in the BRAF gene
- Mutation in the KIT gene
Depending on the results of the genetic examination, German oncologists recommend using a drug from the group of tyrosine kinase inhibitors, immune response checkpoint inhibitors, or a combination of both. Therapy can be continued for up to 2 years. It is canceled in case of the complete regression of the primary tumor and all metastases according to the results of MRI, MSCT, or PET/CT with 18F-FDG. During immunotherapy, the patient undergoes regular examinations in order to assess the general condition and the progression of the disease.
Benefits of immunotherapy for melanoma
Melanoma is a highly immunogenic tumor. Therefore, immune therapy is more effective in its treatment than in most other types of cancer.
At a very early stage, the advantage of localized immunotherapy with Imiquimod cream is that it enables complete cure of the cancer without surgery. This is especially important when the tumor is located in aesthetically and functionally significant areas. At later stages, the advantages of the technique are in the effective and non-invasive suppression of intradermal metastases.
Benefits of systemic immunotherapy for melanoma are as follows:
- Variety of available techniques (cytokines, TIL therapy, oncolytic viruses, vaccines, immune checkpoint inhibitors, and CAR T-cell immunotherapy are used for melanoma)
- High efficacy at all stages
- Response to immunotherapy is observed in the majority of patients with melanoma
- The technique is more effective than targeted and chemotherapy
- Most immunotherapy drugs have low toxicity
Recent studies show that innovative immunotherapy options allow patients with even the advanced stage of melanoma to expect not only long-term survival with complete remission, but also complete cure. Cases have been described where, after all tumors have disappeared as a result of immunotherapy, melanoma has not returned for many years of follow-up.
| Cancer stage | Response to standard treatment protocol | Response to standard treatment protocol + Immunotherapy |
| Stage 3 | 50% | 70% |
| Stage 4 | 20% | 50% |
How to undergo immunotherapy for melanoma in Germany
If the doctors in your country do not have sufficient experience in carrying out immunotherapy for melanoma, or if they do not have access to the necessary drugs yet, then you can visit one of the specialized oncology centers in Germany. You can come here both for a full course of melanoma treatment and for a separate procedure – immunotherapy.
On the Booking Health website, you will find a complete list of clinics that offer this type of treatment, as well as current prices for medical services. You can choose a healthcare facility and make an appointment yourself or ask for the assistance of a Booking Health medical advisor.
Booking Health experts will help you:
- Choose a clinic that specializes in immunotherapy and demonstrates the highest success rates in the treatment of melanoma
- Have a distant consultation with a doctor at a German clinic to clarify the treatment regimen
- Make an appointment for the desired date
- Explore the preliminary program of examination and treatment
- Undergo examination and treatment at a favorable price, without additional fees for foreign patients (save up to 50%)
- Purchase medicines in order to continue treatment in your country
- Keep in touch with a clinic and physician after the treatment completion
- Check invoices from the clinic, and return unspent deposit funds (some clinics ask for a certain deposit when treating people with cancer)
- Get a visa, book plane tickets and accommodation, organize a transfer
- Translate medical reports into German so that the attending physician can review them
- Communicate with your doctor through a personal medical interpreter
Booking Health has been helping melanoma patients undergo treatment in Germany for over 12 years. You can contact Booking Health with any questions regarding the treatment of melanoma in Germany via the phone number on the website or by using the "Need help" form.
Choose treatment abroad and you will for sure get the best results!
See the interview for more information:
INNOVATIVE DENDRITIC CELL TREATMENT IN GERMANY – interview with Prof. Dr. med. Frank Gansauge
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.
Sources:
Read:
Cancer immunotherapy in Germany
Immunotherapy for metastatic melanoma according to the TIL protocol (tumor-infiltrating lymphocytes)
Treatment of melanoma with dendritic cells in Germany
TOP 5 Oncology Hospitals in Germany
