Metastatic melanoma
Why in News?
The Central Drugs Standard Control Organisation (CDSCO) authorized RELOPDUO, a fixed-dose drug combining nivolumab and relatlimab to target two separate immune checkpoints simultaneously.
About
- Definition: It is the most advanced stage (Stage IV) of skin cancer, originating in melanin-producing cells (melanocytes) and actively spreading to other regions of the body.
- Aggressive Nature: Melanoma is uniquely dangerous because it can metastasize relatively early compared to other solid tumours.
- Primary Causes: Severe cellular DNA damage predominantly driven by overexposure to ultraviolet (UV) radiation from sunlight or tanning beds.
- Common Sites of Spread: Typically targets the lymph nodes, distant skin tissues, lungs, liver, bones, and the brain.
Key Symptoms & Risk Factors
- Physical Signs: Hardened skin lumps, swollen or painful lymph nodes, unexplained weight loss, and chronic fatigue.
- Organ-Specific Symptoms: Shortness of breath (lungs), persistent headaches or seizures (brain), and localized bone pain.
- Primary Risk Factors: A family history of melanoma, fair skin that burns easily, light-coloured eyes, and multiple blistering sunburns during childhood.
Modern Treatment Paradigms
- Dual Immunotherapy: Uses immune checkpoint inhibitors (like anti-PD-1 and anti-LAG-3 pairs) to unmask cancer cells so the body's immune system can kill them.
- Targeted Kinase Therapy: Oral drugs targeting specific genetic mutations—such as BRAF or MEK inhibitors—which work effectively in roughly 40-50% of patients carrying these mutations.
- Cellular TIL Therapy: A one-time personalized process where a patient's own T-cells are harvested from the tumour, multiplied by the billions in a lab, and re-infused to attack the cancer.
- Local Intervention: Surgery and targeted radiation therapy remain crucial for relieving local tumour pressure or palliation.
