How to Make the Most of Stage IV Decision Making for Patients and Caregivers

During this webinar, Melissa Wilson, PA-C, MPAS, our host of From the Clinic to the Living Room, welcomes Anna C. Pavlick, D.O., Weill Cornell Medicine, and Michael Postow, MD, Memorial Sloan Kettering Cancer Center, to discuss treatment planning for Stage IV melanoma.

– Overview of treatment options (standard of care for Stage IV)
– What testing should be done upfront
– Financial assistance
– Caregiver tips while on treatment
– What if the standard of care options don’t work

ACCESS THE STAGE IV PATIENT GUIDE: https://bit.ly/STAGEIVTREATMENTGUIDE

Stage IV melanoma, also known as metastatic melanoma, is a serious and life-threatening form of skin cancer that has spread to distant parts of the body. When faced with this diagnosis, patients and their healthcare providers are confronted with the challenging task of making treatment decisions. The complexity lies in balancing the potential benefits and risks of various treatment options while considering individual patient factors such as overall health, personal preferences, and quality of life.

One common treatment approach for stage IV melanoma is systemic therapy. This involves using medications that can reach cancer cells throughout the body via the bloodstream. Immunotherapy and targeted therapy are two main types of systemic treatments used in stage IV melanoma. Immunotherapy stimulates the body's immune system to recognize and attack cancer cells, while targeted therapy uses drugs that specifically target genetic mutations or proteins present in cancer cells.

Immunotherapy has revolutionized the treatment landscape for stage IV melanoma by significantly improving survival rates. Drugs like pembrolizumab and nivolumab have shown remarkable efficacy in clinical trials, leading to their approval by regulatory authorities. However, these therapies can cause immune-related adverse events (irAEs) such as fatigue, rash, diarrhea, or even more severe complications affecting organs like the lungs or liver. Balancing potential benefits against these risks is crucial when deciding on immunotherapy.

Targeted therapy is another option for stage IV melanoma patients whose tumors harbor specific genetic mutations such as BRAF V600E/K mutations. Drugs like vemurafenib or dabrafenib inhibit these mutated proteins within cancer cells to slow down tumor growth. However, targeted therapies may have side effects including skin rashes or joint pain that need careful consideration during decision-making.

Surgical interventions may also be considered depending on individual circumstances. In some cases where metastases are limited in number and location (oligometastatic disease), surgical removal of these metastases may improve outcomes. However, surgery is not always feasible or appropriate for all patients due to factors such as tumor size, location, or overall health status.

Radiation therapy is another treatment modality that can be employed in stage IV melanoma. It uses high-energy X-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy can be used to relieve symptoms caused by metastatic lesions, such as pain or bleeding. However, it is typically not curative for widespread metastatic disease and is often used in combination with other treatments.

When making treatment decisions for stage IV melanoma, patient preferences and quality of life considerations are paramount. Some patients may prioritize aggressive treatment approaches to maximize their chances of survival, while others may opt for less intensive therapies that focus on symptom control and maintaining quality of life. Shared decision-making between patients and healthcare providers becomes crucial in this context to ensure that the chosen treatment aligns with the patient's goals and values.

Making treatment decisions for stage IV melanoma requires careful consideration of various factors including potential benefits, risks, individual patient characteristics, and personal preferences. Systemic therapies like immunotherapy or targeted therapy have transformed the landscape of stage IV melanoma treatment but come with their own set of side effects. Surgical interventions or radiation therapy may also be considered depending on individual circumstances. Ultimately, shared decision-making between patients and healthcare providers ensures a personalized approach that maximizes the chances of achieving optimal outcomes while preserving quality of life.