Melanoma: what to ask about subcutaneous immunotherapy

Melanoma is a type of skin cancer that begins in the melanocytes. These are the cells that produce melanin, a pigment that gives skin its color. While melanoma only accounts for roughly 1 percent of skin cancers, it causes the majority of skin cancer deaths.

Immunotherapy is a type of cancer treatment that helps the immune system identify and eliminate cancer. It’s used in the treatment of many types of cancer, including melanoma. Immunotherapy drugs may be used as a follow-up treatment after surgery or used as a primary treatment for advanced melanoma that has spread

How is immunotherapy administered?

Most immunotherapy drugs are administered intravenously, with an infusion into a vein. There are several immunotherapies that are administered subcutaneously, with an injection into a layer of tissue just below the skin called the subcutaneous tissue. Subcutaneous immunotherapy is a new and emerging treatment option.

The subcutaneous layer is a good route of administration for drugs that need to reach different areas of the body. From the subcutaneous layer, the drug will be absorbed into the lymphatic system, the body’s network of vessels, lymph nodes, and organs that transports immune cells and helps remove unwanted substances from the body.

If you or a loved one is living with melanoma and immunotherapy is a treatment option, it may be worth discussing subcutaneous immunotherapy with your healthcare team.

With that in mind, here are some questions to help you get started.

What subcutaneous immunotherapy drugs are available?

Subcutaneous immunotherapy is a somewhat new and emerging treatment option, and the number of immunotherapy drugs that are available as a subcutaneous injection is limited. However, it’s expected to expand in the future. Your first question will be whether the subcutaneous immunotherapy drugs that are available are a good fit for your diagnosis.

What will an injection appointment be like?

Subcutaneous injections typically take 3 to 7 minutes to administer, though the overall appointment will take longer. If subcutaneous immunotherapy is a treatment option, ask your healthcare providers what to expect at injection appointments, including what the injection process is like, how long you can expect to be at an appointment, and how much of that time will be spent administering the injection.

What part of the body will the injections be administered?

Subcutaneous injections are typically administered to the abdomen or thigh, though specific drugs can only be injected at specific sites.

Where can you go for an injection appointment?

While intravenous infusions typically require a visit to an infusion center or a hospital, subcutaneous immunotherapy can be administered at a healthcare provider's office. Along with shorter appointment times, this may help make immunotherapy more accessible to more people.

What side effects can this therapy cause?

Like all cancer treatments, immunotherapies can cause side effects. Side effects can vary depending on the drug, and side effects can vary depending on how that drug is administered. Fatigue, itching, rash, joint pain and muscle pain, and GI distress are common immunotherapy side effects. In the treatment of melanoma, immunotherapy can sometimes cause depigmentation, called vitiligo-like depigmentation.

Your healthcare providers may be able to recommend strategies or medications to reduce or ease certain side effects.

It’s also important to mention that immunotherapy is typically not recommended for people who are pregnant, who have a history of poorly controlled or uncontrolled autoimmune disease, people who have received an organ transplant, and people who have had a serious adverse reaction to previous immunotherapies.

How can you expect to feel during and after an injection?

Ask your healthcare provider about how you can expect to feel immediately after an injection and in the days after. Ask if they have recommendations, such as having someone there to drive you home after the injection or taking a day off of work to recover.

How can you expect to feel for the duration of treatment?

The duration of treatment can also vary from person to person, depending on the stage of melanoma and the therapy being used. Ask what you can expect to feel like during treatment. Ask what lifestyle adjustments you need to make. For example, steps to prevent infections and proper sun protection.

How often will treatments need to be administered?

The frequency of injections can vary from person to person. Ask your healthcare provider how often you will come in for injections. Also ask how often you will need to come in for checkups and exams, which will be needed to monitor your response to treatment as well as monitor for any side effects or health concerns.

Preparing for your appointments

The questions above are intended as a starting point. Take time to think about what you want to know and write down a list of questions for your next appointment. It can also help to bring a loved one to your appointment, both as emotional support and to help you take notes.

Remember, your healthcare team will be your best source of information, and you are also an important source of information to your healthcare team. Knowing your concerns and questions can help your healthcare team provide you with better care.