Options for treating Melanoma with medicines

1) General Chemotherapy (Interferon and the like)
Interferon is used in stage III, not in stage IV.
It is said to extend life, but is 'brutal' because of side effects.

2) Immune Therapy (for specific cancers, as highlighted on each website)
Objective is to make white blood cells recognise the cancer and fight it naturally.
The drugs remove signals that stop white blood cells to do its natural job.
Drugs are available now but are not covered by insurance:

• Merck/KEYTRUDA (Pembrolizumab): FDA approval 5-Aug-2016, 2,250US$/vial (see prices)
• Bristol-Myers Squibb/OPDIVO (Nivolumab):  FDA approval 17-May-2016, Japan Govt. approval 17-Jan-2017!!!!,  2,400US$/vial (see prices), Latest news***
• Bristol-Myers Squibb/YERVOY (Lpilimumab): FDA approval 25-Mar-2011, 7,000US$/vial (see prices)

Warning: The sites of each drug provide alarming warnings for side effects due to white blood cells attacking healthy organs. Quite disturbing and a cold shower for growing hope....
However, according to my oncologist, the side effects are mostly mild and are caused by over-active white blood cells, which may cause hormonal changes. These side effects can be treated with medications.
My oncologist also mentioned that there are 'exciting' cases known where treatment was stopped due to cost, but the white blood cells continued to recognise the cancer and continued fighting. It was as if the body just needed the trigger given by the first dosages.

3) Medicines for known Melanoma gene mutations
Over 75% of melanoma patients have a mutation in one of three areas: BRAF, NRAS, or c-Kit. Shutting down the activity of those mutations may mean killing the tumor cells.
The fact is, we have drugs that block c-Kit (drug: Gleevac), and a BRAF blockade has just been submitted for FDA approval.

4) Research on new Melanoma mutations
A study in Harvard Stem Cell Institute is making progress in mapping all gene mutations.
Their research is very exciting:
"Stem cell researchers at Children’s Hospital Boston (CHB) have taken two important steps toward the development of a new way of treating melanoma, the most virulent form of skin cancer.

In two letters featured on the cover of the March 24 edition of the journal Nature, the researchers, led by HSCI Executive Committee chair Leonard Zon, MD, report isolating a gene that hastens the growth of melanoma tumors, and using an already approved drug, in combination with a drug now working its way through the federal Food and Drug Administration (FDA) approval process, to uncover new potential therapeutic targets in melanoma. Zon is also a professor in Harvard University’s Department of Stem Cell and Regenerative Biology and heads CHB’s stem cell program.

Zon said his group is now waiting for FDA approval of a drug that blocks the function of the gene BRAF, which has long been known as a melanoma promoter. “We’re planning on starting clinical trials at Massachusetts General Hospital and Dana-Farber Cancer Institute within six months of that approval,” he said.

The path toward the new findings began in 2005 with the development in Zon’s lab of a zebrafish model of human melanoma, Zon said. It was further accelerated, said Richard White, PhD, lead author of the paper and a postdoctoral fellow in Zon’s lab, by researchers’ use of novel genetic and chemical approaches — including drugs already approved for other purposes — that are uniquely available in the zebrafish system.

In the White letter, the researchers report that early in melanoma development, the BRAF gene causes the cells to become more “progenitor”-like, resembling a type of embryonic cell called neural crest stem cells.

“We asked what happens in the early stages of melanoma to the cells that acquire BRAF mutation,” White said. “We figured out that one of the things BRAF does is cause the animal to have too many embryonic-like neural crest cells. So we developed a chemical screen to find molecules that would suppress neural crest cells.”

The researchers screened a library of 2,000 chemicals in zebrafish embryos to find ones that eliminated these neural crest cells. “We look for drugs that are used for something else, and ask whether they can then be used” for the disease being studied, White said. The advantage of this strategy is that if a compound that is already FDA approved is found to be effective in initial studies it can be moved directly to human trials. In this case, the chemical, called lefunomide, was previously approved for treating rheumatoid arthritis.

By combining lefunomide with a drug awaiting FDA approval that blocks the BRAF gene, researchers magnify the effect of two drugs that, administered alone, have a smaller effect. Together, said White, the drugs completely knocked out melanoma in several human cell tests, and reduced tumor size in melanoma cells transplanted into mice as well."

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