Jade Homsi, MD, is a medical oncologist at Banner MD Anderson Cancer Center.
Question: What are the new advances in the treatment of melanoma?
Answer: Did you know that one American dies of melanoma almost every hour? Unfortunately, this type of skin cancer continues to be very aggressive. It is estimated that 76,000 people in the US will be diagnosed with melanoma in 2012. The likelihood of getting melanoma has actually increased in the past 30 years, and no one knows exactly why. Increased UV exposure from the sun and indoor tanning have been identified as risk factors for the disease.
But there is some good news, too! After about 13 years of not introducing any new drugs to treat melanoma, the FDA approved three new ones in 2011. Melanoma has been particularly difficult to treat because it’s resistant to chemotherapy, which generally takes a “kill all” approach toward cells. But all three new drugs take a different strategy by using the immune system or genetic changes in the cancer cells. Two of the drugs are for patients with advanced stages of the disease, and the other is intended to prevent the recurrence of melanoma in patients who’ve had the melanoma surgically removed.
The first one, ipilimumab, is given intravenously and is designed to stimulate the immune system, which will then attack the cancer cells. A minority of patients with advanced melanoma had a prolonged benefit from this drug than was measured in years. The problem is that it has unique side effects as a result of overstimulation of the immune system. Some of these are: severe diarrhea; inflammation of the liver; and a change in the body’s normal hormone levels.
The second new drug available is called peginterferon alfa-2b, which is given as shots in the skin rather than intravenously. It also stimulates the immune system and has an effect on the blood supply to the cancer cells. The drug is for patients who have had a melanoma removed and is designed to reduce the chances of the melanoma returning. Its side effects are more manageable than those of ipilimumab, but can include nausea, body ache, and fever.
Lastly, the third drug is vemurafenib, and it’s given orally. This drug works in a very smart way because it targets a mutation in a protein called B-raf in the cancer cells. Approximately 50 percent of melanoma patients have this type of mutation which makes the drug work only in half of melanoma patients. Vemurafenib has shown to improve survival rates of melanoma patients with manageable side effects.
There are some very promising new drugs currently under investigation in clinical trials, so there could be more progress soon. In the meantime, melanoma continues to be a very aggressive disease and we need to enforce and focus on prevention and early detection as the best way to fight this disease.
Here are a few recommendations:
- Wear sunscreen daily
- Wear a hat when outside
- Avoid tanning beds and prolonged sun exposure
- Do self-skin exam regularly
- See a dermatologist on a regular basis, especially if there is a history of melanoma in your family or you have a lot of moles