In a world-first study, doctors have discovered a new treatment that increases the survival of patients with advanced melanoma. Here’s what you need to know…
It’s the breakthrough Australians with advanced melanoma have been praying for – a new way of treating the deadly disease that can extend life expectancy and possibly even cure melanoma. Associate Professor Georgina Long from the Melanoma Institute Australia and University of Sydney spearheaded clinical trials of anti-PD-1 drugs and says these “anti–PD-1 drugs (pembrolizumab and nivolumab) have already saved many hundreds of lives.”
Here, Dr Long explains what the breakthroughs mean for those with advanced melanoma, and how it will impact cancer treatment…
What is melanoma?
“Melanoma is the deadliest skin cancer we have, that can spread rapidly around the body. Over 12,000 Australians are diagnosed with melanoma each year, of which about 80-90% are curable with surgery. However, approximately 1,500 patients die each year from melanoma – that is a patient about every 6 hours.
“Mostly, you can see the melanoma first developing on your skin, but not always. Often it is a mole or a dark spot that changes quickly, but sometimes it can be a colourless spot that changes very quickly. If you catch it early enough and have surgery, you can cure it. But unfortunately in 10-15% of patients, it can be so biologically aggressive that when you notice it, it’s possibly already spread. Advanced melanoma is when the melanoma has spread around the body and is terminal. It includes Stage 4 patients and some of the Stage 3.”
How is melanoma caused?
“Most commonly it’s caused by sun exposure, which is why in Australia we have such high melanoma numbers. We think the pattern of exposure matters, and intermittent exposure, or sunburn in childhood, can put you at higher risk. Sunbeds also cause melanoma. It’s also linked to our heritage and tends to be a disease affecting very fair people. Asian and black people can develop melanoma, but it’s much rarer than fair skinned people.”
What is the significance of this melanoma treatment?
“Fifteen percent of melanomas spread, and once they spread, it is terminal. Five years ago, the median survival of patients once it spread was 6-12 months. The one year survival rate was only 30-35%. By two years, only 15 out of 100 patients would be alive. These were the statistics for decades. We tried every trial, every combination of chemotherapy and vaccines, but nothing improved those statistics.”
“The last five years research and trials have changed the way we treat melanoma in two very different ways. Firstly, we use new immunotherapies that don’t really use chemotherapy (chemotherapy basically kills most cells, the fast dividing cancer cells as well as the good cells, but it never really worked with melanoma). Secondly, we now use targeted drugs to kill the cancer cells, but not the good cells – the immunotherapy treatment ramps up the immune system in a specific way so that your immune system kills the cancer cells for you.”
What is the life expectancy due to this melanoma treatment breakthrough?
“The one year survival used to be 30-35%, now it is 74% – and that is just using the PD1 targeted therapies (not using multiple targeted drugs or immunotherapies). The two year survival used to be 15%, now more than 50% of patients live beyond this. If we use multiple drugs in sequence, we’re going to see even higher life expectancy figures. We think we are probably curing 25-30% of patients, but it’s still early days so we just don’t know.”
What’s next?
“We have finished the trials on this particular drug (an anti-PD-1), but there are other immunotherapies we are working on now. The TGA (Therapeutic Goods Administration) has approved this drug and we now waiting for the Government to approve and fund it [so people can access via the PBS – Pharmaceutical Benefits Scheme]. Currently, I can prescribe it to patients, but it has to be paid for by them.”
Does everyone respond to treatment?
We know within 12 weeks if people respond to it. Only 40% of people have a really deep shrinkage response, but around 70% in total have shrinkage of some kind. However, there are 30% of people that don’t respond at all to this drug – we are currently working on getting a 100% response rate, and trialling different combinations of treatments in these patients.”
“If you do respond, then we continue the drug, usually for two years, although it’s currently under debate how long we should continue for because we just don’t know at this stage.”
Prevention: what can we do?
“Staying out of the sun and covering up is the best prevention – that means wearing a hat, long-sleeves, sunscreen and being vigilant about checking your body regularly.”
How often should we be having skin checks?
“We don’t recommend people have regular skin checks if they’ve never had a melanoma or if they don’t have a strong family history. They need to check their skin, or have their partner or family check their back and skin regularly. However, people who have had a melanoma or have a strong family history should definitely see a dermatologist regularly for skin checks.”
Dr Long has been nominated for the InStyle and Audi Women of Style Awards being held in Sydney on May 13 for her enormous contribution to medicine, research and saving lives. To vote for Dr Long, visit InStyle or checkout other nominees inspiring stories, including Marie Jenkins, founder of Kosmea, here. For more information on the Melanoma Institute Australia, a non-profit organisation, visit here.
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Were you part of the new clinical trials? We’d love to hear your experiences below…
