Combination Drug Therapy More Effective on Melanoma

melanoma skin cancer on woman arm with sun in the backgroundMy best friend Kelly and I love to go running together. It’s great for both us, since it combines exercise and what we call “free therapy”. She loves the sun, and just feeling its warm rays brightens her mood. The problem, however, is that Kelly is also very fair-skinned—and the two don’t mix. This is compounded by the fact that, as a teenager in New Jersey, she belonged to the baby-oil and iodine club (that only those in their 40’s and 50’s remember now). Many of us are now suffering consequences from the choices we made back then, and these are showing up in the form of wrinkling, sun spots and, most unfortunately, skin cancers. Last year, what Kelly thought was a “beauty mark” on her cheek turned out to be a melanoma. It was removed, and left behind a scar to remind us that protection from the sun is not only wise, it’s also crucial to maintaining good health.

Skin cancers are on the rise and, according to the American Cancer Society, are by far the most common of all cancers. While melanoma accounts for less than 2% of skin cancer cases, the number of cases has been rising for at least 30 years and it causes a large majority of skin cancer deaths.

Here are the American Cancer Society’s estimates for melanoma in the United States for 2015:

  • About 73,870 new melanomas will be diagnosed (about 42,670 in men and 31,200 in women).
  • About 9,940 people are expected to die of melanoma (about 6,640 men and 3,300 women)

I have written on this subject for years and it continues to be something I’m passionate about. With incidents of melanoma increasing, the medical community must grapple with the issues of diagnosis, treatment and, unfortunately, what to do when the cancer spreads to other parts of the body. Obviously, prevention is key, and a crucial component in warding off this potentially deadly disease. That said, there is important melanoma research on evaluating new drugs and potential treatment modalities. While the drug names are lengthy and hard to spell (much less pronounce), the important message is that these new drug therapies show promise in dealing with melanoma. Good news for Kelly and for the thousands of others facing this growing health issue.

Specifically, a recent study has concluded that drug therapy using a patient’s own immune system to fight cancer cells by combining two drugs (rather than one) has proven to be more effective in slowing cancer growth and extending a patient’s progression-free survival period. The two drugs, called nivolumab and ipilimumab, led to better results compared to the use of ipilimumab alone– when given to previously untreated patients with melanoma that had spread beyond the original site (stage III or IV metastatic melanoma).

The double-blinded study (in which neither the researchers nor participants were aware of who was getting study drugs vs. placebo) was conducted using 945 patients. After a minimum of 9 months’ follow-up, disease progression was reduced by 58% when both drugs were used. Dr. Michael Atkins, deputy director of the Georgetown-Lombardi Comprehensive Cancer Center in Washington, said the principal take-home message is that, “Ipilimumab can no longer be considered as standard first-line immunotherapy for patients with advanced melanoma. This clearly has important implications for the field and for our patients.”

Professor Roy Herbst, chief of medical oncology at Yale Cancer Center said the combination treatment, which uses the body’s immune system to attack cancerous cells, could potentially replace chemotherapy as the standard cancer treatment within five years. “I think we are seeing a paradigm shift in the way oncology is being treated,” he said. Dr. James Larkin, a consultant at the Royal Marsden Hospital in London, said, “By giving these drugs together you are effectively taking two brakes off the immune system rather than one, so it is able to recognize tumors it wasn’t previously and react and destroy them.” This results in a sort of “one-two punch” against advanced stage melanoma.

There is some downside, however. The combination drug treatment is expensive, raising concerns regarding relative value. Dr. Atkins said that judgment about whether the additional cost is justified will need to be withheld until it can be determined whether or not the combination treatment can reduce the need for other therapies. Also, there are some concerns regarding increased side effects (know as toxicity) when both drugs are administered, since treatment-related adverse side effects occurred in a greater percentage of the study group which received the combination therapy. However, the management of these side effects suggests that the combination therapy can be used safely in many cases.

While the study results provide optimism for the treatment of advanced stage melanoma, the positive results may not justify the high cost of the treatment. The fact remains–prevention is key. As we head into July 4th weekend, don’t forget to wear sunblock, a hat and long sleeves when out in the sun, because there’s nothing mood-boosting about skin cancer!

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