Outsmarting Melanoma

Enormous medical gains have been made against melanoma over the past four years, and more are waiting in the wings.
ERIK NESS
PUBLISHED: FEBRUARY 17, 2015
Talk about this article with other patients, caregivers, and advocates in the Skin Cancer CURE discussion group.
Peter Daly knew he was running out of options.

In 2002—on his 49th birthday—he’d been diagnosed with metastatic melanoma. After evaluating the dismal track record of the few available treatments, he decided he’d rather take his chances with a clinical trial. He enrolled in an anti-cancer vaccine study, but just six months later his cancer returned.

His doctors in Madison, Wisc., treated him with interferon alfa-2b as the cancer spread, literally from head to foot. Finally another trial opened, this time for the immunestimulating drug Yervoy (ipilimumab), at the National Cancer Institute in Bethesda, Maryland. A phase 1/2 trial, its primary goal was figuring out if the human body could tolerate the drug, and how much of it. So little was known that the consent documents Daly signed contained information on how it had worked in monkeys.

He knew the trial could kill him, but he also knew if he did nothing the melanoma would kill him. Daly’s body did not handle Yervoy well. After just two doses he developed colitis—a common side effect. He was willing to risk a third dose, but the doctors declined.

But two doses had been enough. Within weeks, Daly felt the tumors shrinking. A couple of large growths had to be removed or irradiated, but, spurred by the Yervoy, his own immune system gradually beat back the myriad tumors. Within a few years he was declared cancer-free—an early success story to buoy researchers.




Peter Daly took the immune-stimulating drug Yervoy (ipilimumab) in a clinical trial before the drug’s FDA approval, and remains cancer-free. Photo by Noah Willman.


It would take another seven years of clinical trials, but in 2011 Yervoy—often called ipi—was finally approved by the Food and Drug Administration (FDA). It was the first new drug for the treatment of metastatic melanoma in 13 years. And it was the first melanoma drug ever to show overall survival benefit in a randomized phase 3 clinical trial.

Yervoy was just the beginning. Six additional drugs have been approved since, and more are imminent. Among them are some promising immunotherapies, including a vaccine called T-Vec, which could be approved by the FDA by July 28.

“For years we really didn’t have any effective therapy,” says Lynn Schuchter, chief of hematology/oncology at the Abramson Cancer Center at the University of Pennsylvania, who has been a melanoma specialist for more than 25 years. “It’s been quite remarkable to suddenly have tears of joy in clinic and not just tears."

EXCITEMENT OVER IMMUNOTHERAPY 

Melanoma is skin cancer that forms from melanocytes, the cells in the skin that contain pigment. Basal cell and squamous cell carcinoma are easily treated and far more common forms of skin cancer—they are not even reported to cancer registries. Far rarer, melanoma still accounts for the majority of deaths from skin cancer. Caught early enough, surgery can cure it. But once the disease escapes and becomes metastatic, it ranks among the most aggressive and difficult of cancers.

Talk about this article with other patients, caregivers, and advocates in the Skin Cancer CURE discussion group.
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