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(@deborahwatersiectskin-com)
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Skin cancer: Half of people surviving advanced melanoma

  • 28 September 2019
 
MelanomaImage copyrightHUW EVANS PICTURE AGENCY

More than half of patients can now survive a deadly skin cancer that was considered untreatable just a decade ago, say UK doctors.

Ten years ago only one-in-20 patients would live for five years after being diagnosed with late-stage melanoma. Most would die in months.

But drugs to harness the body's immune system mean 52% now live for at least five years, a clinical trial shows.

Doctors said it was an extraordinary and rapid transformation in care.

How hard is melanoma to treat?

Melanoma is the fifth most common cancer in the UK and kills nearly 2,300 people each year.

If it is caught in the early stages then the chances of survival are good, but as the cancer becomes more aggressive and spreads throughout the body (known as metastatic cancer) then survival plummets.

"In the past, metastatic melanoma was regarded as untreatable," said Prof James Larkin, a consultant at the Royal Marsden NHS Foundation Trust.

He said: "Oncologists considered melanoma different to other cancers, it couldn't be treated once it had spread."

People tended to live between six and nine months after diagnosis.

What did the trial show?

The trial investigated two immunotherapy drugs which are designed to enhance the immune system and let it attack cancer.

There were 945 patients in the trial, a third were given nivolumab, a third were given ipilimumab and a third were given both.

Doctors then looked at the five-year survival rate - the proportion of patients still alive after five years.

The results showed:

  • 26% were still alive on ipilimumab alone
  • 44% were still alive on nivolumab alone
  • and 52% were still alive when given both.

"It's been an amazing surprise to see so much progress in such a short a period of time," Prof Larkin told BBC News.

He said: "It's been the most extraordinary transformation from a disease that was regarded, among all the cancers as the most difficult to treat, the most serious prognosis.

He said there is now "the possibility that 50% of people with stage four melanoma are alive five years after having immunotherapy treatment."

The findings have been presented at a meeting of the European Society for Medical Oncology and published in the New England Journal of Medicine.

What do patients say?

Pam SmithImage copyrightPAM SMITH
Image captionPam Smith: "I might not have seen my grandchildren"

Pam Smith, 67, from Royal Tunbridge Wells, started on the trial in January 2014.

She was "devastated" when she was told her cancer was untreatable and says she "wouldn't have stood a chance" without immunotherapy.

She had treatment once every two weeks for four months, but the drugs gave her such severe diarrhoea as a side-effect that she could no longer continue.

Her tumour halved in size after treatment and has not grown since. Pam now feels "brilliant".

She told the BBC: "I might not have seen my grandchildren.

"It's just over five years now since it happened and my youngest grandchild was six at the weekend.

"I wouldn't have seem him grow up and the other grandchildren as well."

Are these patients cured?

Saying cured is always difficult in cancer, but five-year-survival is a hugely significant milestone.

Some patients taking the drugs are in total remission with no sign of any abnormality on scans.

Others like Pam still have a tumour inside their bodies, but they are no longer growing.

Out of the patients that survived, three-quarters no longer need any form of cancer treatment.

How does immunotherapy work?

Immunotherapy is Nobel Prize-winning science that is making the untreatable treatable.

The field is one of the most exciting in cancer treatment.

The immune system constantly patrols our body, fighting off hostile invaders such as viruses.

It should attack cancers too - but cancers are a corrupted version of healthy tissue and can evolve ways of evading the immune system.

Cancerous cellImage copyrightGETTY IMAGES
Image captionA corrupted cancerous cell will grow out of control, unlike its healthy neighbours

Ipilimumab and nivolumab both stop some cancers from hiding and allow the immune system to attack.

They interrupt the chemical signals that cancers use to put the brakes on the immune system.

Nivolumab blocks the off-switch on white blood cells called PD-1. Ipilimumab blocks a similar switch called CTLA-4.

It is described as taking the brakes off the immune system.

"By giving these drugs together you are effectively taking two brakes off the immune system rather than one so that the immune system is able to recognise tumours it wasn't previously recognising and react to that and destroy them," Prof Larkin said.

Are there side-effects?

Yes, the drugs are changing the way the immune system works inside the body and that can have consequences, such as fatigue, skin rashes and diarrhoea.

Some are severe enough that patients like Pam cannot complete a full course of treatment.

However, even a brief spell of immunotherapy had a lasting benefit on the immune system and on patients.

This is in stark contrast to other cancer treatments such as chemotherapy which stop working the moment the treatment stops.

Although this lasting changes means side-effects could continue to emerge as patients get older.

Are these drugs available?

Yes, earlier results from this trial led to these drugs being made available around the world - including on the UK's National Health Service.

The decision to approve the drugs for melanoma was one of the fastest in NHS history.

And they are also being used in other cancers such as lung and kidney.

What do experts think?

Prof Charles Swanton, chief clinician at Cancer Research UK, said the progress in melanoma had been "incredibly fast".

He said: "I'm inspired seeing the advancements being made in the development of immunotherapies, and their potential to transform the outlook for some patients, giving them time with friends and family they never thought they would have.

"And now work continues to make sure more people with different types of cancer can also benefit from these innovative treatments."


   
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(@lindseycoganiectskin-com)
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It's so exciting to see how far medicine has advanced. Constantly working to improve has brought us a long way. 


   
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(@gabriellemrasiectskin-com)
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That is amazing, technology seems to just constantly be advancing and new treatments seem to be developing constantly that's great!


   
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(@deborahwatersiectskin-com)
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Yes, it is a good thing there is the technology for melanoma. This type of cancer is really affecting many people especially younger people. Some issues are using tanning beds, and sunbathing excessively


   
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(@francescablackiectskin-com)
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Its so so so important that cancers like melanoma, that affect and kill so many people, are still being studied in hopes of resolution. For what seems to be positive study and trial, hopefully this treatment can help melanoma patients live longer, fuller lives. 


   
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(@francescablackiectskin-com)
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@lindseycoganiectskin-com always! Its so wonderfull to watch our generations study, discover, and cure diseases and conditions that have been detrimental to life as long as we know. Melanoma, like many other cancers, may soon no longer be a death sentance for people. 


   
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(@kaytlynmolinaiectskin-com)
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It is truly amazing how much treatment has come and in such a short amount of time. The odds of surviving this have grown drastically. When I was younger my grandfather had skin cancer but I don't remember what kind or stage of cancer it was. He did survive it and is still alive and well today. I try to make sure to get moles and freckles checked once a year just to be cautious. 


   
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(@kaytlynmolinaiectskin-com)
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@francescablackiectskin-com It really is amazing how far we have come. It does make you think that soon we wont have to worry about people losing loved ones to diseases like this. 


   
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(@jaydensugickiectskin-com)
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i am constantly surprised by how far we are advancing in the medical field! every day we are getting further and further than we were before in terms of finding cures and/or solutions to diseases that we once thought were incurable. 


   
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(@jaydensugickiectskin-com)
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@francescablackiectskin-com its amazing seeing these advancements. knowing that the medical fiend and technology continues to work hand in hand to make most diseases today treatable is something to celebrate 


   
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(@delaneyhiggonsiectskin-com)
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It's really encouraging to think about how quickly treatment for melanoma has come along, especially thinking about how that might relate to other forms of cancer in the future. It's also amazing that this treatment is so effective that the one patient who was interviewed in the article didn't even fully finish the treatment and it still helped to treat her melanoma. Hopefully these studies will be able to be used in the future to help better understand how we can treat, and maybe one day even cure cancer.


   
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(@deborahwatersiectskin-com)
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I have had students that had melanoma and recovered. My cousins husband had it on his nose last year and the surgery was rough and too a long time to heal along with plastic surgery but he is cancer free now. Others are not so lucky. I had a friend that found out too late and it had spread to organs and she passed away at 25 years old. The advancements are great and if caught early survival rates are increased


   
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(@kaytlynmolinaiectskin-com)
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@deborahwatersiectskin-com My grandfather had skin cancer, it was caught in time and he is now cancer free as well, thankfully. This is why it's important to go to a dermatologist once a year to get freckles and moles checked. The office I went to in Miami would do it once a year for free by the head dermatologist herself. Dr. Trowers she is pretty well known in Miami and going into her office you have seen all the celebrities that have also gone to her. I haven't found a dermatologist living here in Virginia yet, which is needed because it's now been a year. 


   
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(@sydneymissaleiectskin-com)
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As someone who worked in a Mohs Surgical suite, I can say melanoma is a gnarly fast spreading disease. When using Mohs micrographic surgery to treat a melanoma, patients have to have one slice (or take) of the melanoma to be removed and it has to be sent to the big pathological lab to be tested to see if all margins have been cleared, this process is called Slow Mohs. Its amazing that we can treat melanoma and get rid of it before the damage can be done. Melanoma is considered high priority in the dermalogical world and it must be treated right away. Its important to make sure you are wearing SPF and going to have annual or 6 month skin checks for skin cancer. People that do not have their melanoma treated are at a very high risk of having it spread to important organs and places in the bodt 


   
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(@sydneymissaleiectskin-com)
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@deborahwatersiectskin-com All the suntanning and going to tanning beds and lack of sun screen is what changes the chemical of the cells and make them not normal. Some people are more affect by genetics as skin cancer can be genetic. 


   
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(@laurenjohnsoniectskin-com)
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Science and technology always amazes me! It's incredible that we have found a way to help those who have melanoma live a longer life. Melanoma is very scary and as someone who grew up in Florida and used sun tanning beds I always make sure to get yearly skin checks for any moles that are pre-cancerous. 


   
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(@laurenjohnsoniectskin-com)
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@kaytlynmolinaiectskin-com I agree! I always go in for a yearly check up and get my skin looked at to make sure I don't have any weird moles. I also keep an eye out on my own moles to make sure they don't change color or shapes. 


   
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(@laurenjohnsoniectskin-com)
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@francescablackiectskin-com Hopefully someday patients can overcome cancer completely with advanced treatment! We have come so far but it would amazing to one day see that cancer can be completely cured or even prevented. 


   
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(@marlimartiniectskin-com)
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@laurenjohnsoniectskin-com 

That is one of the best ways to prevent skin cancer, is to be your own advocate! No one knows your skin like you do, so it is so important to always be doing skin checks to keep an eye out for any abnormal activity on the skin. This is something I do everyday!


   
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(@marlimartiniectskin-com)
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@sydneymissaleiectskin-com 

Tanning beds can increase chances of skin cancer by at least twenty percent. Being someone who spent about five days a week in the tanning bed, I am constantly doing skin checks, as well as getting my skin checked by my dermatologist as skin cancer runs in my family.


   
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(@sydneyhurdleiectskin-com)
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It's so important to wear sunscreen!! and to avoid tanning beds, I used to love tanning beds but the damage it does to the skin and the cancer risks just aren't worth it, plus sunless tanner over the years has improved tremendously. Keep an eye out for any abnormal changes or new, occurring, or reoccurring spots!


   
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(@sydneyhurdleiectskin-com)
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@laurenjohnsoniectskin-com I couldn't agree more it's amazing to watch how science and technology has advanced over the years saving so many peoples lives from all types of skin cancer


   
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(@oliviarossiectskin-com)
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My grandmother passed from a form of skin cancer when I was younger so this really makes me hopeful. There used to be such a low life expectancy once diagnosed but modern medicine has made a longer life possible. 


   
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(@oliviarossiectskin-com)
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@sydneyhurdleiectskin-com The best way to help prevent skin cancer is to limit sun exposure and always wear sunscreen. Long term tanning, especially the use of tanning beds, is extremely damaging to the skin.


   
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