Spectacular” breakthrough in melanoma treatment

Doctors have hailed a “spectacular” breakthrough in the treatment of advanced melanoma, which experts have said may bring a “whole new era” for successful cancer care.

What is melanoma?

Melanoma is a type of skin cancer which is considered to be one of the most dangerous forms of skin cancer. It is the fifth most common cancer in the UK, with around 13,000 new cases of melanoma diagnosed each year.

Over 2000 people die every year from melanoma in the UK. Melanoma develops when damage to skin cells triggers DNA mutations which cause skin cells to multiply rapidly and form malignant tumours. It is well known that exposure to ultraviolet light from both the sun and artificial light, such as sun beds, increases the risk of melanoma. However, some people are naturally more at risk of getting melanomas than others.

Melanomas often resemble moles; some develop from moles. It can also appear as a change on the skin, such as a change in colour or a sore that doesn’t heal or a spot or sore that becomes itchy, tender or bleeds.

Treating melanoma

The type of treatment people receive for melanoma depends on individual circumstances and consideration will be taken into the type of cancer an individual has, the stage of cancer and their general health.

Melanoma is often treated by surgical excision of the melanoma. Depending on the staging of the melanoma and whether it has spread, further surgery is sometimes required as well as other treatments such as radiotherapy and drug treatments. Several chemotherapy drugs are often used to treat melanoma that has spread to parts of the body and is mainly given to help relieve symptoms of advanced melanoma.

Recent drug trials

  • Treatment in advanced melanoma is changing rapidly. A recent breakthrough in medical research is giving hope for patients with advanced melanoma to live longer.
  • A British led trial had lead to “spectacular” results. A trial on 945 patients with advanced melanoma at 137 sites worldwide, has found that, by using a combination of two drugs, tumours can shrink by at least a third in 58% of patients.
  • Doctors found that treatment with immune-boosting drugs, ipilimumab and nivolumab stopped the cancer advancing in 58% of cases, which allows patients to live an average of 11.5 months without tumours growing. The treatment works by harnessing the body’s immune system to attack the cancerous cells and work against the melanoma. The drugs help the patient’s immune system to recognize, target and attack the cancer cells, whilst the healthy cells are left alone.
  • Ipilimumab has been licensed for use in the UK since 2011 and in December 2012, was recommended by National Institute for Health and Care Excellence (NICE) as a possible treatment for people with previously treated advanced melanoma that had spread or could not be surgically removed. However, treating patients with the combination of the two drugs seems to have shown that patients live longer and have fewer toxic side effects than patients who receive only Ipilimumab.

When just ipilimumab was used, tumours stabilized or shrunk in just 19% of cases for an average of two and a half months, according to the research published in the New England Journal of Medicine.

Dr James Larkin, Consultant at the Royal Marsden Hospital, told the BBC News that:

“ By giving these drugs together you are effectively taking two brakes off the immune system rather than one so the immune system is able to recognize tumours it wasn’t previously recognizing and react to that and destroy them.”

He added:

“For immunotherapies, we’ve never seen tumour shrinkage rates over 50% so that’s very significant to see. This is a treatment modality that I think is going to have a big future for the treatment of cancer.”

The findings were presented by UK doctors at the American Society of Clinical Oncology annual conference in June 2015. Essentially, both drugs are designed to bring the body’s natural defenses in the fight against the cancer.

Professor Roy Herbst, Chief of medical oncology at Yale Cancer Cancer in the US, said the treatment, which uses the body’s immune system to attack cancerous cells, could potentially replace chemotherapy as the standard cancer treatment within five years.

However, the life expectancy of patients treated with the drugs is still unknown. The side-effects such as fatigue, rashes or diarrhea are also an issue. It is also unknown why some people responded exceptionally well to the treatment whilst others had no benefit at all in the trial.

There is a clear shift however, in the way oncology is being treated and it is hoped that these immunotherapies will prove to be effective treatments for a wide range of cancer types. Several pharmaceutical companies have immunotherapy drugs undergoing trials, with promising results against melanoma, lung, liver, bowel, head and neck cancers.