By Louise M. Perkins, PhD
This time a week ago I was jubilant. The SU2C-MRA Melanoma Dream Team’s paper describing a precision medicine approach to treating patients had just been published. And in the middle of the week an important article published in the prestigious scientific journal Cell describing the comprehensive genomic landscape of over 300 melanomas by The Cancer Genome Atlas team – an enormous work that allows us to better understand and target melanoma.
Clearly, with all of this information at our fingertips, with new immunotherapy treatments, with targeted therapy options and new ways to precisely match treatments to patients we have never been closer to defeating this disease. So much progress! I was so excited.
This week I got a text that brought me back to the real world.
In April, I met a businessman at the Milken Institute Global Conference. He told me of his friend, J, who had advanced melanoma. He asked if I might try to help J in some way. I spoke with her and learned that fortunately, she was already connected with some of the leading docs in melanoma. She’d gotten all the new treatments. But she wasn’t doing great and felt like she needed to move back home to be closer to her mom. I had a chance to learn her story and get to know her a tiny bit and was hopeful that things might turn out well.
The text I awoke to let me know that J. died earlier this week. At 32, she’d lost her fight to melanoma.
Earlier this week, MRA met with folks from the FDA along with two leading melanoma experts (Michael Atkins and Paul Chapman) to discuss the latest in the field from the recent cancer meetings. These conversations help to identify new opportunities and help keep the focus on melanoma. The FDA colleagues are great, by the way, and have been amazing partners in bringing new treatments to patients with melanoma very quickly.
In the discussion, both Drs. Atkins and Chapman pointed out that older melanoma patients, the ones who would typically be least likely to tolerate and respond to chemotherapy, actually seem to respond to AND tolerate checkpoint therapy (anti-CTLA-4 and/or anti-PD-1) treatment better than younger folks. The reasons for this aren’t quite clear but two possible explanations spring to mind. Perhaps the tumors in these older individuals have more mutations acquired over a long life and so have more ‘hooks’ for the immune system to latch on to and recognize as foreign. Another hypothesis is that the older folks have immune systems that aren’t as robust as those in younger patients. That robust immune system might get a little overactive in young folks – harming good cells alongside the tumor ones (leading to more side effects) and also prematurely turning off the anti-tumor response.
Is it possible this is like the Spanish Flu where younger, fitter patients were more at risk than older patients? Researchers are working on understanding the differences between responders and non-responders to try to determine what might be tweaked to elicit more and more responses in patients. One of the key takeaways from the meeting with the FDA was the need to continue to focus on those patients who aren’t fully benefiting from current therapy to understand the unique features of their melanoma and work together to beat it. We talked about sub-types that form in the eye, the mucosal surfaces and on non-sun-exposed sites like soles of the feet. We talked about melanoma that has metastasized to the brain – a vexing problem for too many. All of these patients who don’t respond to treatments, old or young, need better options.
Unfortunately, it is too late to help J, or Jackie, or Tara – the young women MRA got to know in the last two years – or Claire, the 17 year old who went to my high school. The deaths of these young women put a fine point on the urgency to keep the pressure on for all melanoma patients to find a cure.
Thanks to all of you for funding the research to understand what’s different and what to do to change the outcomes for patients like these young women – and all of those with advanced melanoma. We’re committed and appreciate your commitment, too.
About the Author
Louise M. Perkins, Ph.D., joined the Melanoma Research Alliance (MRA) as Chief Science Officer in 2013 where she is responsible for the development and implementation of MRA’s scientific strategy.