In the latest blog series, we talked with Dr. Michael Atkins, Deputy Director of the Georgetown-Lombardi Cancer Center at Georgetown University, and a member of the MRA Medical Advisory Panel.
How did you get interested in melanoma and your field of research?
I had a couple of high school friends who developed melanoma, including someone who died during high school, so I was aware of the disease. In college, I developed an interest in cell biology and immunology. We knew at that time that soluble/diffusable factors could stimulate the immune system at a distance, but no one understood how it worked. I knew that I was interested in oncology because of my interest in cell biology and immunology and I wanted to be involved with patient care. As an oncologist, you’re always an important part of any patient with cancer’s medical team.
My fellowship in hematology/oncology was right around the time that Interleukin-2 (IL-2) was being investigated at the National Cancer Institute, and I got involved in a laboratory researching immunotherapy. The immunotherapy tended to work best in patients with melanoma. So, I was in the right place at the right time and things just came together. My research interest in immunotherapy and my clinical and personal interest in melanoma intersected and led me to focus on this area.
Explain how your research is making a difference for people with melanoma.
One of the most surprising and gratifying aspects of my work has been seeing how many patients with melanoma can actually respond to immunotherapy. The identification of the immune checkpoints that dampen the immune response and subsequent successful efforts to block them and restore anti-tumor immunity with checkpoint inhibitors has revolutionized the way we treat advanced melanoma and some other cancers. I am continually impressed at how many patients have immune cells that can recognize and destroy their tumors once re-activated.
Further, our advances in melanoma immunotherapy have paved the way for similar advances in patients with all kinds of cancers, many of which we never dreamed of being responsive to the immune system.
Have there been any recent advances in treatment/your research that are particularly encouraging?
In my mind there are three important areas that the melanoma community is actively researching:
- Integrating immune therapy with molecularly targeted therapy. We’re looking at the impact of one treatment on the potential responsiveness of other treatments. What’s the appropriate sequence in patients with tumors bearing a BRAF mutation? Does the sequence make a difference? It’s an important practical question that physicians face every day.
- Recent work on checkpoint inhibitors suggests combination checkpoint inhibitors have an advantage over single agents. Studies are showing that patients are experiencing better outcomes if we target the multiple immune checkpoints simultaneously, so combination therapy has to be explored and we have to look at which combinations are most active in particular patients.
- Using biomarkers to make treatment recommendations. We’re trying to answer important questions, like who can respond best to combination or single agent therapy, and can you “rescue” patients given single agent after they have been given it if it doesn’t respond?
How has MRA funding helped your work?
We’re trying to better understand how other therapies, like molecularly targeted therapies, affect immune responses in the tumor microenvironment. MRA supports my research related to a clinical trial where we perform serial biopsies on patients’ tumors who are receiving BRAF inhibitor therapy. Our goal is to determine if there is an optimal time to start immune therapy after BRAF inhibitor therapy, and if giving it even makes sense.
Five years ago, median survival for patients with advanced melanoma was still 6-9 months and had remained constant for decades. When MRA stepped on the scene, there were new potential targets – like BRAF, CTLA4 and PD1– that had recently been identified. Funding from the MRA has been critical to expediting our understanding of how to optimally exploit these various targets. As a consequence, there is essentially no median survival for patients with advanced melanoma. We may have been able to get to this position eventually without the MRA, but the MRA support has enabled us to do so at practically light speed.