MPIP: Melanoma Patients Information Page

The MPIP is the oldest and largest community of people affected by melanoma hosted through the Melanoma Research Foundation. It is designed to provide support and information to caregivers, patients, family and friends. Once you have been touched by melanoma—either as a patient or as a family member or friend of a patient—you become part of a community. It is not a community anyone joins willingly. But if you must be part of this group, you will find no better place to find the tools you need in your journey with this cancer, and the friends who can make that journey more bearable.

The information on the bulletin board is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

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Angela C's picture
Replies 7
Last reply 3/2/2012 - 1:21pm

Hi everyone.

I'm headed to Bethesda next week for the beginning steps of the IL-12 TIL trial. I'll have surgery on Thursday to remove a tumor behind my pancreas. I'll be in the hospital for about a week. They'll grow my cells from it and I'll return in mid to late April for Chemo and the reintroduction of my grown TIL cells.

Here's the trial info if anyone is interested:

http://www.cancer.gov/clinicaltrials/search/view?cdrid=689250&version=He...

~Angela

Be kind, for everyone is fighting a great battle. -Plato

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Dual Inhibition of VEGF and c-MET in Cancer Promises to Decrease Metastasis

A combined dual inhibition of vascular endothelial growth factor (VEGF) and c-MET is showing promise in preventing tumor invasion and metastasis. The data thus far are in a laboratory model of pancreatic neuroendocrine tumors (PNET). The results are published in the journal Cancer Discovery.

Neuroendocrine Pancreatic Tumor—main pancreatic duct (MPD), tumor (T), portal vein (PV), splenic vein (SV), superior mesenteric artery (SMA)

According to the lead author of the study, Donald M. McDonald, MD, PhD, Comprehensive Cancer Center, University of California, San Francisco, this study was designed to demonstrate a proof of principle. The concept is likely to extend to other tumor types.

McDonald explained that the inhibition of both VEGF and c-MET signaling has a synergistic effect on tumors that leads to slowing down of the tumor growth and decreased metastasis.

"The translational significance of the work is not necessarily to demonstrate a promising approach in PNET, but rather to show in general that targeting MET simultaneously with VEGFR is a better general approach than targeting the VEGF pathway alone without inhibiting MET," says Dana T. Aftab, PhD, part of the translational research team at Exelixis, and coauthor of the Cancer Discovery paper.

Many cancers show increased c-MET activity and mutations, including breast, liver, lung, kidney, thyroid, and ovarian cancers. Deregulated c-MET signaling has been shown to be associated with a more aggressive tumor phenotype.

McDonald and his team assessed the role of c-MET signaling when VEGF signaling is inhibited using a pancreatic neuroendocrine tumor mouse model and a second model that exhibited late-onset aggressive and metastatic tumors when the mice are in old age. The range of timing of tumor onset, including the very late-timing in the one model uniquely allows the assessment of whether the aggressive tumor characteristic can be advanced or reversed.

"Because tumors in [one of our mouse models] naturally become more invasive and metastatic with age, but generally do so near the time the mice succumb, this model provided the opportunity to determine whether aggressiveness could be advanced, delayed, or reversed by treatment with a c-MET inhibitor," explained McDonald.

Previous laboratory research showed that while inhibition of VEGF decreased tumor size, there is also a downside. According to Dana T. Aftab, "increased invasiveness after anti-VEGF therapy has been studied in the clinic most extensively in glioblastoma, where frequent imaging with high resolution techniques is standard."

The researchers now show that c-MET expression and activity increase upon VEGF inhibition and tumor hypoxia is elevated. When both the VEGF and c-MET pathways were inhibited, invasion and metastasis went down. This effect was also observed in mouse models of two more types of pancreatic cancers.

The team used a murine anti-VEGF antibody. The c-MET inhibitors used were crizotinib (Xalkori) and PF-04217903. Crizotinib was approved last year for metastatic non–small-cell lung cancer that harbors the EML4-ALK fusion gene. Crizotinib works by inhibiting both the anaplastic lymphoma kinase (ALK), as well as the tyrosine kinase c-MET. PF-04217903 is currently in phase I trials as a monotherapy for a range of advanced solid tumor types.

Cabozantinib, an oral, small-molecule inhibitor, blocks both c-MET and VEGF signaling. "A trial for cabozantinib in patients with pancreatic neuroendocrine tumors will open for patient recruitment soon," said Aftab. "However, the translational significance of the [currently published] work is not necessarily to demonstrate a promising approach in PNET," he added.

The drug is showing promising results in early-stage clinical trials. There was promising activity in metastatic medullary thyroid cancer (MTC) in a phase I trial published last year in the Journal of Clinical Oncology. Of 35 patients, 10 showed a partial response, a notable achievement for a disease that has no standard treatment options. A phase III medullary thyroid clinical trial of cabozantinib further showed an almost three-fold improvement in progression-free survival (PFS) compared to placebo in results announced last October. The median PFS in the cabozantinib arm was 11.2 months compared to 4 months in the placebo arm (P < .0001). The full results will be presented at a clinical meeting.

"We have evaluated cabozantinib in many preclinical models with generally good results, but to my knowledge the only careful examination of VEGF plus MET inhibition, using combinations of selective inhibitors, is [this Cancer Discovery paper]," said Dana T. Aftab.

Activity with cabozantinib was also seen for many solid tumors. In a phase II trial presented at the 2011 American Society of Clinical Oncology annual meeting, cabozantinib showed an ability to shrink bone metastases in prostate cancer, breast, and melanoma patients. It also showed activity in ovarian, and prostate cancers, and preliminary data from a phase II liver cancer trial shows an increased progression-free survival for both treatment-naïve and previously treated patients.

McDonald and his team are already working further along these lines of research. "We are continuing to study the effects of c-MET inhibitors on tumor invasiveness and metastasis," he says.

I'm me, not a statistic. Praying to not be one for years yet.

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http://www.eyesite.ca/CJO/4201/i06-109.pdf

metastatic uveal melanoma
Ana C.A. Frota,* MD; Alexandre N. Odashiro,*† MD, PhD; Patricia R. Pereira,*† MD;
Bruno F. Fernandes,* MD; Katyanne Dantas Godeiro,* MD;
Joao Pessoa Souza Filho,*† MD, PhD; Miguel N. Burnier, Jr.,*† MD, PhD
ABSTRACT • RÉSUMÉ
Case report: We report a case of choroidal melanoma metastatic to the liver diagnosed by fine-needle
aspiration.The biopsy sample was immunostained for COX-2 and c-kit.
Comments: Accurate diagnosis and identification of potential therapeutic targets are important for
subsequent therapy and can be achieved by radiologically guided fine-needle aspiration biopsy.
Observation : Nous signalons un cas de mélanome choroïdien métastatique au foie, diagnostiqué par
ponction-biopsie à fine aiguille. L’échantillon obtenu a été immunocoloré pour la COX-2 et le gène c-kit.
Commentaires : Il importe d’établir un diagnostic précis et d’identifier les cibles thérapeutiques possibles pour
la thérapie subséquente; la ponction-biopsie à fine aiguille (PBFA) guidée par la radiologie permet d’y parvenir.

Malignant uveal melanoma (UM) is the most common primary intraocular tumour in adults, and the liver is the most common site for metastases. The use of fine-needle aspiration biopsy (FNAB) for diagnosis of metastatic UM to the liver has been described by Liu et al1 exhibiting successful rates.2,3 Sensitivity reported in the literature ranges from 67% to 100% and specificity from 80% to 100%.4 To our knowledge, the study of immunohistochemical expression of the COX-2 enzyme and c-kit protein and their role in metastatic UM cells obtained by FNAB has never been described.
CASE REPORT
A 78-year-old man was referred to the oncology clinic of the Montreal General Hospital, McGill University for
evaluation of a choroidal mass in his left eye. Fundoscopy revealed a pigmented, well-circumscribed tumour in the
choroid, displaying low reflectivity on A-scan ultrasound. The tumour measured 9 mm × 6 mm on its basal diameter and 5 mm in height. The diagnosis of choroidal melanoma was established and the patient was treated
with iodine-125 episcleral brachytherapy. After 3 years, abdominal computerized axial tomography scans
revealed hepatic, mesentery, and spleen lesions. Liver FNAB under ultrasound guidance confirmed metastatic
melanoma, epithelioid cell type predominant. Immunohistochemistry for COX-2 and the c-kit protein
CD117 was performed in the sample, revealing positivity for COX-2 (Fig. 1) and negativity for c-kit.
COMMENTS
COX-2 is a prostaglandin synthase involved in human carcinogenic processes such as angiogenesis, invasion,
and metastasis.5 The increased expression of COX-2 has been identified in several malignant diseases including
From *the Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil, and †the Henry C. Witelson Ocular Pathology Laboratory and Registry, McGill University Health Center, Montreal, Que.
Originally received Dec. 2, 2005. Revised May 29, 2006 Accepted for publication July 13, 2006 Correspondence to: Ana Carolina de Arantes Frota, MD, 3775 University St., Lyman Duff Building, Rm. 216, Montreal, Que.; fax 514-398-5728; carolafrota@click21.com.br
This article has been peer-reviewed. Cet article a été évalué par les pairs.
Can J Ophthalmol 2007;42:145–6
doi:10.3129/can j ophthalmol.06-109
COX-2 and c-kit—Frota et al 145
Fig. 1—Positive staining for COX-2 in fine-needle aspiration sample of liver metastasis from uveal melanoma (original magnification ×100).
colorectal cancer,6 cutaneous melanoma,7 and recently, uveal melanoma.8 The presence of COX-2 in mixedcell-
type UM is correlated to worse prognostic factors.7 The U.S. Food and Drug Administration (FDA)
approved COX-2 inhibitors for the treatment of patients with familial adenomatous polyposis coli9 and
epidemiologic studies have shown that these drugs reduce the mortality from colorectal, breast, and lung
cancer.10 In fact, the use of COX-2 inhibitors warrants investigation as an adjuvant treatment for UM.
The c-kit protein CD11711,12 is a membrane-bound tyrosinase kinase receptor and its overexpression has been
observed in several malignancies.13–18 Imatinib mesylate (STI571, Gleevec, Novartis Pharma AG, Basel,
Switzerland) is a compound that inhibits kinase receptors19 and is FDA-approved for the treatment of c-kit–positive gastrointestinal stromal tumours (GIST) and Philadelphia chromosome-positive chronic myelogenous
leukemia.20More than 75% of UM cells were shown to be positive for c-kit, and imatinib mesylate decreased the proliferation and invasiveness of different cell lines of human UM.21 These results suggest that the drug may also
decrease the ability of cells to implant at the metastatic site.
We conclude that FNAB is not only a diagnostic tool but is also useful in tumour classification with regard to
COX-2 and c-kit expression. Patients with UM who present with positive staining for COX-2 and c-kit may
be candidates for tumour therapy with anti–c-kit and COX-2 inhibitors. Currently, the most important goals
are to increase the quality of life and the survival rates of these patients. These new therapeutic interventions
could lead to a decrease in cell invasiveness in patients free from metastasis, as well as delaying the on-going
process in those who already have metastasis, thus reducing the aggressiveness of the disease.
The authors have no financial conflict of interested regarding this manuscript.

I'm me, not a statistic. Praying to not be one for years yet.

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Linny's picture
Replies 4
Last reply 3/1/2012 - 8:18pm

Had a great visit at Johns Hopkins this past Tuesday. My scans were clean and I'm still hanging out with NED. Next scan will be some time in August/September.

But I have to admit that I was getting freaked out by some minor lower back pain on my right side. I knew there were other things it could be besides melanoma, but even knowing that didn't do much to alleviate the "scanxiety". When Dr. Scharfmann broke the news about the clean scans I all but started dancing with him in the exam room.

I'm not sure what my official NED date is, though. Melanoma was discovered in a lymph node back in November 2010 (I had an unknown primary). The subsequent scan in December 2010 done at a local hospital was clean. When I had my full lymphadenectomy done at Hopkins in January 2011, no further evidence of disease was found in the lymph nodes. At any rate, I've had no evidence of disease for over a year. Maybe I can just have two celebration days? ;-)

If you're newly diagnosed, freaked out, and lurking right now, please know that things do get better with time.

I had no idea how significant clean scans were until I found this site. The dermatologist who examined me at Hopkins completely downplayed them so when I left his office I was a complete wreck. He may be a good diagnostician and instructor but his bedside manner sucked, plain and simple. Fortunately I don't have to deal with him on a frequent basis. If you're seeing a bunch of doctors, there's always one who falls into the "jerk" category. Don't let them get you down. If I didn't have this site as a resource, my emotional recovery would have taken months instead of weeks.

 

Linda
Stage III, unknown primary

Stage III, Unknown Primary; 1 positive node in left axilla

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Replies by: Gene_S, Anonymous, washoegal, Janner

See:

For much more info, copy and paste the following into your search for details.

" Briana Cox's daughter was diagnosed with the same stage-four melanoma "

A very sad story

Live 4 today. Thank God for all he has done for us. Looking forward to enjoying tomorrow.

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Anonymous's picture
Replies 2
Last reply 3/1/2012 - 3:08pm
Replies by: vivian, washoegal

For about two months, off and on, I had what seemed to be a hemoroid or small tear that would bleed when I wiped. It seems to have resolved, but my dermo felt I should have a GI consult. I was advised to take any bleeding seriously . I was told melanoma likes to go to the small intestines ( I am stage IV / NED) so, I should have an endoscopy as well as a colonoscopy. I have no other symptoms. Has anyone else gone ahead with these procedures because of a bit of bleeding that comes and goes? I am going to go ahead and have them done on Friday.

NancyGM

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Lisa13's picture
Replies 2
Last reply 3/1/2012 - 5:55am

When I had my 28th week scan from ipi, they noticed I had marginal growth of my lung mets (1-2mm).  When my blood work was done at the end of January, my LDH was down 100 points (around 209) which is considered normal. How is this possible when my cancer has gotten a bit bigger but now my LDH is the lowest it's been since last November??   Half of me hopes that it's really inflammatio and the ipi is still working, but nobody even knows.

I just started ipi again last Friday, so let's hope this continues to work. I think there is a 30-40%,chance,  but I don't think anybody knows how well the reinduction works.  Luckily after a year, I still have lungs mets that are under 1cm and some that are just over 1cm. I also feel good knowing my absolute lymphocytes have been 1900 before I started my reinduction,  so I hope this means good things on my immune system and helps to keep the brain mets from coming back.

Lisa

Many impossible things have been accomplished for those who refuse to quit

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vivian's picture
Replies 3
Last reply 2/29/2012 - 5:33pm
Replies by: lhaley, TSchulz, Erinmay22

After being NED for 16 months, (stage IIIa, nodular, 4.35 mm, mitotic rate 9 on mid back), I found a lump under the skin a little more than an inch below the CLND incision.  The surgeon did an excisional biopsy a week ago.  He called this morning to say that the preliminary report was melanoma.  That's all I know, but of course, my mind is racing.  My last scans were in November and they were clear, so I am hoping (praying) that this is just a single little subcutaneous met.  If so, will they probably just do a wide excision as they did with the primary?  Does this move me to stage IV?  

I know I don't have enough information yet to even guess at what is to come, but my appointment with the oncologist isn't for a week.  Between now and then, I would like to do as much research, planning, etc. as possible so that I can ask informed questions about treatment possibilities.  I do know what to expect if it is stage IV.

Thanks for any information/experiences you can share.  I hope all of you are feeling well this morning!

Lear

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HelperDaughter's picture
Replies 1
Last reply 2/29/2012 - 12:35pm
Replies by: boot2aboot

My mom died on Wednesday, February 22, 2012.  I can't believe it.  I really don't know what else to say.  My mom is gone. 

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himynameiskevin's picture
Replies 12
Last reply 2/29/2012 - 12:29pm

Well it turns out because of the recent brain mets and steroids, I don't qualify for any trials I was hoping for right now. The news was a little disappointing, but kind of expected and completely understandable. I know that if Zelboraf does work for me, it's only a temporary solution, which makes me a little nervous, but I remind myself a temporary solution is better than no solution, and if all works out, maybe it'll get me to a point of stability where I could qualify for a trial of some kind down the line. I'll be seeing a doctor on Wednesday and hopefully get started on Zelboraf as soon as possible. I also have another brain MRI Monday morning to assess what might be a possible lesion or two, but might just be blood vessels. I'd be ok with either, just praying that nothing new shows up. I'm a little anxious and a little nervous at the moment, having the weekend of waiting in front of me. But I'm hanging in there and know these feelings will pass, as they have before, just have to stay focused, and remember all the things to be thankful and hopeful for. Thanks for hearing me out.

As always, I'm thinking and hoping for the best, for all of us.
-Kevin

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Hello.

I had a consult at NIH last week. They wanted to put me in the TIL plus TBI trial. I just found out that I don't qualify because of my prior radiation history. So, now I have to decide between doing the TIL + IL-12 trial at NIH or going to Moffitt or MD Anderson and doing their TIL protocol.

NIH wasn't sure if MD Anderson and Moffitt were getting the same results that they have been able to get with TIL. They had heard that they may be having trouble growing the TIL cells. Does anyone know anything about this??

I'm really not sure what to do. It's so hard to make these decisions sometimes.

Thanks!!

~Angela

Be kind, for everyone is fighting a great battle. -Plato

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WalterA's picture
Replies 7
Last reply 2/29/2012 - 5:06am

I had a PET/CT scan yesterday (Thursday), and it showed four lesions in/on my right lung. They are of recent origin, and they are very small. Because they are so small, my doctor believes they can be treated with chemotherapy. (My two previous recurrences -- one lesion in my left lung and one in my liver -- were successfully dealt with by CyberKnife and RFA treatment, but these are two small.) I'm not sure when things will get rolling, but I'm back in the lair of the beast. Next week, I will "celebrate" the 10th anniversary of my initial diagnosis, so this is an interesting time.

"Thus I am!" -- Guido in "The Ring and The Book "One day is worth two tomorrows." -- Benjamin Franklin "If it ain't baseball, who cares?" -- Me

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Carole K's picture
Replies 14
Last reply 2/29/2012 - 4:56am

HI Everyone,

I frequented this board from 1999 until around 2008 and certainly do miss all my old frends from MPIP.  I knew so many people here, we got together in ASheville NC< MIchigan, Florida, Seattle, Vancouver and on and on.  They were good times and sad times . Most importantly the support I got here could never be measured. I will all cherish everyone here  and all the love we gave each other. 

For all of you I just want to say DO NOT GIVE UP.  NEVER GIVE UP HOPE.  I should have been dead 11 years ago and I am still kicking. Doing well, getting a bit old these days and loving life. 

I was dx in 1995 with ulcerated mole on my back as a stage II.  Fast forward to 2001 when dx with lung mets and in Dec. 2001 with a brain met.  It was not an easy journey and yet it could have been far more difficult had it not been for this board.  The support I got here cannot be measured.  There was alwasy HOPE>  We would often spend all night in the chat room and let me assure you , if you were depressed when you went in, you were laughing long before you left. 

The one thing my oncologist told me I have never forgotten..CAROLE, DO NO LOOK AT STATISTICS.. NOONE CAN TELL YOU HOW THEY WERE ARRIVED AT.  FURTHERMORE YOU ARE AN INDICIDUAL AND EVERYONE IS  " DIFFERENT".  I hung on to those words for dear life and here I am 11 years later having the best affair with NED, the only man I have never minded sharing.......even with men. 

To all of you NEVER GIVE UP.. NEVER LOOK BACK JUST KEEP LOOKING AHEAD.  WE CAN DO THIS.

Sending positive thoughts to all of you

LOVE AND LIGHT

CAROLE

 

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hope4cure1's picture
Replies 3
Last reply 2/29/2012 - 12:56am

Hi everyone.  My husband's PET and CAT were still clear today. In January 2011, he had 4 mets to liver and 2 lymph nodes in his chest.  He started on a Carboplatin/Abraxane/Avastin combo.  He tolerated the treatments well.  In June, he stopped the Carbo due to an allergic reaction and continued with the Abraxane/Avastin.  In July and September his scans were clear.  He stopped  Abraxane in September and continued with Avastin as a maintenance drug.  Today's scans mark 7 months NED.     

I realize that chemo doesn't have a stellar response record.  However, I want to give a glimmer of hope to anyone whose doctor has suggested chemo as the next step.  Statistics only apply to where you fall within the numbers.  This was my husband's first line of treatment, after surgery to remove lung mets in late 2010.   He is BRAF negative, NRAS positive.

My hopes and prayers go out to all of you.  Now that melanoma is starting to take its rightful place in the spotlight, hopefully the cure is imminent.

Much love,

Hope

    

Become what you admire.

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Hi All,

I am 42, married, and mother of two children, a boy who is 6 and my ‘mini-me’ daughter, who is 9. I always thought one day I would join a blog or message board, but I thought it would be to talk about children, the Oakland Raiders or even work. What I never imagined was joining a message board, seeking support and answers for Melanoma, however, here I am! I was diagnosed four days ago and it changed my world. I haven’t been eating or sleeping, and have been distracted by this all day at work. Of course, I am thinking the worst and hoping for the best. I must say though, of all websites I have been reading about and poking around on, this one is the most positive, supportive, knowledgeable one out there. So thanks for having me.

I don’t have much history with melanoma, however my mom had Thyroid cancer 5 years ago, my dad had a basal cell removed from his face 4 years ago, and my aunt (fathers sister) had a mastectomy 7+ years ago. All are 60+ and come through their cancer with positive results. I have always been, should we say, concerned about skin cancer and suspicious moles within the past 15 years. I am considered fair skinned and do remember a burn or two when I was in my 20’s.  I was at the dermatologist approx 7 years ago, had a full body scan and everything was fine. About 3 years ago, I had a couple suspicious beauty mark/moles removed, sent for testing, which came back fine. Now to today, I had a mole, dark brown in color, the size of a pin head on my right inner thigh. I didn’t remember having it when I was younger, but, thought maybe it had always been there. About three months ago, it was irritating me. Never bled, but was sore. I thought maybe I cut it shaving etc. so I waited a few weeks to see if it  changed, got worse etc. which it didn't, was kinda just there.When I felt it, it was smooth and ever so slightly raised. I figured, can’t hurt in getting it looked at. Even the doctor didn’t seem concerned; however, did a punch biopsy that came back positive. Invasive Malignant Melanoma and I haven’t been the same since. Scared!  I have read a couple posts where it’s been requested to post the results of the pathology report, so here it is. Clark Level is IV, Breslow is 1.2MM, Regression is Absent, Ulceration is Absent, Mitotic rate is 1 per square millimeter, Microscopic satellites are Absent, Vertical growth is present, Vertical growth Cell type: Epitheltoid, Lymphocytic Infiltrate is Minimal, Lateral Margin is involved, Deep Margin is Involved, Re-Excision with appropriate clear margins for Invasive Malignant Melanoma is recommended. Melan-A stain is consistent with this diagnosis. So what does is all mean???

I went back to the dermatologist with these results and he just kept commenting that he was surprised because the mark was so small and that I was Stage II. He didn’t give me much reassurance and suggested that I schedule with a Melanoma Specialist (which I didn’t need him to suggest as I did that the day after I found out). The dermatologist told me that they would be doing a dye test to see if the tumor has attacked any lymph nodes. He mentioned if one tests positive they would take more and I would then be considered Stage III, then talk to me about Chemo or other treatments. He glanced over the remaining moles that I have and commented ‘normal’ – ‘normal’ – ‘normal’….wouldn’t they all be suspicious at this point?? I want them all biopsied and removed if necessary…I just don’t get why I didn’t get a more thorough exam?

I just keep thinking that I must be here for my kids. I have not told anyone in my family. The only reason my husband knows is because I wasn’t home when the doc called with results and he pushed the doctor to tell him. I really don’t think he gets the potential severity of the situation anyway. I have not told my parents, siblings or his. My parents would be devastated, they live out of state and I want them to live the rest of their lives happy, not worrying about me. I realize that there are people on this message board with more advanced, serious conditions, so I appreciate any guidance or recommendations of next steps. I continue to try and have the attitude that it is what it is and be prepared to fight for my life and family, if that’s what the outcome is. You all are in my prayers and wish we were meeting under better circumstances.

Kelli

Life is ten percent what happens to you and ninety percent how you respond to it. Lou Holtz

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