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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marfda's picture
Replies 2
Last reply 11/22/2011 - 10:54pm
Replies by: Charlie S, lhaley

I saw a Rad Onc today after my radiation session. I am recieving radiation to my lower back for recurrent sub q tumors along my scar line. Yesterday I discovered a lump on my groin underneath my SNB scar. Showed it to the doctor today and it is concerning. He estimates it's 2-3cm wide. I am seeing my surgeon on Monday for a fine needle biopsy. It will be interesting to see what decisions will be made about surgery vs continuing radiation. I suppose since the radiation and surgery would be in two different places, I could probably technically do both at the same time. Have any of you faced an interruption of radiation? I'm also wondering when I'll have scans again. My last was in October, it was clear. Would they remove the sub q tumor even if the tumor has spread further in my body?

I know I'm assuming the lump in Melanoma. Sometimes I do better emotionally expecting the worst case scenario. 

Who shall separate us from the love of Christ? Shall tribulation, or distress, or persecution, or famine, or nakedness, or danger, or sword?... No, in all these things we are more than conquerors through him who loved us. Romans 8:35–37

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glewis923's picture
Replies 2
Last reply 11/24/2011 - 1:31pm
Replies by: KatyWI, jag

Brief history:  11 odd braintumors foun Jan, 2011.  Had 7 or so srs "zaps"  Now 1 spot has "edema'd" again and is more than likely new tumor growth-  I guess they never know if it's tumor or necrosis.  I'd like to here from someone like JAG that has been thru it.  The "mass" in question near surface-  mid frontal area on left wich habors right motor strips.- which explains severe right leg seizures i've been having.  2 radiologist seem scared to do anything because of radiation-overload induced necrosis, but in reading other posts, I see many options.  I know i havn't provided enuff info. but ask me and fill you in where maybe someone can give me "suggestions"

 

Thanks with Love for All,  Grady.

I'm Here for Now, I've got the rest of my life to die; and if so, old age could be overated and God does exist.

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boot2aboot's picture
Replies 1
Last reply 11/23/2011 - 1:36am
Replies by: CaptAaron

 

Melanoma International Congress: Clinicians and Researchers Make Sense of Resistance Mechanisms

 
By CancerNetwork Editors | November 17, 2011
 
 
The theme of the Society for Melanoma Research (SMR) meeting in Tampa this year was “Advancement through Collaboration,” and this theme was clearly reflected. With melanoma therapies stealing the plenary session limelight two years in a row at the annual meeting of the American Society of Clinical Oncology (ASCO), with the presentation of ipilimumab in previously treated metastatic melanoma patients, and two abstract presentations: ipilimumab as a first-line treatment for metastatic melanoma, and the targeted BRAF inhibitor, vemurafenib, for first-line treatment of metastatic melanoma in patients with BRAF-mutated tumors.

 

Ipilimumab, approved in March of this year, was the first agent approved for metastatic melanoma in 13 years, with vemurafenib not far behind. These two drugs appear to be just the tip of the iceberg for melanoma treatment. Already, there are trials testing a combined BRAF and MEK inhibitor that will move into a phase III trial next year and, based on the partial phase I and II results, the combo is more efficacious and has lower adverse events than a single BRAF inhibitor.

 

Patients from clinical trials of targeted agents (and especially from the BRAF inhibitor trials) are providing important data in the form of tumor and blood samples and response rates. A major hot topic of the meeting is also the study of the mechanisms of resistance to vemurafenib.

Vemurafenib has an approximately 80% response rate within a two-month treatment cycle, with a two- to eighteen-month period of regression. However, all patients eventually develop resistance to the drug and relapse. The mechanisms of relapse are sometimes through a secondary BRAF mutation; another mutation in the same, MAPK pathway; or activation or up-regulation of an alternative survival pathway. Several papers have already been published documenting the types of novel mutations seen in patients’ resistant tumors. These analyses are ongoing along with pre-clinical research on mechanisms of resistance.

 

The rationale is that knowing what other genes and pathways become important upon resistance to BRAF inhibitor exposure will direct the development of unique combinations to block these pathways and prevent both resistance and disease recurrence. Researchers at the Melanoma Congress highlighted the importance of identifying the “universe” of resistance mechanisms and integrating these with clinical characterization of the disease.

 

The laboratory of Gavin Robertson, PhD of the Department of Pharmacology at Penn State is looking at the epigenetic changes that occur in melanoma upon BRAF inhibitor exposure using a melanoma cell model. Robertson and colleagues have found that an invasive suppressor, CD82, is both methylated and silenced upon BRAF inhibitor exposure, suggesting that a combination of BRAF and DNA demethylation targets is a potential clinical approach to overcome resistant, invasive melanoma.

 

Keiran Smalley, PhD of the H. Lee Moffitt Cancer Center and Research Institute and colleagues are studying a unified approach to overcome resistance based on the observation that the majority of genes implicated in vemurafenib resistance are targeted by the heatshock protein HSP90. Treating melanoma cell lines with either intrinsic or acquired resistance to vemurafenib with XL188 (veliparib), a targeted HSP90 inhibitor, resulted in inhibition of growth and survival.

 

The negative results of a phase II clinical trial of veliparib combined with temozolomide(Drug information on temozolomide) in late-stage metastatic melanoma patients was also reported at the meeting. These new data reinforce the common sentiment of researchers in the field that the complexity of melanoma requires combination and, potentially, sequential combination treatments. A phase I clinical trial combining a BRAF inhibitor and XL188 is currently being planned.

 

Rather than going on a “fishing expedition,” researchers now have the tools to create hypothesis-driven models of melanoma resistance in the laboratory. With the large number of available targeted agents, many of which have already been tested in human trials, clinical trials with the most promising combination treatments can be taken to the clinic. “The biology of late, compared to early, resistance may be different,” said Dr. Jeffrey Sosman, director of the melanoma and tumor immunotherapy program at the Vanderbilt Cancer Center in Nashville, highlighting another key area of research that needs to be pursued. The key will be the continued collaboration of laboratory researchers and clinicians

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Charlie S's picture
Replies 8
Last reply 11/23/2011 - 8:20pm

Spoke with his wifey today and Jerry has rebounded (once again !)  Still on anti-biotic, but docs feel they have infection under control.  He has regained some mobility, was moved from ICU to a step down unit over the weekend and is now being moved out of the hospital to a physical rehab facility.

His wife and I had a good laugh when I mentioned what a time he has had and how touch and goes it was for a bit, and she gave a big laugh and said "Yeah, he always likes to do things in a big way !

So, pretty good news.

Cheers,

Charlie S

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boot2aboot's picture
Replies 0

 

Protein linked to spread of skin cancer
Tuesday 22 November 2011

 

An international team of researchers working together on both sides of the Atlantic have pinpointed a protein, called P-Rex1, that seems to play a key role in the spread of malignant melanoma - the most deadly form of skin cancer, according to a paper in Nature Communications.

The team, led by researchers from the Cancer Research UK-fundedBeatson Institute of Cancer Research in Glasgow, were studying cells called melanoblasts - highly mobile cells involved in the early development of the skin.

Researchers believe that the way melanoblasts move around body tissues very similar to how melanoma cells spread. The major cause of death from melanoma is due to it spreading, or metastasising, from the initial tumour.

The discovery came when the team noticed that mice which lacked the gene that which makes the P-Rex1 protein, had skin cancers that did not spread.

Armed with this knowledge, the research team then tested human melanoma cells and tumour tissue and discovered raised levels of P-Rex1, suggesting that the protein was involved in the movement of the cells.

The discovery will give researchers a better understanding of how the cells work, which in turn enables them to better select a target for developing new treatments.

Researcher Channing Der, a member of the team based at the Lineberger Comprehensive Cancer Center the US, said: "We know that mutations in a gene called BRAF are important for the development of melanoma and several years ago we published a collaborative paper listing 82 proteins that seem to be affected by this genetic pathway. From that list, we focused on P-Rex1."

The BRAF gene was discovered to be involved in melanoma by Cancer Research UK scientists, and this year a drug - vemurafenib - was developed that targets melanomas in which the BRAF gene is defective. This is thought to be the case for around 80 per cent of patients.

The discovery that P-Rex1 is 'downstream' of BRAF - in other words, signals coming from BRAF need to 'pass through' P-Rex1 - is significant because it suggests that drugs that target P-Rex1 could - in theory - help the 20 per cent of people with melanoma whose cancer doesn't have a faulty BRAF gene.

Nell Barrie, senior science information manager at Cancer Research UK, said: "Cancer is difficult to treat once it has spread, and research that helps us to understand how cancer cells travel around the body is helping scientists to target this process with new drugs. Studies like this give us more ammunition against melanoma and other types of cancer, but it's important to remember that it can take years to turn a discovery in the lab into a treatment for patients."

Copyright Press Association 2011

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boot2aboot's picture
Replies 2
Last reply 11/22/2011 - 4:01pm
Replies by: boot2aboot, TracyLee

 

Melanoma International Congress: Immunotherapy and Targeted Therapy Combinations Touted
By CancerNetwork Editors | November 22, 2011
 
Immunotherapy is finally getting the cancer clinical and research community excited:  A large portion of the presentation and discussion at the Melanoma International Congress, held in Tampa, Florida last week focused on immunotherapy approaches for the treatment of the disease. 
 
With the approval of the anti-CTLA4 antibody, ipilimumab, for metastatic melanoma, which has shown an overall survival of 10.1 months in a second-line trial and is now approved as both a first-line and second-line treatment for the advanced disease, the immunology field is seeing a lot more of the limelight. Academic researchers working on novel immune-harnessing treatments and vaccines are garnering more interest from the pharmaceutical industry for commercialization.
While the enthusiasm for ipilimumab from both patients and clinicians continues, there is a already anticipated excitement about a novel immunotherapy currently in early development, an antibody called anti-PD1. Both CTLA4 and PD-1 are critical immunologic checkpoints that normally function to restrain the immune system. While multiple anti-PD1 agents are in development, the one with the most patient data is BMS-96558 (MDX-1106), a potent, fully human antibody against PD-1. Phase I trials in melanoma patients as well as other cancer patients have shown promising, durable responses.
Dr. Mario Sznol, professor of medicine and co-director of the Melanoma Program at the Yale Medical School, in his presentation said anti-PD1 “is one of the most promising approaches in melanoma.” Part of that reason is that, based on the less than 50 patients for whom there is longer-term data; the immunological adverse event rates appear more muted compared to those seen with ipilimumab.
The question of whether ipilimumab, in addition to anti-PD1 treatment is more efficacious than a single agent-treatment is being addressed in a small phase I trial that's carefully looking at the best tolerated dosage in order to minimize adverse events while increasing the response rate and durability of ipililumab monotherapy. 
The congress presentations also highlighted both immunology agents and targeted treatments for melanoma. Importantly, the meeting emphasized a multi-disciplinary approach of combining these two treatments. Jedd Wolchok, MD, PhD from the Memorial Sloan Kettering Cancer Center, who was an integral part in the clinical trials that led to the approval of ipilimumab, described the rationale for combination therapy. Specifically, he discussed the combination of ipilimumab with vemurafenib, the targeted, oral BRAF inhibitor, as having the potential to achieve the balance of the high response rate of vemurafenib with the durable disease control seen with ipilimumab.
Dr. Antoni Ribas of the UCLA Jonsson Comprehensive Cancer Center presented preclinical data on the evidence that the combination may be effective. Using cell lines derived from a mouse model with a V600E mutation in BRAF, the mutation in BRAF that is targeted by vemurafenib, Dr. Ribas and his laboratory have shown that cells treated with both agents respond with apoptosis, as well as prevention of activation of the pathway components downstream of BRAF, namely the effector proteins, ERK and MEK. Importantly, the preclinical data shows that there is no effect of vemurafenib on lymphocyte viability, which is crucial for ipilimumab to achieve its effectiveness. A first in-human trial combining vemurafenib and ipillimumab in metastatic melanoma patients is scheduled to begin by 2012. The hope, according to the researchers, is that vemurafenib will increase the effectiveness of immunotherapy in part by facilitating tumor antigen presentation. The trial will also address whether the timing and rate of resistance to vemurafenib will be affected by concurrent ipilimumab therapy.
“In two years we will have our tenth anniversary. Before the IMC meetings began, there was no real galvanizing meeting that focused on melanoma research and the [Society for Melanoma Research] meeting has since evolved into the premier meeting, with the strong emphasis on research while also reaching out to our clinical colleagues. The research results from the laboratory translate very quickly into the clinics with ever increasing frequency and is a very broad effort,” said Meenhard Herlyn, Professor of Dermatology at the Wistar Institute and part of the University of Pennsylvania School of Medicine, commenting on the evolution of the annual melanoma meeting.
Looking to the future, researchers are coming together as part of the Breakthrough Consortium to begin important clinical trials, including promising combination therapies. Professor Herlyn advocates for better and more rigorous pre-clinical testing of these combinations before the start of patient trials.
“There is now a consortium established by the Melanoma Research Foundation, called the Breakthrough Consortium and this consortium has integrated 12 different institutions conducting clinical trials, with the specific goal of developing combination therapies. Both clinical trials are starting. Instead of going blindly into those clinical trials, we need more preclinical studies to carefully plan for them and so each clinical trial should have a solid rationale from pre-clinical studies. This will also be established through this consortium, which has five different sub-committees. We hope that in this way, the melanoma disease model will become the core of an adaptive, rapid learning community that provides each patient with the best possible outcome while aggregating results over all patients to advance the standard of care."
Melanoma has become a model example of a cancer for which clinical outcomes are refined based on molecular subtypes and for which there is a tremendous interaction of the melanoma clinical and research community. With many industry and academic-funded combination trials in the near future, there outcomes in the next few years should prove to be very interesting.  
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My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

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Theresa123's picture
Replies 1
Last reply 11/22/2011 - 3:18pm
Replies by: lyndaloo

My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

Login or register to post replies.

My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

Login or register to post replies.

My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

Login or register to post replies.

My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

Login or register to post replies.

Theresa123's picture
Replies 2
Last reply 11/28/2011 - 6:04pm
Replies by: Theresa123, mombase

My Dr. wants me to have abdominal and subcutaneous surgeries to remove melanomas.  I just had my 2nd Yervoy, and I wonder if this is a good idea.  I am getting a second opinion at Angeles Clinic.  I just wonder if anyone else has had this issue.

I have Stage IV for about 2 years, and this is my 4th treatment(s).  Interferon, Ipi, Bio, and Til

Every day is a miracle.

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davidfromsingapore's picture
Replies 5
Last reply 11/22/2011 - 9:49am

Hello 

I was on this board 3 years ago when i was stage 3B.  Unfortunaltely a few weeks ago I was having headaches and a scan revealed 3 brain mets.  I had 2 removed via resection and the third via radiation (SRS).  My life is a bit complicated.  I am an American citizen with a wife and 3 children but we live in Singapore.  I have an oncologist at Mayo in Rochester, Minnesota and one here.  My Mayo doc is recommending that I start with Zelboraf soon.  So here are my questions:  

1) Is Zelboraf considered adjuvant therapy - meaning that it is given to patients who had melanoma removed but for the time being are NED?  Or is it only effective when a patient has active lesions?

2) Is it possible to get a complete or durable response from Zelboraf?

3) Are there any of you out there who are taking Zelboraf who like me have brain mets or had them and you are taking Zelboraf to keep the diease at bay? Is it working?

4) Are there any of you out there who are taking Zelboraf and have had long term responses?

 

Thanks in advance for your replies.  I am looking forward to getting to know some of your again now that I am back on the board.  

 

David

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” ― Albert Einstein

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TracyLee's picture
Replies 5
Last reply 11/23/2011 - 1:45am

Hi y'all,

Still hanging in, trying to make it to 12/1 without another lung drain. Has anyone done Zelboraf in combo with Temodar?

Side effects, even just on Temodar? Tips? I'm sorry, I know there are posts for Temodar, but I'm too tired to try and find them. I'm still working full time, not sleeping well at all.

BUT, I'm here, and I have so much to be thankful for. Those long, sleepless nights, I pray and list all the small and large joys of each day.

Praying for us all!

TracyLee

 

Never will I leave you, never will I forsake you. Hebrews 13:5 Cast all your anxiety on Him, because He cares. 1 Peter 5:7 Stage IV 5/16/11 Ipi - 4 rounds May - July 2011 BRAF expanded access trial 8/8/11

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jmmm's picture
Replies 8
Last reply 11/27/2011 - 7:38pm
Replies by: Anonymous, jag, momof2kids, kylez, KatyWI, davidfromsingapore

My husband is scheduled for a craniotomy next Wednesday to remove a large (5cm x 5cm) tumor. We are both scared and worried about complications. It's in the motor area and the doctor said there was a chance of left side paralysis, plus a bunch of other complications. Any advice on what to expect, how to handle the anxiety and fears, recovery, etc. We have 3 young boys at home and I'm worried about juggling it all. He's been through a small bowel resection and a thoracotomy and breezed through both surgeries with no complications. This surgery sounds so scary. Any advice?

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