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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Anonymous's picture
Anonymous
Replies 4
Last reply 3/28/2014 - 2:32pm
Replies by: Janner, Anonymous, dellriol, POW

I am having such a problem with my oncologist at a reputable research facility. All questions are answered with one or two words, or no answer at all. I have tried everything I can to get a conversation going, but have gotten nowhere.

I don't think he realizes it, but the effect on me is cruelty - I have been trying to talk to him for a year and I can't get an answer on how I am doing or what might be ahead for me.

Does anyone have any suggestions.

Mary

ps I have a rare melanoma and it is difficult to find information on the web.

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Immunotherapy in Melanoma Before or After BRAF Inhibitors

 

Research · February 27, 2014
 

TAKE-HOME MESSAGE

  • Treatment sequence of immunotherapy (IT) used before or after BRAF inhibitors for metastatic melanoma was evaluated. For IT (ipilimumab and IL-2) followed by BRAF inhibitors (n = 32), response rate was 57%, overall survival (OS) was 6.7 months, and progression-free survival was 19.6 months. These results were similar to when BRAF inhibitors were used initially. However, when IT was used after BRAF inhibitors were discontinued, the OS was only 2.9 months.
  • “In this retrospective study, patients who received BRAF inhibitors after ipilimumab had a 57% response rate, in keeping with expected results. However, among a subset of patients receiving IT after progression on BRAF inhibitors, responses were poor. These data suggest that treatment with IT before BRAF inhibitors may be preferable in eligible patients.”

- Richard Bambury, MD

 
ABSTRACT

BACKGROUND

The immunotherapy (IT) agents ipilimumab and interleukin-2 as well as BRAF inhibitors (BRAFi) vemurafenib and dabrafenib, with or without trametinib (MEK inhibitors), are all FDA-approved treatments for BRAF metastatic melanoma, but there are few studies to guide optimal sequencing. This retrospective analysis describes the outcomes of patients treated with either BRAFi before IT or IT before BRAFi.

METHODS

A cohort of patients treated with BRAFi alone or with MEK inhibitor was retrospectively identified. Response rate (RR), overall survival (OS), and progression-free survival (PFS) were evaluated for the entire cohort, subdivided by BRAFi prior to or after IT.

RESULTS

RR and median PFS and OS calculated from commencement of BRAFi following IT (N = 32) were 57%, 6.7 months (95% confidence interval [CI] = 4.3-9.1 months), and 19.6 months (95% CI = 10.0-undefined months), respectively; whereas for BRAFi initially (N = 242) were 66%, 5.6 months (95% CI = 4.7-6.8 months), and 13.4 months (95% CI = 10.1-17.0 months). Results were similar when controlled for prognostic variables. A total of 193 patients discontinued BRAFi, with OS of 2.9 months (range of 1.8-4.4 months) from day of BRAFi discontinuation. Forty patients subsequently received IT with ipilimumab. Only half could complete 4 doses of ipilimumab; PFS with ipilimumab was 2.7 months (95% CI = 1.8-3.1 months) and OS was 5.0 months (95% CI = 3.0-8.8 months).

CONCLUSIONS

In this retrospective analysis, prior treatment with IT does not appear to negatively influence response to BRAFi. Outcomes for IT with ipilimumab following BRAFi discontinuation are poor. Randomized controlled trials are needed to define if sequencing IT prior to BRAFi therapy is superior to sequencing BRAFi prior to IT.

Cancer
Outcomes of Patients With Metastatic Melanoma Treated With Immunotherapy Prior to or After BRAF Inhibitors
Cancer 2014 Feb 27;[EPub Ahead of Print], A Ackerman, O Klein, DF McDermott, W Wang, N Ibrahim, DP Lawrence, A Gunturi, KT Flaherty, FS Hodi, R Kefford, AM Menzies, MB Atkins, GV Long, RJ Sullivan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

 

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New Therapies Giving Hope for Patients With Advanced Melanoma
American Academy of Dermatology, 2014 Mar 21
News
 
 

 

Denver, Colorado; March 21, 2014—Although melanoma—the deadliest form of skin cancer—accounts for less than 5 percent of skin cancer cases, it is responsible for about 75 percent of all skin cancer deaths. When melanoma is detected early and treated before it spreads to the lymph nodes, the five-year survival rate is approximately 98 percent. However, when the disease spreads, the five-year survival rate drops considerably—to 62 percent in patients whose melanoma has spread to the lymph nodes and only 16 percent in patients whose melanoma has spread to other organs.

Within the last three years, significant progress has been made in treating advanced melanoma when the disease has spread beyond the skin. Now, new immunotherapeutics and molecularly targeted therapies are offering a glimmer of hope in stopping the progression of advanced melanoma and prolonging life for patients fighting this deadly disease.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT

Information is provided by board-certified dermatologist Delphine J. Lee, MD, PhD, FAAD, a professor of immunology at John Wayne Cancer Institute in Santa Monica, Calif.

NEW IMMUNOTHERAPEUTIC DRUGS: A GOOD START FOR PROLONGING LIFE

Prior to 2011, two aggressive therapies were the mainstay of treatment for advanced melanoma that had spread to the lymph nodes or other organs—high-dose IL2 (interleukin 2) and interferon. However, neither drug demonstrated the ability to prolong the lives of melanoma patients. In addition, interferon, which is recommended as a five-year therapy, poses many side effects (including intense and prolonged flu-like symptoms) that many patients cannot tolerate for the long treatment period.

New combination therapy yields higher response rate

Two new melanoma drugs—dabrafenib and trametinib—previously approved in May 2013 for individual use were granted accelerated approval by the Food and Drug Administration (FDA) for use as a combination therapy in January 2014.

  • This FDA program is important because it allows patients earlier access to promising new drugs while the drug manufacturers confirm drug benefits through clinical trials. Initial studies show that 76 percent of patients treated with this combination therapy experienced a reduction in size or disappearance of their melanoma that lasted an average of 10.5 months.

Dabrafenib

Dabrafenib is a drug that targets a specific gene mutation known as BRAF, which is present in about half of melanomas and causes them to grow. Now, patients with melanoma can be tested for this gene mutation with a biopsy.

  • If patients test positive for this mutation, this personalized cancer therapy can work for them by temporarily blocking one pathway that melanoma uses to spread to other areas of the body (slowing its progression and growth).
  • This is the second BRAF inhibitor drug available to treat advanced melanoma, which Dr. Lee explained brings competition to the market.
    • This helps bring down the cost of this type of drug and makes it more accessible for melanoma patients.

Trametinib

Trametinib works similarly to dabrafenib by blocking another pathway located downstream from BRAF known as MEK, which melanoma also can use to spread the disease to other organs.

  • This is an important new drug because it helps further delay the progression of advanced melanomas that have effectively surpassed the temporary roadblock set up by dabrafenib.

Combination therapy of dabrafenib and trametinib has not been shown to improve overall survival rates, but Dr. Lee explained it is an important new therapy because a higher percentage of melanoma patients have experienced a positive response to this therapy, resulting in an increase in the number of months patients are disease-free before melanoma recurs. For example:

  • The response to this combination therapy is referred to as "Progression-free survival."
    • During this time, patients may experience a quality-of-life improvement and, in some cases, be able to start another therapy that may prolong life.

Ipilimumab

In March 2011, two new immunotherapeutic drugs that work by helping the immune system fight cancer were introduced for patients with advanced melanoma. Ipilimumab is the first new melanoma drug shown in randomized clinical trials to provide an increased survival rate. This immunotherapeutic drug works by “taking the brakes off” the immune system, causing it to be more active to attack cancer cells. The overall survival advantage is not particularly long, Dr. Lee explained that it is a step in the right direction. Specifically:

  • Studies showed the median overall survival in patients with advanced melanoma taking ipilimumab was 10.1 months, compared to the survival rate of 6.4 months in patients who did not receive ipilimumab.

Stabilized interferon

To make interferon more stable and more tolerable for patients, the stabilizer polyethylene glycol was added, and the new drug called peg-interferon also was introduced in March 2011. Known benefits include:

  • The drug is administered to patients at a lower dose to minimize side effects.
  • Improved side effects allow patients to better tolerate the drug and extend the period of time they can take it.
  • The improved survival benefit is unknown at this time, but Dr. Lee expects the drug could prolong life if the patient can tolerate taking this drug for the recommended five-year period.

Vemurafenib

In August 2011, vemurafenib was the first BRAF-inhibitor drug introduced to target the BRAF gene mutation. Dr. Lee reviewed the key findings of vemurafenib:

  • Clinical trials of the drug conducted in 2010 showed a very dramatic and quick response when vemurafenib was given to patients whose melanoma had spread to the lungs. In these instances, the tumors on the lungs completely disappeared.
  • In another clinical trial that compared the response of vemurafenib to decarbazine (a chemotherapy drug commonly used before the new melanoma therapies were introduced in 2011), melanoma patients taking vemurafenib lived longer.
    • At six months, the overall survival of patients taking vemurafenib was 84 percent compared to an overall survival of 64 percent for patients taking dacarbazine.
    • As a group, melanoma patients taking vemurafenib lived longer by a few months compared to those patients taking dacarbazine, but Dr. Lee noted that melanoma eventually recurred when the cancer cells learned to bypass the initial roadblock and find a new path to spread to other organs.
  • Dr. Lee believes the use of drugs that target specific pathways contributing to uncontrolled growth, such as vemurafenib or dabrafenib, has a lot of potential in blocking the spread of melanoma and shrinking existing tumors. Equally important, these types of drugs represent the beginning of fine-tuning therapy for advanced melanoma patients by personalizing their treatment.

ADOPTIVE CELL THERAPY: DRAMATIC SURVIVAL RATES FOR SOME PATIENTS

Another very personalized cancer therapy that is being offered in only select treatment centers across the country is adoptive cell therapy. This labor-intensive therapy for patients with metastatic disease begins by taking and growing the patient’s T cells (cells in the immune system that protect the body from infection and aid in fighting diseases) in a laboratory. Once the supply of T cells has expanded, the cells are then given back to the patient to help the immune system fight melanoma. The protocols may vary slightly from center to center.

Dr. Lee explained that not everyone responds to adoptive cell therapy, but the patients who do —although they're not cured—experience a long-lasting response, which is substantially longer than other melanoma therapies currently available.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE

With so many new melanoma therapies being introduced, it is important for patients with advanced-stage melanoma to get a few different opinions on their treatment options before making a decision,” said Dr. Lee. “The progress we’ve seen in melanoma therapy has been considerable compared to 10 years ago, and patients have reason to hope for longer survival rates in the future. Any drug that can prolong life — even for a short period of time — and stop the spread of tumor growth gives patients the opportunity to try another therapy or participate in a new clinical trial that could help them live even longer.

Copyright © 2014 American Academy of Dermatology

 

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Anonymous's picture
Anonymous
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Ipilimumab Retreatment in Patients With Pretreated Advanced Melanoma

 

Research · March 11, 2014
 

TAKE-HOME MESSAGE

  • In this retrospective analysis of patients previously treated with ipilimumab and noted to have progression on imaging, retreatment with ipilimumab resulted in disease control in 55% of patients, with 42% still alive at 2 years and a median overall survival of 21 months. 
  • Although only a small number of patients were included, this analysis demonstrates that ipilimumab retreatment is possible and can provide continued disease control in a subset of patients with a minimal increase in toxicity.  

- Chris Tully, MD

 
ABSTRACT

Background

Retreatment with ipilimumab has been shown to re-establish disease control in some patients with disease progression. Here, we report the efficacy and safety of retreatment with ipilimumab 3 mg kg−1 among patients participating in an expanded access programme in Italy.

Methods

Patients who achieved disease control during induction therapy were retreated with ipilimumab upon progression (3 mg kg−1 every 3 weeks for up to four doses), providing they had not experienced toxicity that precluded further dosing. Tumour assessments were conducted after retreatment, and patients were monitored throughout for adverse events.

Results

Of 855 patients treated with ipilimumab, 51 were retreated upon disease progression. Of these, 28 (55%) regained disease control upon retreatment and 42% were alive 2 years after the first induction dose of ipilimumab; median overall survival was 21 months. Eleven patients (22%) had a treatment-related adverse event of any grade during retreatment. These were generally mild-to-moderate and resolved within a median of 4 days. No new types of toxicity were reported.

Conclusions

For patients who meet predefined criteria, retreatment with ipilimumab is generally well tolerated and can translate into clinical benefit. This strategy should be compared with other therapeutic options in randomised controlled trials.

British Journal of Cancer
Ipilimumab Retreatment in Patients With Pretreated Advanced Melanoma: The Expanded Access Programme in Italy
Br. J. Cancer 2014 Mar 11;[EPub Ahead of Print], V Chiarion-Sileni

 

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Nomograms Can Predict Outcome of Therapeutic Lymphadenectomy in Late-Stage Melanoma

 

Research · March 10, 2014
 
 

TAKE-HOME MESSAGE

  • In this study, a mathematical model was developed to predict the response of patients diagnosed with stage IIIB and IIIC melanoma to therapeutic lymph node dissection. Extracapsular extension and nodular pathology subtypes were good predictors for 2-year recurrence incidence. Age, number of positive lymph nodes, and extracapsular extension were predictors for overall survival. 
  • This mathematical model provides assistance in predicting outcomes in patients with late-stage melanoma and clinically involved lymph nodes.

- Chris Tully, MD

 
ABSTRACT

The publisher has made this article available for free until 4/9/2014 12:00:00 AM .

Access this article now

Background

Current staging algorithms in melanoma patients undergoing therapeutic lymph node dissection (LND) fail to accurately distinguish long-term survivors from those at risk of rapid relapse. Our goal was to establish and validate nomograms for predicting both recurrence and survival after LND.

Methods

A prospective cohort of stage IIIB and IIIC melanoma patients was ascertained from a tertiary hospital in Brisbane, Australia. Failure-time multivariate analysis identified key factors that, in adjusted combinations, generated nomograms to predict 2-year recurrence and 5-year melanoma-specific survival. The predictive value of these nomograms was further validated in a patient cohort from Rotterdam, The Netherlands.

Results

In 494 Australian patients, number of positive lymph nodes, extra-capsular extension and nodular histopathological subtype were the main independent predictors of 2-year recurrence while age, number of positive nodes and extra-capsular extension were the independent predictors of survival. Predictive value was confirmed in The Netherlands cohort of 331 patients. The nomograms were able to classify patients according to their 2-year recurrence and 5-year survival rates even within each stage III sub-class.

Conclusions

Models that include extra-capsular extension predict outcomes in patients with clinically involved lymph nodes. This tool may help tailor treatment and monitoring of this group of patients.

European Journal of Cancer
Nomograms to Predict Recurrence and Survival in Stage IIIB and IIIC Melanoma After Therapeutic Lymphadenectomy
Eur. J. Cancer 2014 Mar 10;[EPub Ahead of Print], K Khosrotehrani

Copyright © 2014 Elsevier Inc. All rights reserved.

 

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Leslie'sHusband's picture
Replies 5
Last reply 3/30/2014 - 5:36pm

Les and I are heading to Duke on Monday morning for a consult with Dr. Tyler.  I know that we are going to discuss the clinical trial "Feasibility and Safety of Minimally Invasive Inguinal Lymph Node Dissection in Patients with Melanoma".  Based on conversations with our local surgical oncologist, the "normal" surgery sounds pretty involved for an outpatient surgery.  Moving a muscle, or at least part of a muscle, to cover exposed major blood vessels sounds a little bit on the "involved" side to us.  Les wants to do whatever it takes to make sure that this cancer is out of her body, though. 

We are also going to ask about the E1609 trial as well, though I will admit that I don't like the statistics I'm seeing on the Interferon success rates.  Interferon was the only treatment offered locally.

Any advice on what questions to ask would be greatly appreciated.

 

David

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out4air's picture
Replies 2
Last reply 3/28/2014 - 10:14am
Replies by: Anonymous

Many, many people need this drug that cannot get into a clinical trial including my husband.

 

 
 
We are in it to win it!

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HelenQLD's picture
Replies 6
Last reply 3/29/2014 - 8:44pm

Mum lost her battle at 7.20pm on 27/3/2014 at home after fighting the black beast for six months after finding out her stage iv diagnosis. 

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Anonymous's picture
Anonymous
Replies 1
Last reply 3/27/2014 - 8:57pm
Replies by: JoshF

I have been hearing about about a complete response and partial response to ipi. Does complete response mean remission and is it forever?

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Anonymous's picture
Anonymous
Replies 0

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evleye's picture
Replies 7
Last reply 3/29/2014 - 5:20pm
Replies by: Anonymous, evleye, dellriol, Patina, hbecker

I am stage IV melanoma and papillary thyroid cancer.  I have mets to ovary and breast.  I am having total thyroidectomy on Tuesday and follow with yet to be determined clinical trial.  I have two children aged 16 and 10 and they know what is going on but in a super upbeat no big deal kind of way (I was stage I 8 years ago so they know I've had this before).  I am struggling with telling people.  I am torn between wanting people to know and not burdening them with knowing.  I fear that people will treat me differently.  On the other hand, do other people have the "right" to know?  I have informed my younger child's school and my husband's job but I haven't told my siblings.  In the world of social media, I have no idea how to break the news.

 

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Anonymous's picture
Anonymous
Replies 2
Last reply 3/28/2014 - 6:19am
Replies by: tschmith, BrianP

My turn has finally arrived.  I'm participating in the "Phase I/II Study of the Treatment of Metastatic cancer that Expresses MAGE-A3 Using Lymphodepleting Conditioning Followed by Infusion of HLA-DP0401/0402 Restricted Anti-Mage-A3 TCR-gene Engineered Lymphocytes and Aldesleukin".  

I'll let you know how it goes!  Chemo begins tomorrow. Cells introduced on April 4th with IL2.

Terrie

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Hcates's picture
Replies 2
Last reply 3/28/2014 - 12:02am
Replies by: jahendry12, vivian

Hi, 

I'm new here.  I just found out on Tuesday that a mole I had biopsied is melanoma.  It's .3mm deep so caught very early.  I attribute this to my great dermatologist and my annual mole scans.  I am a 11 year lymphoma survivor and am wondering, do I have a greater risk of melanoma infiltrating my lymph system than someone who has never had lymphoma?  I'm thinking more of in the future, if another spot turns up and is deeper.  I'm sorry if my terminology or understanding of this cancer is incorrect, I'm still reading up on it.

Thanks for any advice,

Heather

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jyoakum's picture
Replies 4
Last reply 3/27/2014 - 8:46am

I have had two melanoma moles removed and lymph node axilliary dissection on the same side with one positive melanoma lymph node out of the 14 removed. I was satisfied with the "catch 'em and cut 'em" method but my oncologist wants me to look at clinical trials. Can anyone tell me of specific clinical trials they know of that have worked, what to avoid and any other specific advice? One of my big questions is: If my PET scan and brain MRI was clear, then the melanoma is microscopic at this point. How can we find something that can't be detected and when would we know when it was eradicated? I have no symptoms, just lots of scars and more to come (two more dysplastic coming off next week). Will the cure be worse than the disease? Is it worth it?

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Tina D's picture
Replies 19
Last reply 4/6/2014 - 12:24pm
Replies by: meg, Anonymous, dellriol, Tina D, katie1, BrianP, casagrayson, jogo

Anyone have adrenal insufficiency due to treatments and if so, does your Doc give you a "stress dose" option for your prednisone? In times of added demands either physical or emotional . I am having extra fatigue, and am in the midst of some demanding stressors at the moment. Thyroid was also low again, so the dosage adjustment may take care of it, but if not, they told me we can discuss the prednisone next visit. Just wondering what others are doing. Thanks! I have been on 5 mg pred for long time, after pituitary inflammation brought on by ipi last year ( started on 60 and tapered to 5 eventually) I also have a history even prior to the ipi of likely being adrenal insufficient, always requiring Cortisol to keep any BP during and after surgeries.

Thanks!

Tina

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