Archive for the ‘Science and Studies’ Category

More Hope for Melanoma Patients in a Year of Milestones

Wednesday, August 24th, 2011

Treatment options for melanoma have advanced in the past year with heartening results.  As we wrote in March 2011, the drug Yervoy (ipilimumab or “ipi”) appears to be successful for a small group of patients with inoperable, metastatic melanoma in extending survival.  In fact, WebMD says that “Yervoy … is the first drug ever shown to help late-stage melanoma patients live longer.”

Now, there’s more news to be hopeful about on the pharma front with potentially greater results: The FDA has also given the go-ahead to a drug called ZELBORAF (vemurafenib, pronounced vem-yoo-RAF-en-ib).   A comprehensive overview by ABC News offers a clear explanation of how Zelboraf attacks a genetic mutation (known as BRAF V600E) which is found in about half of melanoma patients, inhibiting the disease’s ability to spread.

We now have the capability to analyze a patient’s melanoma tumor for the genetic mutation BRAF and use the targeted treatment Zelboraf to attack the tumor, shrink it and stop the progression of this deadly disease,” said Dr. Anna Pavlick, director of the NYU Melanoma Program at the NYU Cancer Institute, who has been involved in clinical trials for Zelboraf. …Zelboraf shuts down the abnormal signals of the tumor cells that are caused by the genetic mutation and stops the cells from dividing, without affecting healthy cells.

At the same time, the FDA approved a genetic test to determine if patients carry the mutation since only those with the abnormal “BRAF” gene can take Zelboraf.  Interestingly, since the same genetic mutation is found in those with other forms of cancer, there may be future help from this drug beyond skin cancer and is now, for example, being tested on thyroid cancer patients.

This is the fastest the FDA has ever approved a drug to come to market – in just five years.  And even better: Zelboraf, which is a first-in-class drug, is anticipated to be available in the next two weeks.

There are differences between Yervoy and Zelboraf.   As described in the coverage by the SF Chronicle,

Yervoy was found to extend patients’ lives, an improvement over many current treatments. However, the drug works for less than 20 percent of patients, and doctors say they can’t predict which patients will find it most effective.

Zelboraf was clinically effective in 50 percent of patients [with the] specific genetic mutation … Most of the therapies for melanoma work for less than 20 percent of patients, and some fall into single digits.

Neither Zelboraf nor Yervoy cure melanoma.  And as a patient who had great success in a clinical trial for the new drug said, “there’s nothing that says this medication will help you forever.”  But these drugs bring hope for a longer life, and as new therapies come along the melanoma pipeline, there is reason to be optimistic.

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Interesting Read…

Monday, August 15th, 2011

Just a quick post here: We’ve been hearing from friends that this Pulitzer Prize winner is a very compelling read:

Emperor of all Maladies

Emperor of all Maladies

As one friend wrote of “The Emperor of all Maladies”: “May sound depressing but it’s not. It’s fascinating and feels (so far) like a must-read for anyone who has had cancer or been touched by someone who did. Said another way, EVERYONE.”

The official description:

“…a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.”

Have you read it?  What are your thoughts? As always, your comments are welcome.

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Olé! A Toast to Spanish Researchers

Friday, August 5th, 2011

We’ve read, with grape expectations (!) about the anti-oxidant benefits of red wine…when consumed in moderation, of course, darn it.  In this Mayo Clinic report, for example, the possibility was discussed that resveratol — a polyphenol in the wine — offers some benefit to your heart.  Now, scientists from the University of Barcelona and the CSIC have shown that a compound found in grapes or grape derivatives may protect skin cells from skin-damaging ultraviolet radiation.

Here’s how it may work, as described by MSNBC.com:

When UV rays hit your skin, they activate “reactive oxygen species,” or ROS, which then oxidize big molecules like lipids and DNA. This activates particular enzymes that kill skin cells. But grapes’ flavonoids work to decrease the formation of the ROS’s in skin cells that were exposed to UVA and UVB rays.

Basically, the thinking is that the flavonoids in grapes help halt the chemical reaction that kills skin cells leading to skin cancers and melanoma, and causes sun damage.

The catch? Consume as you will, but the researchers will be applying their findings to the development of new photoprotection skin products, sun-shielding drugs and cosmetics.

Cheers.

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Women and Melanoma

Sunday, July 10th, 2011

There were two interesting studies out in the past several weeks regarding women and the risk of Melanoma, both of which were reported in the Journal of Clinical Oncology and are sort of “the good news and the not quite as good, but interesting, news.*”

First, as stated by MedPage Today,

“If you have to have malignant melanoma, be a woman – your chances are better.”

While it’s considered preliminary data, the article share that “women exhibited a consistent independent advantage in melanoma progression, metastasis, and survival across all stages which was independent of hormonal status.”

That means the results were the same, regardless of age.  The challenge is that we still don’t know WHY women survive melanoma or it progresses less quickly than in men. Even the speculation that it was behavioral was ruled out — such as men avoiding the doctor more than women — and is seen as something biological.  But what?:

It’s…not an obvious effect of changes in hormone levels driven by menopause. Women 45 or younger had similar rates of progression-free survival as women 64 and older. But there could be other hormonal factors, differences in vitamin D metabolism, or variation by sex in how people handle reactive oxygen species and oxidative stress, [Arjen Joosse, MD, of Erasmus University Medical center in Rotterdam, the Netherlands] speculated.

Even such a factor as obesity might play a role, since adipose tissue releases hormones, he said.

Indeed, the key question is no longer if the observation is true, but what’s causing it,

Vitamin D supplementation at a relatively low dose plus calcium did not reduce the overall incidence of NMSC or melanoma. However, in women with history of NMSC, CaD supplementation reduced melanoma risk, suggesting a potential role for calcium and vitamin D supplements in this high-risk group. Results from this post hoc subgroup analysis should be interpreted with caution but warrant additional investigation.

That leads us to the next report that just came out, and as reported by MedScape Today:

Calcium plus vitamin D supplementation did not reduce the overall incidence of nonmelanoma skin cancer (NMSC) or melanoma in postmenopausal women in the Women’s Health Initiative (WHI), researchers say.

However, the placebo-controlled study found that, in women with history of NMSC, calcium plus vitamin D supplementation reduced subsequent melanoma risk, suggesting a potential role for the supplements in this high-risk subgroup, said the authors, led by Jean Tang, MD, PhD, from Stanford University in California.

So, while we don’t know why women do better in battling melanoma, and we know that Calcium and Vitamin D seem to be ruled out as a factor in preventing the disease, there DOES seem to be some evidence that the supplements may hold melanoma at bay a bit in women who have had NON-melanoma skin cancers before.

The takeaway continues to be, as with our other posts on studies and treatment news, that we are continuing to gain ground and promising results are coming in.  But, we must continue the research and continue down the path a ways to reach a cure.

*Please remember, we share information on Melanoma Updates that we found interesting, inspirational, or thought-provoking.   Any science or clinical study news you read here or elsewhere should be reviewed with your doctor.

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A Happy, HEALTHY Father’s Day for Dad AND Kids

Saturday, June 18th, 2011

Our best wishes for a happy and HEALTHY Father’s Day!  And apropos to that, WebMD posted an excellent reminder about the need to protect young children from the sun because “the changes that lead to skin cancer may actually begin during baby’s first year, when an infant’s skin is most vulnerable to burns and sun damage, according to a new report in the July issue of Pediatrics.”  So, here’s a reminder of best sun safety practices for kids…and even kids at heart:

“A child’s skin has structural quality that makes it more vulnerable to the effects of UV radiation, and this can result in an increased risk of later skin cancer,” said Roya Samuels, MD, a pediatrician at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park.

New York City dermatologist Doris Day, MD, says that “newborns, infants, and toddlers have skin that is continuing to develop…and it is really important to protect it,” she says.

However,  it’s not easy to find sunscreen for infants and toddlers: “Sunscreens for infants must be non-irritating to the skin and eyes…” For both these reasons, for the first six months, infants should be covered from direct sun via clothing, hats, etc., This is also important since harmful rays can penetrate car and home windows. (Consider clear protective window coatings.)

EWG-dadimage Then, in selecting a sunscreen, with a minimum SPF of 15, many parents “may prefer that infant sunscreen leave a temporary film so they can be sure all exposed body parts are well covered. In addition, water-resistance is an important quality for infant and toddler sunscreens….” as is the need to ensure a sunscreen blocks against both UVA and UVB rays.  The thicker zinc- or titanium-based products are more opaque and sit on skin more than getting absorbed.  “…And zinc and titanium don’t irritate the eyes as much because they tend to stay in place.”  babyganics-coverup-baby-sunscreen-mdn

We shared the Environmental Working Guide’s new rating of more than 1,000 sun products in our last post.  And The Daily Green culled through that list to post their selections from that list of the 13 most affordable natural kid and baby sunscreens with mineral sunblocks.

As mentioned in WebMD:

Ravinder Khaira, MD, a pediatrician with Sutter Independent Physicians in Sacramento, Calif., says that applying sunscreen — and reapplying it according to the directions — is the No. 1 way to prevent sunburn and sun damage that can lead to skin cancers when children grow up.

Take special care to cover their ears, nose, and scalp, he says.

Young children do have highly sensitive skin, so it’s a good idea to do a small patch test before slathering on a new sunscreen. “Test it on the forearm and wait about 30 to 40 minutes to see if any hives, swelling, redness, or itchiness occur,” Khaira says.

If children get sunscreen in their eyes, flush their eyes and face with cold water to minimize any irritation, he says.

It’s not always easy being a dad…or a mom.  But once the kids are slathered up, you can sit back and rest.  For a second.

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If you must tan…

Friday, April 15th, 2011

There is still a feeling by many that tan-looking skin is preferable to pale.  We’re still working to buck this perception Rome wasn’t built in a day. So, for those who still want the glow but have at least gotten the message that they should do it without the sun, here are some suggestions by NBC’s Today Show  style editor, Bobbie Thomas on the best of sunless tanners.

Note: this is not an endorsement of any particular product…just an endorsement of getting the look you want in a safer way:

1. First up, cult favorite “Big Bronzer” by Cargo Cosmetics. The jumbo oversized palette will instantlBuzz from Bobbie Thomas_1302394347737y warm up your face or body. With just a hint of shimmer, you can quickly apply a little or a lot for a natural looking glow.
2. For an even easy-to-apply application simply swipe on a little color… Kate Somerville’s Tanning Towelettes are paraben-free, streak-free and mess-free, while Dr. Denese’s Glow Younger Self-Tanning Gloves will do the same and offer anti-aging benefits.
3. New on the bronzing scene is Temptu’s Summer Skin 3 Step Air Pod system–perfect for die-hard spray tan fans who want to give it a go at home.
4. Last but not least, if you want a faux glow without the long-term commitment, L’Oreal and St. Tropez both offer great “1 Day” options that easily wash away with soap & water.

PS:  The timing has never been better for encouraging your teen to try sunless tanners. According to the American Academy of Dermatology, which officially opposes indoor tanning and supports a ban on indoor tanning for non-medical purposes, most tanning salon patrons are white females in their teens and 20s.  And not coincidentally they also point out:

  • Melanoma is the second most common form of cancer for adolescents and young adults 15-29 years old.
  • Melanoma is increasing faster in females ages 15-29 than males in the same age group. The torso is the most common location for developing skin cancer which may be due to deliberate tanning.
  • Studies have demonstrated that exposure to UV radiation during indoor tanning can lead to skin aging, immune suppression, and eye damage, including cataracts and ocular melanoma.
  • So consider Bobbie’s sunless tanners recommendations or take those of the AADA and just say no to tans altogether.

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    Green Light for Yervoy May Slow Melanoma in Its Tracks

    Monday, March 28th, 2011

    As we wrote about back in June, the most promising drug in the war on Melanoma, ipilimumab, was fast-tracked and finally approved as “Yervoy” for Bristol-Myers Squibb by the FDA last week.

    Ipi is an immune therapy drug: it tries to activate or stimulate the immune system to clear cancer cells. While ipi’s funny name has not improved much with a brand name like Yervoy, it is anything but laughable.  We have been challenged to make ANY progress with drug therapy and this new therapy is a welcome advance. With the usual current immuno-therapy treatments, such as interleukin, we haven’t been able to significantly extend the immune response to melanoma cells.  As described on WebMD:

    Yervoy appears to extend survival when used as a first-line treatment for inoperable stage III or stage IV melanoma, Bristol-Myers announced earlier this week. Details of the study will be reported at the June meeting of the American Society of Clinical Oncology.

    Yervoy is a biologic therapy. It’s a kind of man-made antibody (a monoclonal antibody) that blocks a crucial switch on immune cells called CTLA-4. Cancers use this switch to turn off the body’s anticancer immune responses.

    Most drugs like this come with possibly severe side effects, and Yervoy is no exception. The drug can provoke powerful autoimmune reactions in which the immune system attacks normal cells in the body. In clinical trials, nearly 13% of patients taking Yervoy had severe or fatal autoimmune reactions.

    Even with those caveats this does seem to be some light at the end of the tunnel:

    FDA approved the drug based on a Bristol Myers study of 676 people with advanced, inoperable melanoma who had already failed two other treatments, giving them a very short life expectancy. They were given one of three treatments: ipilimumab by itself, ipilimumab combined with another immune-stimulating treatment, or the immune-stimulating treatment alone.

    Average survival was 10 months with ipilimumab versus just more than six months for the others. But a very small group of patients survived longer than six years, suggesting that with more study the drug could be targeted to those who will respond the most.

    About 85 percent of patients had little response to the drug. Researchers say the response rate should improve as the drug is used earlier in the disease cycle.

    “I think the direction this is headed is toward intervening earlier, when patients’ immune systems are still intact, rather than waiting until they are so sick,” said Dr. Anna Pavlick, director of the New York University’s melanoma program. Pavlick, a spokeswoman for the Skin Cancer Foundation, helped conduct several early-stage trials of ipilimumab.

    Bristol-Myers Squibb expects to begin shipping YERVOY within weeks.

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    Melanoma screening and detection news

    Tuesday, March 1st, 2011

    Duke University is testing a promising new Melanoma detection laser - which, for the first time, gives scientists the ability to identify substantial chemical differences between cancerous and healthy skin tissues and prevent unnecessary biopsies, by identifying a pigment more prominent in cancerous moles. As of now it is being tested on biopsied tissue samples, but may eventually be an effective pre-biopsy tool as well.

    There are two issues at play here.  The first is the need for improved detection of Melanoma.  As we’ve noted here repeatedly, the MoleSafe technique takes skin cancer  assessments and screenings to the next level, well beyond the “naked eye exam,” which, as I described again in my last post, is a good precursory practice between more rigorous screenings but is out-dated when used as the exclusive approach.  The second issue is that there is still the challenge in interpreting the results of biopsies of suspicious moles, no matter how they are discovered.

    As the Duke article says,

    Doctors typically use a light and a magnifying glass or tissue biopsy, where a pathologist removes suspicious skin cells and looks at them under a microscope, to spot signs of disease. But using a lens and a light is a “17th century” technique that is only 85 percent accurate, at best, and tissue biopsy is not much more reliable…

    In 14 percent of biopsy diagnoses, pathologists would disagree on whether or not the sampled cells were cancerous, according to a 2010 study published in the Journal of American Academy of Dermatology. The statistic implies that two pathologists would have opposing diagnoses on 214,000 to 643,000 melanoma cases each year.

    Since, as a result, many doctors will follow the “when in doubt, cut it out” philosophy, this new laser holds the promise of maximizing accurate diagnoses, and down the road perhaps being a promising pre-biopsy screening tool as well.

    ———-

    In other screening news, Bloomberg’s BusinessWeek reported on a story posted in the Archives of Dermatology on the increased skin self-exams conducted by kidney transplant patients from good old-fashioned education and information. Compliance in self-exams jumped to 89% among those in the study group, resulting in a dozen patients actually spotting an area of concern and making an appointment with their dermatologist.

    The patients in the intervention group were given printed educational materials to promote skin self-examination. The patients in the control group did not receive the educational materials. Follow-up revealed that patients in the intervention group were much more likely to perform skin self-examinations than those in the control group — 89 percent vs. 22 percent.

    This just underscores the ongoing need for education and awareness.  We hope more physicians will take the time to educate ALL patients – high risk or not.

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    Take Five so Melanoma Doesn’t Take a Life

    Saturday, February 12th, 2011

    Valentine’s Day is upon us once again with another a way to show your love, and show your skin!  According to the Skin Cancer Foundation couples with close bonds are about three times more likely to perform a mutual skin exam. Unofficial sources suggest those couples have more fun, too!  But kidding aside, we all need to find every opportunity to scrutinize our skin, from head to between the toes. Here’s how. add-molemap

    While dermatascopes and the analyses used at MoleSafe are the most effective in detecting skin cancers and Melanoma, being vigilant by starting with your own naked eye exam is important, too.  AND it’s important for doctors to mandate that as well.  Shockingly, only 59.6 percent of family practitioners and 56.4 percent of internists conduct regular full-body skin exams, compared to 81.3 percent of dermatologists. (We would like to know why it is not 100% of dermatologists, though.)

    According to a story in Bloomberg Businessweek last month,

    “The most common reasons for not performing this type of examination were patient embarrassment/reluctance, time constraints, and other patient illnesses.”

    About half of the internists and family practitioners cited time constraints as an impediment to conducting the naked eye exams.

    I find all those reasons unacceptable since taking five minutes is nothing compared to a diseases that takes lives.

    Our post in 2009 here on Melanoma Updates publicized the suggestion that not only should medical students be trained in naked eye exams no matter their ultimate specialization, but asking your doctor to keep an eye open while checking your lungs and seeing your back, or seeing your legs while checking your reflexes.

    So, show the love this year and start by checking yourself, check your mate, and check with your doctor.

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    On Common Ground: Applying “Open Source” to Cure Melanoma

    Tuesday, January 18th, 2011

    Most doctors feel for their patients and we empathize with the challenges of their illness.  We work to the best of our experience and understanding to find cures, solutions, or sometimes just more comfort.  But when it comes to big challenges, such as advancing treatment options for diseases like Melanoma, sometimes empathy is not enough.  Sometimes what sparks the motivation to find solutions or cures is personal experience….

    That is what spurred e-commerce entrepreneur, Marty Tennenbaum.  While he’s not a doctor or even medical researcher, he does know his way around computers, and the value of “open source” as a route to developing solutions.  So, after surviving Melanoma in the late ’90s he begin applying his expertise to help move the needle on treatment solutions.

    Many scientists today work in relative isolation, left to follow blind alleys and duplicate existing research. Data are fragmented — trapped behind firewalls, locked up by contracts or lost in databases that can’t be accessed or integrated. Materials are hard to get — universities are overwhelmed with transfer requests that ought to be routine, while grant cycles pass and windows of opportunity close.

    Marty recognized that dilemma and his doing his part to use his tech know-how to bring about a tool to help solve that problem:  An app.

    Dr. Marty Tenenbaum, a survivor of melanoma, shows off his free Cancer Commons app

    Dr. Marty Tenenbaum, a survivor of melanoma, shows off his free Cancer Commons app

    Launching today (1/18/11), the “Cancer Commons” app will integrate existing data about melanomas, and cross reference promising experimental treatments.   Then, patients or doctors can in put patient-specific info on the progression of the disease including test results, such as specific genetic mutations.

    “From that information, the app tells patients what specific cancer “subtype” they have as determined by an expert panel. They also learn what drugs have shown the most promise in treating that specific form of the disease and where clinical trials are being conducted that could allow patients access to that treatment.”

    Marty explains that he’s just “trying to pull together all the pieces that are needed to do a real, rational attack on cancer.”

    …’The way to do that,’ he says, ‘is to pull people out of their individual labs, offices and hospitals to collaborate in a way not possible before the Web and mobile technologies made it easy to pool vast amounts of information.

    ‘How much of cancer could be turned into a manageable disease if we only knew what we knew?’”

    It’s a challenge to wrap our arms around the collected knowledge of thousands of researchers.  Groups like Health Commons and Open Science are taking a page from today’s socially networked world to tap that trust and are working to throw open the doors to the brain trust.  MoleSafe and Melanoma Updates applauds this approach, and gives Marty Tennenbaum and the collected participants pitching in a big Hat’s On Award to helping shine the light on the way to a cure for Melanoma and other cancers.

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