Medical News Today recently reported on a study done by the CDC which found that the United States loses billions of dollars every year due to Melanoma.
“…each year between 2004 to 2006, over 45,000 cases of melanoma were reported in 45 states and the District of Columbia. In the U.S. skin cancer is the most prevalent form of cancer. Although melanoma is the third most prevalent type of skin cancer, it is more dangerous than other skin cancers, and is the leading cause of death from skin disease killing approximately 8,000 individuals each year as well as costing the country billions.”
The exact number of money lost each year totals at about $8 billion. “Deaths caused by melanoma accounted for $3.5 billion in lost productivity every year”, reported David Goodhue for AHN News Reporter. Another startling fact was that researchers found that melanoma patients died 20 years prematurely. That number is only 17 for most other cancers.
These new statistics only point out the importance of spreading the word about melanoma prevention. People can take great efforts to successfully prevent themselves from contracting this horrible cancer. If caught early enough, Melanoma can be stopped from taking lives. MoleSafe, is here to help with that.
Treatment options for melanoma have advanced in the past year with heartening results. As we wrote in March 2011, the drugYervoy (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.
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.
Note: Since we posted the below entry, good news: the FDA has now announced their new guidelines which will include mandatory labeling by the summer of 2012. Here’s an excellent overview from ABC:
In the meantime, please remember to review your choices, and keep applying that sunscreen!
The Environmental Working Group’s guide to effective and less-toxic or non-toxic sunscreens is out again with additional options on this 2011 version. This comprehensive list, and associated articles, does an excellent job of explaining the challenges with both the FDA’s progress in setting standards for sun-protection products…and consumers’ understanding of the elements that go into that sunscreen — good or bad.
Even since we shared their 2010 list last May, more outcry has been heard about a common ingredient in many mainstream sunscreens, that is a derivative of Vitamin A: Retinyl palmitate. In fact, in June of last year, Senator Chuck Schumer called on the FDA to investigate it, as mentioned in this release from his office:
Retinyl palmitate is an ingredient found in most of the 500 most popular sunscreen products. Scientists at both the NCTR and the NTP have been working diligently over the last decade at the FDA’s request in order to determine whether this Vitamin A derivative, retinyl palmitate, is safe to use in sunscreen products. In one study, tumors and lesions developed up to 21 percent faster in lab animals coated in retinyl palmitate-laced cream than animals treated with a cream that did not contain RP. While these studies have been completed for almost a year now, the FDA has not issued an assessment of ruling on either of them….
Schumer added, “Millions of Americans use sunscreen to keep themselves and their families protected from the dangers of too much sun. If the product they are using is doing more harm than good, they have a right to know.”
Of course, there is NO safe way to TRY to tan, just as the American Academy of Dermatology says. But in tan PREVENTION, there are things to consider. Here’s something from a section on their Website about sunscreen, that you might not have known:
Q: When should sunscreen be used? A: Sunscreen should be applied every day to exposed skin, and not just if you are going to be in the sun. UVB rays cannot penetrate glass windows, but UVA rays can, leaving you prone to these damaging effects if unprotected.
For days when you are going to be indoors, apply sunscreen on the areas not covered by clothing, such as the face and hands. Sunscreens can be applied under makeup, or alternatively, there are many cosmetic products available that contain sunscreens for daily use. Sun protection is the principal means of preventing premature aging and skin cancer. It’s never too late to protect yourself from the sun and minimize your future risk of skin cancer.
Don’t reserve the use of sunscreen only for sunny days. Even on a cloudy day, up to 80 percent of the sun’s ultraviolet rays can pass through the clouds. In addition, sand reflects 25 percent of the sun’s rays and snow reflects 80 percent of the sun’s rays.
So, as the inquiry continues, we, again, are of the belief that smart skin cancer prevention tactics start with covering up and include generous use of sunscreen. Of those, perhaps making a more natural choice of mineral (titanium dioxide, for example) vs non-mineral protection is a better option. The introductory paragraph to the Environmental Working Group’s guide says it all:
The best sunscreen is a hat and a shirt. No chemicals to absorb through the skin, no questions about whether they work. But when you can’t get away from exposing your skin to the sun, use EWG’s top-rated sunscreens to provide broad-spectrum (UVA and UVB-sunburn) protection with fewer hazardous chemicals that penetrate the skin. Sunscreen and sunblock makers are awaiting FDA approval for a wider selection of UVA-blocking chemicals. In the meantime, all [the Guide's] top-rated products contain either zinc or titanium minerals to help cut UVA exposures for sunscreen users.
PS: And now, yes, “there’s an app for that.” The EWG Sunscreen guide reviews some 1700 products, so keeping them straight at the point of purchase will be easier for iPhone owners now. Check it out in iTunes app store, for free.
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 instantly 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 Podsystem–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 coincidentallythey 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.
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.
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.
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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.
Exactly six months ago, I shared a blog with Melanoma Updates readers, written by a woman chronicling her battle with Melanoma. I shared her story because I was impressed by her good attitude, helpful information, and generosity of spirit, and thought her blog would be helpful beyond her small community in Cyprus. Her name is Alethea Ayers and she is the 35 year old mother of a toddler.
While there are, sadly, many victims of skin cancers and Melanoma — hence the existence of Melanoma Updates and our goal of driving awareness and preventative actions, Alethea is one who has been inspiring and very public about her battle with the disease.
Now that battle has faced a two-sided assault: she has received news of some 10 brain tumors, and is also fighting to raise the funds to travel from Cyprus to Germany for more advanced treatments. As a physician I can say that this kind of metastasis is unfortunately statistically common in Melanoma patients, and survival rates are statistically unsatisfying. You can read more on brain metastases on the Skin Cancer Foundation Web site.
I can tell you I don’t know Alethea, and have not vetted her case or her cause, but between her Facebook page and very specific blog posts I find her story and attitude very compelling and worth the read… and perhaps a contribution. That is a personal decision, and there are many worthy causes we could all support. At the very least, I want to share her very human emotions in her latest post here, filled with reminders of what we’ve been touting at MoleSafe as well:
Getting hopeful with every passing day as it means a day closer to when I can start my treatment. I can’t wait till they start shrinking these darn things and I can start a normal life again.
No one teaches you in school or as you grow up what do to in these situations, there’s no break glass in case of emergency and there is no instruction manual on what to do in case you get brain tumours. So I live every minute by the minute and make it through the day with all your wonderful help.
All I ask that you please please avoid sunbeds, and sunbathing. Please love the skin you are in. Milk bottle white, means you are alive and will be alive. Life is too precious.
On the heels of my last post, showing supermodel Marissa Millerin just the skin she’s striving to protect from sun damage, Allure Magazine coincidentally polled readers on their tanning habits. In sync with about 72% of participants in a poll by American Academy of Dermatology, results from a survey done by Emory University on on HotorNot.com showed most respondents feel that tanner just looks, well, sexier and, sadly, healthier.
Most distressing is still the lack of concern about the clear correlation between tanning and skin cancers, even when that risk is specifically explained. On ABCnews.com Dr. Audrey Kunin said:
It’s incredibly difficult to get someone not to do something that perceive as providing them with a positive perception. It was the same thing with smoking. Especially younger people have a hard time seeing themselves as getting older and having to deal with these risks. … “All of my younger melanoma patients, girls in their early twenties, have been tanning bed users,” says Kunin. She tries to put things into perspective by pointing out that twenty minutes in a tanning bed is the same as an entire day on the beach with no sun block, but she says that until they have skin cancer, it’s hard to get people really to understand the risk.”
In another recent study…[2/3rds] of women who saw the effects smoking would have on their facesvowed to give up their bad habit…as a direct consequence of seeing how their appearance will change.
Harvard Department of Dermatology’s Dr. Kristina Collins suggests the young person who is tanning addicted ask an older friend or relative, such as their mom or grandmother, to show them their sun-exposed forearm up against the more more sun-protected abdomen. The arm skin will usually look much older compared to the skin on their stomach, and “the young people will usually be pretty surprised by what they see….freckles, age spots, poor skin tone” compared to the stomach skin, which can often look 30 years younger. That, she says, may help them to redefine “what’s hot” — tanning and aging faster, or not.
The tan transition aid? Spray tans and other self-tanners… And more celebrities coming out and taking a stand — naked or not! — about sun safety.
The past couple of months, some compelling new stories have circulated about promising Melanoma treatments. In June, you read about “ipi” – in the news and here on Melanoma Updates. And, this past month, more news touted early clinical trials with another targeted therapy drug, PLX4032. As always, we are cautiously optimistic, but to shed some light on two exciting, but still emerging options, I thought a basic overview might be helpful.
So, what do these drugs do? Quite simply, one attacks a gene mutation found in about 50% of all melanoma patients. And one works to modulate the immune system.
Ipi for Immunity
Ipi is an immune therapy drug: it tries to activate or stimulate the immune system to clear cancer cells. With the usual current immuno-therapy treatments, such as interleukin, we haven’t been able to significantly extend the immune response to melanoma cells. But Ipi has been shown to extend that immune protection for longer and longer time spans, for the first time ever, leading to 2-year survival rates in around 56% of a certain group of patients (again, with advanced melanoma survival rates typically not extending past 10 months.) Ipi has been in advanced trials for years, and the very promising Phase III results spurred the recent media frenzy. As such, it is on the fast track for priority approval – perhaps as soon as the end of this year – and may become the first new melanoma drug approved in decades.
Gene Mutation Therapy
First, it’s important to know that about half of patients with metastatic melanoma have a mutation in a gene called BRAF. This is a gene that seems to program the “runaway cell division that is a hallmark of cancer.” When the impact of the BRAF gene mutation was established, scientists set to work to find a way to switch it off or slow down the programming to cells, and one of those ways may be an exciting new gene therapy drug, PLX4032 (no catchy name as of yet.) A remarkable 81% of cases showed marked and in many cases immediate improvement and reduction in tumor size and growth. Granted, the news came after just a small Phase I clinical trial, but there was such excitement about the results that in a rare move, the drug has skipped Phase II and is now being tested in longer term and wider scope Phase III trials.
No other drug has ever helped that high a percentage of patients with melanoma or any other solid tumor, says Paul Chapman, co-author of the study in today’s New England Journal of Medicine. The results are especially striking, he says, considering that only 10% to 20% of patients respond to standard treatments for melanoma, which don’t improve overall survival.
USA Today also has a sidebar Q&A piece that does a nice job of summarizing the caution and optomisim surrounding PLX4032. They include a phone number for more information about it as well: 888-662-6728.
A One-Two Punch?
Since the back to back encouraging news broke for ipi and PLX4032, some are combining the two in other drug therapy trials. Here is a quote from the National Cancer Institute Bulletin this past week:
In June, researchers announced that ipilimumab, a treatment that targets the immune system, helped patients with advanced melanoma live longer. Together, ipilimumab and PLX4032 have changed the landscape of melanoma research and raised the prospect that the new agents could be tested in combination or sequentially, said Dr. Claudio Dansky Ullmann, who oversees melanoma trials for the NCI Cancer Therapy Evaluation Program.
"These studies have opened the doors to a lot of possibilities for treating metastatic melanoma,†said Dr. Dansky Ullmann. "We can now test many treatments that were not available or proven until recently. This area of research is taking off.â€
Just watched the premiere of Showtime’s new hit, “The Big C,” in which Laura Linney plays a woman newly diagnosed with Stage Four Melanoma. The plot revolves around her decision to “carpe diem” and forgo traditional therapies to live out her anticipated remaining year joyfully and sometimes frivolously. As the show’s writer says,
“in many ways, this series is not about cancer per se. It’s about living the life we want to live and not wasting our precious time!”
“Seizing the day” can be a good prescription for any human being, and I encourage it wholeheartedly (though not as foolhardily, perhaps, as she does, when she knocks down her porch and shade tree to spontaneously add a swimming pool to her small front yard!) However, I would remind viewers that while the most serious and often most aggressive form of skin cancers, melanoma can be treatable and when caught early especially withproper screenings does not have to be a death sentence.
Aside from that, it is good to see the disease brought to light. While there is not much apparent sidebar content or instructive information about melanoma on Showtime’s site, there isan alliance with the American Cancer Society that promises donations in exchange for viewing a clip of the show…a good approach to raise awareness of the show, for sure, but also for our passion: raising awareness about melanoma.
View Big C trailer to have $1 Donated, thanks to Showtime and American Cancer Society
And here’s a link to the Big C Facebook page in case you want to participate there (to be sent right to that page be sure you’re logged in on Facebook) and weigh in. Oddly, though, neither that Facebook page or the Showtime page for the show itself seem to provide any links to the More Birthdays Facebook page which they are supporting. That is a lost opportunity to drive more donations and align themselves deeper with the cause. Clearly, this is a “comedy that plays with dark and light tones.” And entertainment sells, but there is always more room for responsible education, even if via links from their site.
In terms of Cathy’s life expectancy, as depicted on the show, it is, unfortunately fairly accurate: The typical survival rate for patients with metastatic melanoma is six to nine months. However, the new drug you may have read about here in June and elsewhere is continuing to show some promise in extended life expectancy, if slowly:
Metastatic melanoma patients who took the drug demonstrated a median survival rate of 10 months, a 3.6 month improvement over those who did not take the medication.
No one is laughing about the seriousness of melanoma. But we all must just keep trying to find the joy, if even through television escapes.
y 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.
