“Among patients with clinically stage I or stage II melanoma, those treated with the immune system–boosting agent CpG-B were less likely to experience recurrence of their disease than those who received placebo, according to results from two randomized, placebo-controlled phase II clinical trials presented at the CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference (Abstract A050), held September 16–19 in New York.
“ ‘Even though stage 1 and stage 2 melanomas can be removed surgically, in a considerable proportion of patients, cells from the tumor have already spread and eventually lead to tumor recurrence,’ said Tanja D. de Gruijl, PhD, Professor and Head of the Immunotherapy Laboratory in the Department of Medical Oncology at the VU University Medical Center Cancer Center Amsterdam. ‘We set out to investigate whether intradermal injection of the immune-stimulatory compound CpG-B around the site of surgical removal of the primary tumor could boost patients’ antimelanoma immune responses and provide local and systemic protection against early metastatic events that could otherwise lead to tumor recurrence.’ “
New research shows that melanoma is more likely to strike twice in people with melanomas that have spread. The researchers studied 7,800 people with advanced melanoma who had not been treated with drugs, known as BRAF inhibitors, and found that new skin melanomas arose in 5% of those with stage III melanoma (229 out of 4,215) and in 1% of those with stage IV melanoma (43 out of 3,563). New skin melanomas were more common in men as well as in people who had previously had more than one skin melanoma. The researchers note that people treated with BRAF inhibitors have even higher rates of new skin melanomas, but caution that they also get more skin checks.
In keeping with previous findings, the latest study on a new genetic test confirms that it can predict whether melanomas will spread. These results were presented at the American Academy of Dermatology meeting. While survival rates are generally high for people with melanomas that have not yet spread, metastases do occur in about 14% of this group. The test, called DecisionDx-Melanoma, classifies people as either low or high risk of metastasis based on the activity of 31 genes in their tumors. To date, the test has been validated using follow-up data on 400 people with early-stage melanomas. Knowing which people are likely to develop melanoma tumors in other parts of their bodies will help doctors tailor their long-term care appropriately.
The likelihood that people will survive melanoma is often based on whether the sentinel lymph nodes—those closest to the tumor—contain cancer cells. But new research suggests that the status of other nodes can also help predict survival. The researchers assessed 329 melanoma patients with ‘positive’ sentinel nodes, and found that ‘nonsentinel’ nodes were also positive in 24% of the patients. People with positive nonsentinel nodes had higher rates of tumor recurrence, and sharply lower rates of 5-year survival (46% vs 72% for those who only had positive sentinel nodes). In addition, those with positive nonsentinel nodes were also more likely to be older and to have tumors that were thicker and ulcerated.
Journal of the American College of Surgeons│Jul 2013
People who are melanoma-free a decade after diagnosis are generally thought to be ‘cured’—but a new study shows this isn’t necessarily true. The researchers followed 4,731 people after diagnosis with melanoma and found that this cancer recurred in about 7% of them at 15 years and in 11% at 20 years. Compared to people with recurrences in the first 3 years, those with late recurrences were 40% more likely to survive. In addition, their initial melanomas were thinner, less likely to be on the head or neck, had not spread to the lymph nodes, and occurred when they were younger (averaging age 41 years vs 51 years for those with early recurrences). The researchers recommend that people who have had melanoma get lifelong yearly skin checks by physicians even if there is no sign of this cancer.
Callahan, M, Rampal, R ... Levine, RL, Chapman, PB. NEJM. Dec. 13, 2013.
Vemurafenib, a selective RAF inhibitor, extends survival among patients with BRAF V600E–mutant melanoma. Vemurafenib inhibits ERK signaling in BRAF V600E–mutant cells but activates ERK signaling in BRAF wild-type cells. This paradoxical activation of ERK signaling is the mechanistic basis for the development of RAS-mutant squamous-cell skin cancers in patients treated with RAF inhibitors. This study reports the accelerated growth of a previously unsuspected RAS-mutant leukemia in a patient with melanoma who was receiving vemurafenib. Exposure to vemurafenib induced hyperactivation of ERK signaling and proliferation of the leukemic cell population, an effect that was reversed on drug withdrawal.