Many people spent their summers at the beach when young; enjoying the sun and spending hours playing in the surf, with little regard to the price some people pay for this simple pleasure.
It turned out to be melanoma – the deadliest form of skin cancer.
Melanoma – the most serious form of skin cancer
Melanoma, a cancer of the skin, is the third most common type of cancer in Australia, and the most common cancer in 15 to 39 year olds.
Hope from medical research
Melanoma, a cancer of the skin, is the third most common type of cancer in Australia, and the most common cancer in 15 to 39 year olds. Medical research offers the greatest hope, which is why scientists from the Royal Adelaide Hospital and the Centre for Cancer Biology (CCB), are determined to find ways to combat this deadly disease. Professor Hamish Scott and Professor Michael Brown are working together to try and find an answer.
Professor Michael Brown operates the Royal Adelaide Hospital Cancer Clinical Trials Unit and is a senior consultant medical oncologist in the Royal Adelaide Hospital Cancer Centre. “Most melanoma cancer is curable. If it’s confined to the skin, usually surgeons can remove it.” Professor Brown says, “In fact, 90% of melanomas are curable, it’s only when they spread that the chance of curability is decreased. That’s when the devastating impact of this disease can take hold.”
Having lost his mother to breast cancer and with a brother diagnosed with cancer, Damian was worried. He remembers, “I was horrified to find out that I had skin cancer.” Following his diagnosis he underwent surgery where his melanoma and a lymph gland were removed. A couple of months later Damian collapsed at work. Unfortunately, his cancer had metastasised (spread) and was now in his brain. He underwent an aggressive treatment regime – surgery to have the tumour removed and then a course of intensive radiotherapy treatments.
Damian spent most of his childhood on the beach. He says “Being sunburnt was common, it’s only now that I realise just what damage that did.”
Glad to be back at work after recovering from his brain tumour treatment, Damian’s next health challenge started when his leg became sore and then to his dismay, went numb. He began having a great deal of difficulty walking, and remembers, “After what I had already been through, I was really scared. My doctor, Professor Brown, was also concerned, and ordered an MRI scan to see what was going on.”
Unfortunately the MRI revealed that Damian’s cancer had spread even further; it had moved into his spine and adrenal gland.
Cancer treatment revolution
There’s a revolution in cancer management underway, treatment is now ‘personalised’ to the genetic mutations in each person’s cancer. This promises to maximise the benefit of specific treatments and is designed to deliver the right drug to the right person at the right time.
Damian underwent more sessions of radiotherapy before being put into a clinical trial at the Royal Adelaide Hospital. Prof Brown explains “Testing in Professor Scott’s Molecular Pathology Lab revealed that Damian’s melanoma had a BRAF mutation. This is an abnormal change in a gene that enables melanoma tumours to grow and spread throughout the body.”
“I put Damian onto a clinical trial testing immunotherapy drugs to try and control his disease. Unfortunately they didn’t work. The next option was to try BRAF kinase inhibitor drugs.” Prof Brown says “Fortunately medical research has developed drugs that are specifically designed to kill the BRAF mutated cells. I was able to choose drugs that hopefully would get control of Damian’s cancer.”
“The new drugs are shrinking Damian’s disease and he’s gradually improving. He has to use a walker – at only 43 – but he is starting to walk better; he can even walk without aid at home.”
“It’s fantastic, I’m starting to regain my independence, and really looking forward to going back to work.” Damian is optimistic, “I was just waiting and hoping that the new drug would kick in and fight the melanoma. When I started to be able to walk again, it encouraged me, it’s like the treatment is really starting to work.”
The breakthrough new technique that identified Damian’s cancer mutation is now standard testing in Adelaide. Prof Scott says “We’ve improved the way we test tumours. Instead of testing for one mutation at a time, we now test for almost 200 mutations and 5 genes which give the clinician more treatment options, and hopefully a better outcome for the patient.”
Breakthrough testing now standard in Adelaide
“As new drugs are discovered, they’re tested in clinical trials to ensure that they will be even more effective and safer than current treatments.” Prof Brown adds, “I’m excited about the future –research holds the key to improving survival rates and getting control of many cancers, as it has done with Damian.”
Damian’s experience is pretty typical, big surgery, and lots of it, then large doses of radiotherapy, then chemotherapy – it’s quite an ordeal.
Researchers have also identified crucial mutations in melanoma. These are proteins called kinases, and they contribute to the speed of cell growth. Prof Scott explains “That’s what cancer is – a cell that is growing out of control, very fast. We’ve found that around 50% of tumours have a mutation in the kinase gene.”
Kinase inhibitor drugs are revolutionising cancer treatment for patients with metastatic melanoma. Prof Scott says “One of the most common ones is imatinib which has extended people’s life spans to almost normal, where they used to die within 2 to 3 years of diagnosis. So it’s absolutely revolutionary!”
Kinase inhibitor drugs are revolutionising cancer treatment for patients with metastatic melanoma.
Prof Scott says “One of the most common ones is imatinib which has extended people’s life spans to almost normal, where they used to die within 2 to 3 years of diagnosis. So it’s absolutely revolutionary!”
A BRAF mutation leads to uncontrolled cell growth that typically results in cancer. The highest incidence of BRAF mutations are found in melanomas (27–70%). Newly developed BRAF kinase inhibitor drug treatments block the BRAF protein that makes the cells divide. The drug has been shown to significantly prolong the overall survival rate to 13.6 months compared with 9.7 months with chemotherapy alone.
“Beyond kinase inhibitors, one of the biggest areas in cancer treatment is immunotherapy.” Prof Scott says, “This is trying to teach a person’s immune system to recognise a tumour and fight it.”
Immunotherapy latest treatment to be tried
“You may have heard of miracle cancer cures – in fact what has probably happened is that a person’s immune system has gathered up enough force, by itself, to fight off the tumour. The immune system has a memory; if the tumour tries to come back the immune system goes back in and kills the tumour again.” Prof Scott explains, “A lot of new treatments are trying to get people’s immune systems to recognise tumours and attack them.”
Prof Brown adds “Immunotherapy is looking very promising, and I believe will be the new type of treatment used for many other cancers – not just melanoma. As the drugs progress through clinical trials they will be even more active and safer than current treatment of melanoma.”
“So far we’ve found that the immunotherapy drugs can control the disease in up to 80% of patients, where conventional drugs and radiotherapy have poor response rates.”
Early detection for skin cancer
Both Professor Scott and Professor Brown agree on the important fact – early detection is the key to survival.
Prof Brown adds “As I said earlier, melanoma is curable in 90% of cases – but that’s only if you catch it early enough.”
Preventing melanoma is more than just limiting your exposure to the sun; your skin type also plays a part – the fairer skin you have, the more likely it is for you to get melanoma.
Requires an investment in research
South Australians dying every year from cancer is unacceptable –that can only change with greater investment in research. A donation to medical research can help shift the odds of cancer survival in favour of people like Damian. Investing in medical research does make a difference.
Prof Brown says “Research leads to clinical trials, which means that we get evidence to make good decisions about approving drugs, and most importantly, about providing the best options for patients.”
This is a sentiment echoed by Prof Scott, “More money for medical research means that more people can participate in more trials. And that means better treatment options for more people.”
“Better screening of genes means we will be able to identify why someone gets cancer, and why someone else doesn’t. Funding will help discover new and improved drugs, and a system that more quickly integrates research into clinical practice.”
Medical research is furthering what we know about cancer every single day – discovering better treatments, making the recovery quicker, and the optimism greater. Every dollar you donate will help what research can achieve.