Drugs give hope to melanoma patients

Pip Mills, 34, is battling stage 4 metastatic melanoma which was diagnosed last August. Picture / Brett Phibbs

A cancer researcher has predicted that advanced melanoma patients could survive the disease within five years, thanks to dramatically improved drugs.

Malignant melanoma is the most deadly form of skin cancer and New Zealand's fourth most-common cancer. The country has one of the world's highest incidence and death rates from malignant melanoma.

Each year, more than 2000 new cases are diagnosed and more than 250 people die from the disease.

If a melanoma is detected early it is readily treated by surgery. Of patients diagnosed with a tumour just 1mm thick and whose cells haven't spread, more than 90 per cent will be alive five years later. But in cases where it has spread to organs before detection, fewer than 10 per cent are alive after five years.

However, a melanoma conference in Wellington yesterday heard hopeful news about the progress of drugs in clinical trials for patients with disease that has spread - metastatic melanoma.

"These advances offer the realistic promise of our being able to convert metastatic melanoma from a death sentence to a chronic disease within five years," said Professor Richard Kefford, the director of the Westmead Institute for Cancer Research at Sydney University.

Auckland District Health Board oncologist Dr Mike McCrystal told the Weekend Herald he was less optimistic than that, but some of the new drugs, with response rates more than three-fold greater than the current standard chemotherapy, were still "a huge breakthrough".

Professor Kefford expected that, as had happened with Herceptin for breast cancer, the new drugs would eventually be extended to earlier stages of disease - "in patients who have a very low tumour burden, such as those who have just had lymph node involvement and had it all removed surgically and have nothing to be seen on a Pet scan, but are nonetheless at 50 per cent risk of dying of melanoma in five years."

"It is not unreasonable to think ... that we will see a big difference to that 50 per cent when we use these drugs for six or 12 months after surgery.

"That's when we will see, I think, a very dramatic prolongation of life, and some of those patients may be cured - just as we know some women with early breast cancer who have adjuvant therapy never relapse. But that remains to be seen."

The drugs are Vemurafenib, which has just finished a phase 3 clinical trial that included 17 New Zealand patients; and GSK 2118436, which has been studied by his institute.

Both drugs are aimed at inhibiting a protein produced by a mutation of the "Braf" gene in patients who are found by testing to have the mutation.

The mutant v600e Braf protein, which can cause rapid, uncontrolled cell growth, is present in half of malignant melanomas and 8 per cent of all solid tumours.

Roche, one of the companies developing Vemurafenib, is keeping the latest trial result details quiet until a major cancer meeting in the US in June, but says patients treated with it had "improved overall survival" compared with those on standard chemotherapy.

It is talking to the NZ Health Ministry about a medicine licence application and intends to seek taxpayer funding of the medicine but it is likely to be expensive.

Plucky cancer patient eyes new trials

Pip Mills' melanoma was diagnosed last August when she suffered ongoing pain and other problems after a bout of pneumonia.

Secondary tumours had spread to her lungs, liver, brain and bones by the time the melanoma was diagnosed.

No primary tumour was found.

"It came out of nowhere," the 34-year-old from Mission Bay in Auckland said yesterday.

She has had radiation therapy and is having ongoing courses of chemotherapy, both of which made the tumours shrink - but then they started to grow again.

The shrinkage of a hip tumour led to a bone fracture and hip replacement surgery.

Auckland City Hospital indicated last August that she could expect to live for six to nine months.

"That was completely shocking to hear; unbelievable. I don't want to believe it. I feel like it's not my time yet," said Miss Mills, who was having a break from chemotherapy and seemed bright and positive.

"I'm feeling the best I've felt."

She has stayed at the Gawler Foundation cancer retreat in Australia, which runs wellbeing programmes, and she is exercising regularly, has adopted a vegan diet and does art therapy.

"I think I've come to terms with it [having cancer] and I think it's happened for a reason, which is hard to say, because it's been the most horrible time in my life."

She has the BRAF gene mutation in melanoma cells but has not participated in any trials of the experimental melanoma drugs that can inhibit the resulting protein.

Work colleagues and her partner Greg Shepherd organised a fund-raising campaign which ran a successful auction of donated items at a Freemans Bay cafe on Thursday evening.

She is relying on advice from her oncologist, Dr Mike McCrystal, on drug trials.

Melanoma

Outlook
* Typically fatal within one year for about 50 per cent of people if it has spread to any organs when first detected.
* Fatal within five years for more than 30 per cent of patients if it has spread to lymph nodes when first detected.

New drugs
* Experimental drugs have created hope for extending lives of patients with melanoma that has spread.
* In one trial, three-quarters of patients had a 30 per cent reduction in tumour size.Malignant melanoma is New Zealand's fourth most common cancer.

www.esmo.org