The traditional cancer treatment days of cut, poison and burn may be a step closer to being over as Australian doctors report a major breakthrough using immunotherapy.
The results of a new melanoma treatment are being called a game-changer by doctors, who report that for the 75 per cent of patients who respond well to dual immunotherapy given before surgery, only 3 per cent had tumours return after surgery, suggesting that 97 per cent will likely be cured.
Australia has the highest melanoma rates in the world, with one person diagnosed every 30 minutes, and the Melanoma Institute Australia, which led clinical trials and produced the study, estimates 1300 people will die from the disease this year.
Standard treatment for melanoma sees patients undergo surgery first, followed by drug treatment.
The study, published in the prestigious Nature Medicine, pooled data from six clinical trials where drug therapy was given before surgery, a strategy known as neoadjuvant therapy.
The data suggested that a short course of immunotherapy drug treatment before surgery was effective in preventing the deadly spread of the disease in melanoma patients who were at high risk of the cancer recurring.
“We have flipped the ‘surgery-then-drugs’ rationale on its head,” said study co-author Professor Georgina Long. “By using our arsenal of ground-breaking new treatments before surgical removal of the tumours, this approach is proving effective in stopping melanoma in its tracks and preventing its recurrence and spread to distant organs.
“The neoadjuvant approach is a new way of dealing with melanoma and is a game-changer for stage III patients with bulky disease that has spread to their lymph nodes.”
Researchers found that giving patients with stage III melanoma a short course of pre-operative targeted immunotherapy was effective, and the stronger a patient’s response to that treatment in the first six to nine weeks, the greater the likelihood the disease would not recur after surgery.
Doctors believe when a bulky tumour is still in place in the body, it provokes a stronger immune response in the patient, and so these results could pave the way for the use of immunotherapy pre-operatively in many other cancers.
Sydney teacher Sandra Moore was an ideal candidate for the clinical trial, being diagnosed with stage III melanoma. She underwent two infusions of immunotherapy drugs, before surgery to remove a tumour that had spread to lymph nodes.
“It literally saved my life. To live and be this well with no treatment more than three years after diagnosis is incredible,” she told The Sydney Morning Herald. “I feel so lucky.
“I’m back at work full-time teaching. I’ve had no adverse effects. I’m super well and no-one would know that I had cancer.”
Medicalexpress.com reports that neoadjuvant therapy also helps a doctor assess early on if a patient is responding to a treatment and then proceed with an alternative plan if required.
Associate Professor Alex Menzies, Melanoma Institute of Australia (MIA) oncologist and study first author, said: “Although neoadjuvant therapy for stage III patients is not currently an approved standard of treatment, we anticipate that this will ultimately change following the very promising clinical trial results.
“This study shows that giving drug therapy before surgery reduces risk of recurrence even further, preventing spread to vital organs like the brain and liver and saving more lives. We can also now tell whether the drugs are working for an individual patient, so we can direct subsequent treatment and follow-up accordingly.”
Professor Richard Scolyer, MIA co-medical director, said treatment for advanced melanoma patients had come a long way in the past decade. “It is exciting that patients with earlier stage disease are now also benefiting from research breakthroughs,” he added. “If we can prevent these patients from progressing to stage IV or metastatic disease, then we will be even closer to achieving our goal of zero deaths from melanoma.”
Has the well-publicised risk of melanoma prompted you to be far more cautious about outdoor activities?
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