This cooked goose is grateful for science

4 minute read

Melanoma treatment leaps ahead, which is just as well for us late-stage Gen Xers who baked ourselves crispy.

In a classic case of seek and ye shall find, I am now scheduled to have a couple of suss moles excised by a most excellent skin cancer GP.

My own silly fault, really. I went along to cover the Australasian Melanoma Conference in Brisbane for TMR back in March and learned some stuff.

Rookie error, to be honest.

Apart from finding out that overdiagnosis, when it comes to melanoma in situ, is a fact of life and probably not a bad thing, I also learned about the complications of a national screening program – the good, the bad, and the ugly.

But the thing that stuck most in my mind was a casual conversation I had with an esteemed expert after his presentation.

“Cate,” he said. “At our particular age, the reality is that a skin check is going to find something.”

How right he is (pending pathology results).

By the time old Sid the Seagull started singing his sibilant Slip, Slop, Slap silliness in 1981 my goose was, as they say, well and truly cooked. At school, I was a sporty kid playing tennis most weekends, not a hat or a drop of sunscreen to be had. When I got my licence, it was straight down to the Goldie every Sunday for a few hours spent frying under a layer of coconut oil on Main Beach. I remember going to work one Monday with the backs of my legs so burned I could hardly walk. Ah, the 80s. Disco, legwarmers and peeling skin. Best years of my life.

There’s nothing funny about melanoma, of course, and the fact is people like me in our late mumblemumblemumbles are prime suspects, given the decades it can take sun damage to turn into something dangerous.

The good news is medical science is moving forward in leaps and bounds when it comes to the treatment of melanoma.

The latest is data from a new US trial which shows that a whopping 89% of patients with desmoplastic melanoma responded to immunotherapy alone, without the need for the often toxic combination therapies.

The findings were reported at the American Association for Cancer Research’s 2023 annual meeting last weekend.

A previous trial in which 30 patients in “Cohort A” with resectable melanoma were treated with three cycles of pembrolizumab resulted in a pathologic complete response rate of 55%.

The latest trial involved “Cohort B” – 27 patients with unresectable disease who were given pembrolizumab. Of the participating patients, 89% had a favourable treatment response to single-agent immunotherapy treatment with pembrolizumab and 33% had a complete response.

“With responses this high with single-agent pembrolizumab, combination therapy – with its increased potential for toxicity – is not needed as first-line therapy for patients with unresectable desmoplastic melanoma,” said lead investigator Dr Kari Kendra, from the Ohio State University Comprehensive Cancer Center.

“Not all melanomas are the same, and they don’t respond to treatments in the same degree. Identifying the best treatment strategies for these unique patients can improve outcomes, which is our continual goal.

“This study makes us truly question whether combination therapy is necessary for these patients, and it presents important knowledge that could help us further tailor treatment based on characteristics of the patient’s unique tumour and reduce the potential for toxicity from combination therapies.”

The study was funded by the National Institutes of Health/National Cancer Institute through grants, and the research team also received financial support from Checkmate Pharmaceuticals, GlaxoSmithKline, Immunocore, Medspace, Inc., Merck, Novartis and Varian Medical Systems, Inc.

The good news is that in Australia pembrolizumab is already approved by the TGA as a monotherapy for the treatment of unresectable or metastatic melanoma in adults. In November 2022 it was approved for the adjuvant treatment of adult and adolescent (12 years and older) patients with Stage IIB, IIC, or III melanoma who have undergone complete resection.

I hope I don’t ever need it. But like a lot of people my age, I’m very glad the science keeps moving forward in case I do have to pay for the folly of my youth.

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