Skin Cancer: Half Of People Surviving Advanced Melanoma
Health and science correspondent, BBC News
More than half of patients can now survive a deadly skin cancer that was considered untreatable just a decade ago, say UK doctors.
Ten years ago only one-in-20 patients would live for five years after being diagnosed with late-stage melanoma. Most would die in months.
But drugs to harness the body’s immune system mean 52% now live for at least five years, a clinical trial shows.
Doctors said it was an extraordinary and rapid transformation in care.
I Survived Stage Iv Melanoma: How Immunotherapy Saved My Life
When Mary Elizabeth Williams was told she had advanced-stage skin cancer, she opted to join a clinical trial for a new immunotherapy drug combination. Watch the video to hear her story of survival and about the new generation of drugs that saved her life.
Another Symptom Might Have Tipped Your Doctor Off
Sometimes we find a stage 4 melanoma diagnosis because the patient has a symptom or abnormality somewhere else in the body, says Dr. Friedlander. That could mean shortness of breath or a lingering cough due to a lung metastasis, or severe headaches due to your melanoma spreading to the brain. In these cases, doctors have to work backward to find melanoma is the root cause.
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Treatments For Advanced Melanoma
In most cases, treatment can’t cure advanced melanoma. But some can help you live longer and feel better. The goal of any therapy you get will be to shrink or remove your tumor, keep the cancer from spreading further, and ease your symptoms.
Surgery. This is the main way to remove melanoma from the skin and lymph nodes. You might also have an operation on organs where the cancer has spread. Thereâs no guarantee your surgeon will get all of it. Some melanoma is too small to see, even with high-tech scans.
Radiation. Your doctor might recommend radiation to kill any cancer cells that have been left behind after surgery or if melanoma spreads to your brain or bones. It can also relieve pain from the disease or treat melanoma that comes back over and over.
Immunotherapy or biologic therapy. These drugs help your immune system find and attack cancer cells. Depending on the ones you take, you might have to go in for treatment every 2, 3, or 4 weeks.
Your doctor might want you to take more than one drug. Some studies show that people who do have fewer side effects.
The flip side of immunotherapy is that sometimes these drugs cause your immune system to attack healthy organs. Then youâd need to stop melanoma treatment and take drugs to stop the attack.
Chemo can shrink the cancer, but chances are it will start growing again after a few months and youâll need more treatment. Immunotherapy and targeted therapy usually work better.
Other side effects include:
Immunotherapy Combination Attacks Brain Tumors In Stage 4 Melanoma Patients
In a breakthrough clinical trial, T cells bypass the blood-brain barrierto attack metastatic tumors
Colleen Wittoesch learned in March 2016 that she had late-stage melanoma in the most difficult way.
“I couldn’t get my thoughts together, I kept forgetting things,” she recalls. “One night I was talking to my daughter and she said ‘you don’t sound right, we need to take you to the ER.'”
An MRI scan showed 12 tumors in her brain. A surgeon removed the two largest, which were applying pressure on her brain and affecting her thinking.
Wittoesch sought treatment at MD Anderson, where she had volunteered for 12 years, seven of those in the Melanoma clinic.
For stage IV melanoma that has spread to the brain, surgery and radiation can remove small tumors and provide relief from symptoms, but they don’t stop disease progression. Median survival for these patients is four-to-five months.
Melanoma brain metastases are known to be resistant to multiple types of chemotherapies. In addition, due to the poor prognosis associated with melanoma brain metastases, patients often are excluded by drug companies from clinical trials.
In 2016, this had started to change, and Wittoesch’s oncologist, Rodabe Amaria, M.D., an assistant professor of Melanoma Medical Oncology, enrolled her in a clinical trial of two immunotherapy drugs designed to free the immune system to attack cancer.
Not long after the three-month initial regimen of the drugs ipilimumab and nivolumab, Amaria had good news.
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for melanoma skin cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread beyond the skin where it started.
- Regional: The cancer has spread beyond the skin where it started to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body, such as the lungs, liver, or skin on other parts of the body.
Stop Tumors In Their Tracks
Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. Its impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.
To be sure youre spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total body skin exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.
Trust your instincts and dont take no for an answer, Leland says. Insist that a doctor biopsy anything you believe is suspicious.
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Are All Stage 4 Cancer Diagnosis Cases Terminal
I guess what they are saying to you when they say cure is the likelyhood of making it to 5 years post diagnosis. If you ask your oncologist to speak frankly they will give you some statistics, they are reluctant to give you a time span because it varies so much person to person and for many people it can destroy their hope. Hope is very important when you have cancer. Without hope you can give up and shorten your life. I needed to know for practical reasons of looking after my family when I’ve gone. I am told that my type of cancer at stage 4b same stage as your mum has a 25% chance of being alive in 5 years time. I could live 10 years or die next year. I could also choke on a sausage skin or get run over and die tomorrow, to put it in perspective. If you really want to know, the information is here on this website. I am so sorry to hear that you’ve lost both your dad and sister to this awful disease, wishing you and your mum the best possible outcome.
General Survival Rate Information
Five-year and ten-year survival rates tell you what percent of people live at least five years and ten years, respectively, after the cancer is found.
Statistics on the survival rates for people with melanoma are based on annual data from past cases and over multi-year timeframes.
Because treatments for melanoma are more successful in early stages, it is informative to look at survival rates based on stage and stage subgroups rather than on the cancer as a whole.
It is important to remember that survival rates do not predict an individuals survival. Every person and every case are different, and many factors contribute to an individuals survival. Its also important to remember that new and successful treatments have emerged over the last few years, and survival rates have increased in Stage III and Stage IV melanoma.
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Advanced Skin Cancer Was Once A Death Sentence Immunotherapy Is Changing That
Most cancer patients are haunted by the same two questions:
“Why me?”
“Why now?”
Walton, 34, actually feels lucky advanced melanoma struck when it did.
If I had been diagnosed five years prior, who knows if I would be here,” she says.
Stage 4 melanoma used to be a death sentence. The disease doesnt respond to radiation or chemotherapy, and patients survived, on average, less than a year.
But over the last decade, doctors are successfully using a new approach, one significantly different than the treatment options available for the last 150 years.
Instead of burning or poisoning cancer cells, new medicines unleash the body’s natural defenses to fight them.
This treatment is called immunotherapy.
Beating the Odds
When Walton was 26, she found a mole on the back of her hip.
“It started morphing into this ugly, dark, bleeding thing,” she says, grimacing. “I just knew something was wrong.”
Doctors surgically removed her tumor. But a couple of years later, she discovered a tiny lump in her abdomen. It felt like a popcorn kernel, and within a few weeks grew to the size of a walnut.
A biopsy revealed she had stage 4 melanoma.
Walton searched online for information about the disease. She recalls the moment she discovered the average survival rate: six to nine months.
“I remember sort of losing my hearing, almost losing my vision to where I felt like I was in a tunnel,” she says.
But when she consulted with her oncologist, Dr. Adil Daud of UC San Francisco, he had consoling news.
Survival And Clinical Outcome
Fifty-nine patients had died of melanoma progression at the time of the analysis, among which 32 died with progressing brain metastases. The median overall survival duration from the time of initial brain metastasis was 12.8 months , and the median overall survival duration from the time of initial melanoma diagnosis was 60.5 months for all 79 patients. The median overall survival durations from the time of craniotomy and stereotactic radiosurgery were 17.3 months and 15.4 months , respectively. The median survival durations of patients who received anti-CTLA-4 antibody, anti-PD-1 antibody and BRAF inhibitor after the diagnosis of brain metastasis were 19.2 months , 37.9 months and 12.7 months , respectively. Tables and describe the outcomes of the entire cohort as well as specific subsets of patients. Figures and illustrate the Kaplan-Meier curves of overall survival for all patients and for those who were treated with or without anti-PD-1 therapy, respectively.
Fig. 1
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How Long Does A Person With Stage 4 Melanoma Have To Live
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Survival Rates By Disease Extent
A second method estimates survival rates based on the extent of cancer in the body. This is the approach used by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. The SEER system classifies cancer in one of three broader categories:
- Localized: Cancer limited to the lungs
- Regional: Cancer that has spread to nearby lymph nodes or structures
- Distant: Metastatic cancer
Under the SEER classification system, distant disease and stage 4 cancer are synonymous.
The one drawback to the SEER approach is that stage 4a and 4b lung cancer are melded into one category. This generalized approach not only returns a much lower five-year survival estimate but fails to reflect the wide variability in stage 4 survival rates, particularly in people with limited metastases.
| SEER Stage at Diagnosis |
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Can I Lower My Risk Of The Melanoma Progressing Or Coming Back
If you have melanoma, you probably want to know if there are things you can do that might lower your risk of the cancer coming back, or of getting a new skin cancer.
At this time, not enough is known about melanoma to say for sure if there are things you can do that will be helpful. We do know that people who have had melanoma are at higher risk for developing another melanoma or other type of skin cancer. Because of this, its very important to limit your exposure to UV rays and to continue to examine your skin every month for signs of melanoma coming back or possible new skin cancers. Skin cancers that are found early are typically much easier to treat than those found at a later stage.
Adopting healthy behaviors such as not smoking, eating well, being active, and staying at a healthy weight might help as well, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of melanoma or other cancers.
Ask Your Doctor For A Survivorship Care Plan
Talk with your doctor about developing a survivorship care plan for you. This plan might include:
- A suggested schedule for follow-up exams and tests
- A schedule for other tests you might need in the future, such as early detection tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
- A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
- Diet and physical activity suggestions
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The End Of The Bronze Age
While the newest melanoma drugs aim to decrease the mortality rate attributed to metastatic melanoma, most researchers agree that theres another, more powerful way to lower the number of people who die from the disease: keep people from getting it in the first place.
Despite all the encouraging research in therapies, what would make the most impact on improving survival is better prevention, says Swetter.
Tanning in a UV bed a single time increases a persons risk of developing melanoma by 20 percent, a 2012 study in the British Medical Journal reported. If indoor tanning starts in young adulthood before age 35 or if a person has had more than five sunburns, that risk is at least doubled, studies have found. While most cases of melanoma are in light-skinned Caucasians, dark-skinned people can also get the cancer they also have increased odds the more times they sunburn and the more time they spend in tanning beds. In all, researchers estimated in 2011 that about 86 percent of melanomas in fair-complexioned individuals are due to ultraviolet exposure.
So what can be done to stop these climbing rates? Queensland an Australian state with the highest rates of melanoma in the world launched massive public health campaigns beginning in the 1980s aimed at educating the public on the risks of sun exposure and tanning, as well as how to recognize early melanoma, Swetter says. Since then, theyve seen the rates of melanoma in Queensland start to drop.
It May Not Be Your First Run
Many people with stage 4 melanoma have a history of primary melanoma, says Philip Friedlander, M.D., a medical oncologist specializing in melanoma at Mount Sinai Hospital in New York City. Earlier-stage melanoma that was considered high risk may return at some point as stage 4, he says. In fact, 13.4% of those with a high-risk melanoma had a recurrence, research in JAMA Dermatology showed. Seventy percent of those recurred in a local area, while 29% had a recurrence somewhere else on their body.
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Metastatic Melanoma: A Wife Reflects On Husband’s Shocking Diagnosis
My husband, Steve, was diagnosed with stage IV melanoma in January 2012 at age 34. We have two daughters, ages 2 and 10. He had just started a job working from home and our life seemed to be going so smoothly. I had had some minor health issues that prevented me from working and Steve’s new job enabled me to stay home and focus on getting better. One day in December 2011, Steve asked me to feel a strange lump on his neck. It was directly above his right clavicle and was swollen to about the size of an egg. I immediately started scouring the Internet to see if I could figure out what was going on. After a few minutes, I determined it was a supraclavicular lymph node. Everything I read about the right supraclavicular lymph node pointed to cancer or a very bad infection. Steve had just gotten over a cold, so I was hoping it had something to do with that. After a few days, it had not gone down. At this point he began to get worried, too, so we decided to go to the ER.
Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a procedure to test for the spread of cancer.
It may be offered to people with stage 1B to 2C melanoma. It’s done at the same time as surgical excision.
You’ll decide with your doctor whether to have a sentinel lymph node biopsy.
If you decide to have the procedure and the results show no spread to nearby lymph nodes, it’s unlikely you’ll have further problems with this melanoma.
If the results confirm melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required.
Additional surgery involves removing the remaining nodes, which is known as a lymph node dissection or completion lymphadenectomy.
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