Still The Same

"Melanoma is the tumor that gives cancer a bad name." Dr. George Canellos, M.D., Dana-Farber Cancer Center

Being the sort of guy who really knows how to have a good time on a beautiful Saturday morning during Easter weekend, I attended the Melanoma Research Foundation’s patient education symposium in Denver, where this cheery quote was featured in my doc’s introductory slide in his presentation on targeted agents for metastatic melanoma treatment. While driving home from the session, pondering what I had and hadn’t heard, it struck me that next to nothing has changed for Stage III patients since I checked into the Hotel in 2003.

2011 was, thank heavens, a year of life-extending treatment advances for Stage IV melanoma patients that included FDA approval of both Ipilimumab/Yervoy and Vemurafenib/Zelboraf. And with FDA approval, these two drugs are now the “control” drugs in pending clinical trials of other promising Stage IV treatment drugs now in the development pipeline. But the only adjuvant treatment options for Stage III patients who’d like to reduce the odds that their cancer will recur and progress to Stage IV are, still, interferon-alpha2b-- which the FDA approved in 1995-- or some clinical trial that isn’t open and available to all comers.

Unfortunately, it sounds like this situation isn’t likely to change for several more years. Several pending Stage III treatment studies were briefly mentioned at the symposium:

■ The results of a small study on biochemotherapy v. interferon will soon be published. It didn’t sound to me like this study is expected to prove that biochemo is sufficiently more effective than interferon to justify its extreme toxicity and necessity that the patient be hospitalized during treatment. I’m apparently one of the lucky 26% of biochemo vets who “responded” to this treatment, but trust me when I say that if you didn’t like the interferon option, you most certainly wouldn’t find biochemo to be an attractive alternative.

■ A large, multi-center study of Yervoy v. interferon is underway, involving Stage IIIb and IIIc patients. The study involves one “control” arm of patients receiving interferon and two arms of patients receiving different doses of Yervoy. It will be at least two or three years before the data is available from this study that could potentially lead to Yervoy being approved by the FDA for Stage III treatment.

■ A study of Vemurafenib/Zelboraf for Stage III patients will soon be underway.

Oy. I’ll sign off with a new version of Bob Seger’s “Still The Same”…

http://www.youtube.com/watch?v=HjDpKeiYxOU


You always win, every time you place a bet
You're still damn good, no one's come and cured you yet
Every time they are sure they have you caught
You are quicker than they thought
You just mutate genes and walk

You always said, C docs could never do you wrong
The trick you said was never stay the same too long
A gambler's dare, the desperate risks that we would take
The normal lives we would forsake
For only drug you couldn't fake

And you're still the same
I learned about you Saturday
Giving C bad name
No drug standing in your way
Turning on your harm
Long enough to get you by
You're still the same
You still aim high

Dang you’re good, every doctor talks ‘bout day
Tables turn and you’re away
There is nothing left but pray

'Cause you're still the same
You're still the same
Giving C bad name
Will things ever change?
You’re still the same