2 Nov 2012

Good news in the fight against skin cancer

More and more often now when I cover a cancer story it is good news.  There  has been a development or a breakthrough or even a cure. This has not always been the case.  When I started health reporting more than 20 years ago often as not it was interviewing grieving relatives trying to raise money for research or the lack of funds to treat patients.  There have been some very distressing moments indeed.

But today is a day for excitement, even celebration.  The National Institute for Health and Clinical Excellence (NICE) has approved two drugs for malignant melanoma, a usually fatal form of skin cancer. 

The two drugs, Vemurafebib – trade name Zelboraf and Ipilimumab (Yervoy) have increased patient survival and improved their quality of life.  Quite simply, they offer hope where there was none before.

Today I interviewed Professor Martin Gore, medical director of the Royal Marsden Hospital in London, who is a specialist in melanomas. 

He said that throughout his career there have been some very dark days.  “This is a real game changer,” he said.  “This is the first major advance for 30, 40 even 50 years,” he said.

 The two drugs approved today work very differently.  Vemurafebib blocks the effects of a cancer-causing mutated gene BRAF.   Fifty per cent of patients  metastatic melanoma have this mutated gene. 

The trials for this drug began after the Institute fo Cancer Research was able to show how this mutated BRAF gene drives this cancer’s development.  And so successful were the randomised trials that they stopped them after six months and put all eligible patients on to the treatment.

It has increased survival by more than a year and it is still early days, although doctors are at odds to say this is not a cure.  But in an area where there was once little hope, this is a breakthrough.

For those without the mutant there is Ipilimumab which harnesses the body’s own immune system to fight cancer.

Patients are given four doses over three weeks. 

And according to the literature 46 per cent of patients survive for more than a year.

 But we met patient Sandra Sayce, aged 49, from Ruislip.  She was first diagnosed with malignant melanoma in October 2001. 

By 2005 more lesions appeared on her legs and eventually they spread to her lungs, liver, lymph nodes and spleen.  Mrs Sayce was given six cycles of standard chemotherapy and it slowed down the progression of the lesions and then a couple of months later she was put on a trial.

But in September 2006 she was told that it was not working and that she probably had four months to live.  They did give her a choice though:  palliative care or to try one more trial.  It was for Ipilimumab.

She told me that almost immediately she knew it was working.  And six years later the lesions have flattened, no more have appeared and the ones in her live cannot even be seen on a CT scan. 

“I know that I was in the right place at the right time,” she said.  “I pinch myself because I know how lucky I am.  Not lucky to have the cancer but lucky for there to have been this trial and to be eligible.”

Something was desperately needed.  ABout 2,000 people a year die in the UK from malignant melanoma, with young people disproportionately affected by the disease. 

Over the last 25 years, rates of the disease have risen in Britain faster than any other common cancer and it is now thought that within the next 15 years there will be around 15,500 cases a year.

All of it down to sunbathing and burning, hence the campaigns to cover up and use sun screen. 

There is a footnote, though. Nice initially turned down these drugs because of the cost. But following the publication of their first draft guidance last year which did not recommend ipilimumab, Bristol-Myers Squibb provided extra data and analysis regarding its cost-effectiveness and they also submitted a patient access scheme. And the manufacturer of Vemurafenib, the drug company, Roche, also provided extra information on its effectiveness.

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