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Important to know: The innovations in non-metastatic melanoma

Many cancer patients end up coping with the disease, are defined as healthy and return to routine - then discover that the disease has returned due to tiny tumor remnants that were not noticeable and developed over time.

There are new treatments that may prevent the recurrence of the disease

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• Melanoma

• skin cancer

BMS, sponsored by Bristol Myers Squiv Israel Ltd.

Wednesday, 16 September 2020, 12:51

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About 1,500 new melanoma patients in the country each year.

Melanoma cancer cells (Photo: ShutterStock)

Melanoma is the least common type of skin cancer (only 2 percent of all types), but most of us still know its name because it is the most dangerous and the cause of most skin cancer deaths (75 percent), especially if it is not detected in stages. Early.

Every year, about 1,500 new melanoma patients are diagnosed in the country.

About 85 percent of them are diagnosed early, that is, when the cancer cells are in the skin only.

This stage (known as stage 1 or stage 2) can be cured by surgery to remove the tumor, and in some cases also to remove a lymph node for its sampling.

In 10 percent of cases, melanoma is diagnosed at a more advanced stage, in which the cancer cells have spread to lymph nodes near the affected skin area - usually in the armpit, groin or neck.

In such a case, the chances of recurrence of the disease in the years after diagnosis and surgery are higher and therefore preventive treatment is needed that will reduce the risk of recurrence of the disease.

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The cancer may return - and this is the type of treatment that reduces the risk of it

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In any case of stage 3 melanoma the option of adjuvant therapy will be considered, and in half to two thirds of them the decision will be to carry out the treatment.

Adjuvant therapy is a preventative, complementary treatment, which aims to reduce the chance of recurrence of the disease after the surgical procedure.

What is an adjuvant?

Dr. Nati Asher

"Until January 2019, the date of the introduction of adjuvant therapy into the drug basket in Israel, patients in stage 3 entered a long follow-up period after surgery to remove the tumor, or were treated with interferon, in order to reduce the chance of recurrence of the disease," explains Dr. Nati Asher. Between 2017-2018, three modern studies were published that made this period very exciting for oncologists working with melanoma and for their patients. Following those studies, there are now three drugs available that are effective and have a profile of side effects that are usually relatively simple to diagnose and manage. "Two of them are from the family of immunotherapy and one from the family of biological therapies."

Immunotherapy is based on the understanding that the cancerous tumor cells suppress the immune system in their immediate environment, through proteins that bind to the cells of the immune system and paralyze their activity.

One of its main mechanisms relies on the fact that cancer cells send a signal to a receptor called 1 PD that is found on the surface of cells of the immune system.

This signal renders the immune cells inactive and they are unable to attack the tumor, and so it can grow.

Blocking this repressive mechanism through immunotherapy allows the immune system to return to activity and mobilize it to fight the cancer cells - the cells are attacked by the immune system and thus the tumor tissue shrinks until it disappears.

Immunotherapeutic therapies block the 1 PD receptor and thus prevent the signal from reaching the cancer cells, and then there is nothing to stop the immune cells from performing their function.

"The treatment 'upgrades' the aggressiveness of the immune system and helps it eliminate the melanoma cells left in the body after surgery," explains Dr. Asher.

And what about the side effects? The variety of side effects of immunotherapeutic treatments stems from their mechanism of action. Activation of the immune system may, In some patients, it causes autoimmune symptoms to develop, that is, to develop symptoms caused by the body attacking its own systems. The chance of developing a side effect is about 10 percent, and these are usually relatively simple to diagnose and manage - itching or skin rash, skin pigment changes, Diarrhea, liver dysfunction and hormone production disorders

"It is recommended to see a dermatologist once a year"

If preventive treatment is not given, melanoma may recur as a metastatic disease (stage 4).

Such was the case of Dr. Hedva Gonen, founder and CEO of the Israeli Skin Cancer Association, who was diagnosed in 2013 with metastatic melanoma following the discovery of metastases in the liver, lungs and spleen.

Dr. Gonen was admitted to the study with treatment at an immunotherapy stage that was still experimental at the time (and showed good initial results). "Today, the treatment leads to a regression in the growth of over half of patients with metastatic melanoma and may lead to a full recovery of 20 percent." , Dr. Gonen flew to Sloan Kettering Hospital in New York.

She stayed there for a year and a half for 4 combined treatments and continued treatment with one immunotherapeutic drug that she completed in Israel.

"The fact that I control my destiny and choose to do the treatment here and now is very encouraging."

Dr. Hedva Gonen

"Since I was only diagnosed in the advanced stage of the disease - stage 4, adjuvant therapy was no longer relevant to me," she says. "Had the disease been detected in me in stage 3, I might have won and received the treatment and thus increased my chances of recovery, and avoided more intensive treatment."

During the treatment period, Dr. Gonen felt that there was a place for an organization that would gather all the information about melanoma (and other types of skin cancer) in a clear and accessible manner and also provide support and advice to patients and their families. She has since served as the association's general manager, and is also defined as "cancer-free.

" Until a year ago, people diagnosed with stage 3 melanoma had to wait for the disease to progress on its own, in order to receive medical treatment. Today, research breakthroughs allow us to treat stage 3 as well, and thus better control of the disease and the chance of overcoming it, "Dr. Gonen explains. "The fact that I control my destiny and choose to do the treatment here and now is very encouraging."

Meanwhile, Dr. Gonen reminds to be vigilant for possible early signs of the disease: "Not everyone knows that solar radiation in Israel is dangerous even on a cloudy and cloudy day, and you have to protect yourself when you go outside. I’m not talking about a hat and sunscreen a short walk from the parking lot, but definitely yes when it comes to hiking or prolonged walks. In general, the recommendation for everyone is to see a dermatologist once a year, including children. For those with fair and / or particularly spotty skin, I recommend coming twice a year, "concludes Dr. Gonen.

It should be emphasized that the choice of possible treatment is for the decision of the therapist who registers the prescription in consultation with the patient. The information is correct as of February 2020. For more information, please contact the attending physician. Public service

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