Melanoma is more aggressive than most common cancers. Chemotherapy drugs that work on them have near zero impact on melanoma. Without effective treatment, the fatality rate for melanoma that has spread is 63 percent at one year and 90 percent at two years.
With those odds, Mike was indeed lucky that he ended up at the Mass General Cancer Center. While other institutions have access to drugs like Yervoy, which saved Mike’s life, Mass General stands out for its personalized medicine approach that uses information about genes and proteins to prevent, diagnose and treat disease.
Portfolio of Cancer Therapies
About half of all Mass General cancer patients receive a “targeted drug” that attacks a specific molecule or protein involved in cancer cell growth. These drugs are more precise and have greater likelihood of working than standard chemotherapy drugs, which kill all rapidly dividing cells including healthy ones.
“What distinguishes our program is the deep portfolio of investigational as well as approved therapies,” says Keith Flaherty, MD, director of the Mass General Cancer Center’s Henri and Belinda Termeer Center for Targeted Therapies. “This ‘toolbox’ allows us to craft tailored treatment strategies for each patient based on the stage of their disease and their genetics.”
Approximately 50 percent of patients with advanced melanoma (including Mike) have a mutation in the BRAF gene. In 2002, when scientists discovered this mutation, it was the first time they had a target for drug development. In the past decade, Dr. Flaherty and his team have led several breakthrough clinical trials that demonstrate the effectiveness of targeted drugs in shrinking tumors for patients with this mutation
Testing Triple Combinations
The success, while remarkable, is not necessarily long-lasting. Some cancer cells may be left behind. These cells find a way to survive, and the tumor grows back. To counteract resistance to any single drug, Dr. Flaherty’s team is testing several triple combination targeted drugs in clinical trials. The hope is to turn melanoma into a chronic disease like AIDS, where a cocktail of drugs ensures survival.
In Mike’s case, Dr. Flaherty turned to Yervoy, an immunotherapy drug that stimulates the body’s own immune system to attack cells in melanoma tumors. Elsewhere, he notes, Mike would have been placed on treatment that targeted his BRAF mutation as a first course of action based on a short-term focus.
“Although BRAF inhibitor-based therapy provides the greatest possibility of short/intermediate disease control,” he says, “for someone with the aggressive disease characteristics that Mike had, there was a very narrow window of opportunity to pursue immunotherapy, with the hope of achieving long-term remission.”
At two years, the odds are strongly in Mike’s favor that he will outlive the disease.
Decisions Based on Biology
Another piece of this puzzle is prevention. “Sun protection is the one modifier that we know about, and we [melanoma specialists] think about it in the same way that lung specialists think about smoking,” Dr. Flaherty says.
Treatment, on the other hand, is not so simple. Knowing which drugs will work is still somewhat of a mystery. The goal is to base treatment decisions on biology, not guesswork. With many therapies in early clinical trials, Dr. Flaherty is optimistic about the future.
“We have melanoma on the run, with tripling and quadrupling of survival times for patients with metastatic disease,” he says. “Philanthropy enables us to jump on new leads immediately without losing one to two years’ time while seeking public support.”
Mike was lucky that he came to Mass General. But for Dr. Flaherty, luck is not enough. He is determined to have greater confidence in knowing who will benefit from a particular treatment. By learning from and refining current therapies, Dr. Flaherty aims to create more success stories like Mike’s.
To learn more about how you can support cancer research at Mass General, please contact us.