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Skin-Cancer

Updated 01 June 2015

New drug boost skin cancer survival

Two novel drugs produced unprecedented gains in survival in separate studies of people with melanoma, the deadliest form of skin cancer, doctors reported.

Two novel drugs produced unprecedented gains in survival in separate studies of people with melanoma, the deadliest form of skin cancer, doctors reported.

In one study, an experimental drug showed so much benefit so quickly in people with advanced disease that those getting a comparison drug were allowed to switch after just a few months.

The drug, vemurafenib, targets a gene mutation found in about half of all melanomas. The drug is being developed by Genentech, part of Swiss-based Roche, and Plexxikon Inc., part of the Daiichi Sankyo Group of Japan.

The second study tested Bristol-Myers Squibb Co.'s Yervoy, a just-approved medicine for newly diagnosed melanoma patients, and found it nearly doubled the number who survived at least three years.

"Melanoma has just seen a renaissance of new agents," said Dr Allen Lichter, chief executive of the American Society of Clinical Oncology. The new studies were published online by the New England Journal of Medicine.

Great success

"This is really an unprecedented time of celebration for our patients," said Dr Lynn Schuchter, of the University of Pennsylvania's Abramson Cancer Centre. The new drugs are not by themselves cures, but "the future is going to be to build upon the success" by testing combinations of these newer drugs, she said.

Melanoma is on the rise. Only two drugs had been approved to treat it, with limited effectiveness, until Yervoy, an immune-system therapy, won approval.

The experimental drug, vemurafenib, is aimed at a specific gene mutation, making it the first so-called targeted therapy for the disease. The drug got attention when a whopping 70% of those with the mutation responded to it in early safety testing.

The new study, led by Dr Paul Chapman of Memorial Sloan-Kettering Cancer Centre in New York, was the key test of its safety and effectiveness. It involved 675 patients around the world with inoperable, advanced melanoma and the gene mutation. They received vemurafenib pills twice a day or infusions every three weeks of the chemotherapy drug dacarbazine.

The results

After six months, 84% of people on vemurafenib were alive versus 64% of the others.

Less than 10% on the drug suffered serious side effects - mostly skin rashes, joint pain, fatigue, diarrhoea and hair loss. About 20% to 30% of patients developed a less serious form of skin cancer. More than a third needed their dose adjusted because of side effects.

The study is continuing, and many remain on the drug, including Brian Frantz, a 50-year-old former firefighter from Springfield, Virginia.

Within a week or two of starting on the drug, "we noticed an improvement" and shrinkage in his many tumours, he said. "It was just a miracle."

Schuchter said that's typical of how patients have responded to the drug. "Within 72 hours, their symptoms improve, pain medicines can be reduced," she said.

The study is a landmark and the results are "very impressive" in people who historically have not fared very well, said Dr April Salama, a Duke University melanoma specialist.

The study was sponsored by the drug's makers, and many of the researchers consult or work for them. The companies are seeking approval to sell the drug and a companion test for the gene mutation in the US and Europe. A Genentech spokeswoman said the price has not yet been determined.

Not chemo

The other new drug, Yervoy, is not a chemotherapy but a treatment to stimulate the immune system to fight cancer. Dr Jedd Wolchok of Memorial Sloan-Kettering led the first test of it in newly diagnosed melanoma patients.

About 502 of them received dacarbazine and half also got Yervoy. After one year, 47% of those on Yervoy were alive versus 36% of the others. At three years, survival was 21% with Yervoy versus 12% for chemotherapy alone.

Side effects included diarrhoea, rash and fatigue. More than half on the new drug had major side effects versus one quarter of those on chemotherapy alone.

Bristol-Myers Squibb paid for the study and many researchers consult or work for the company. Treatment with Yervoy includes four infusions over three months and costs $30,000 (about R200,000) per infusion.

(Sapa, June 2011)

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