Melanoma rates have also been increasing for the past 30 years—at rates exceeding other cancers.

“Incidence of melanoma is increasing in men more than any other malignancy,” the authors of a 2013 review wrote.3 “Women also demonstrate a similar trend with melanoma increasing more than any other malignancy except lung cancer. Melanoma still remains the most common cancer death for women 25 to 30 years of age.”


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Yet strategies for combating advanced melanoma are still improving: the U.S. Food and Drug Administration and European Medicines Agency approved 9 drugs over the last 6 years. Some therapies among them, Dr Dummer and co-authors noted, “show better response rates than seen with earlier therapies, and increase the likelihood of longer survival in patients with advanced melanoma.”

Nonetheless, up to 50% of patients don’t respond to immunotherapy, and about half of those who achieve clinical response with kinase inhibitors “eventually develop acquired drug resistance that leads to disease progression.”

This presents a pressing need for more treatment options. And, Dr Dummer said, yet another argument for biobanking.

“From an economic measure and from a scientific and patient perspective it would be really helpful to have biomarkers that can help us to avoid unnecessary treatments,” he said. “If we have all of these patients treated in the centers we will systematically collect the clinical information. We will systematically collect materials and biological information and hopefully, in the long run, we can fuse the medical information to the basic research information and develop risk-benefit scores for each individual.”

There may, however, be resistance from primary caregivers.

“One of the reasons is that in this context the patients are also customers. And, depending on the system, it is an important revenue for the physicians,” Dr Dummer said. “If they send all their cancer patients to specialized centers, then many physicians will lose a lot of money.”

RELATED: Gynecologic Melanoma: Genetics and Targetable Mutations

He believes a 2-pronged approach may clear the way. One aspect involves stimulating cooperation between the centers and the primary caregivers, with the centers sending patients back to their physicians for long-term follow-up care after their specialized treatment. The other depends on support from patient advocacy groups, which are dedicated to promoting the best care regardless of the personal interests of the physicians involved.

“I think this type of medicine has a future only if it is fully accepted and appreciated by the patient advocacy groups,” he said.

References

  1. Dummer R, Ramelyte E, Levesque M, Goldinger SM, Braun RP. Critical aspects to achieve a high-quality melanoma clinic. Curr Opin Oncol. 2016 Dec 23. doi: 10.1097/CCO.0000000000000357 [Epub ahead of print]
  2. Cancer Facts & Figures 2016. American Cancer Society website. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2016.html. Accessed December, 2016.
  3. Trotter SC, Sroa N, Winkelmann RR, Olencki T, Bechtel M. A global review of melanoma follow-up guidelines. J Clin Aesthet Dermatol. 2013 Sep;6(9):18-26.