How we’re outsmarting melanoma

Five years ago, patients with late-stage melanoma that had spread to other organs had no good treatment options. 

A pair of treatment breakthroughs changed that in 2011.

The first immunotherapy drug of its type, which freed the immune system to attack melanoma, and the first drug to hit a specific target on melanoma cells were approved by the U.S. Food and Drug Administration for stage IV melanoma.

Both extend survival in many patients – by years for some – and improve quality of life.

“I never would have thought we’d come so far, so quickly in just five years,” says Patrick Hwu, M.D., chair of Melanoma Medical Oncology and division head for Cancer Medicine. “It’s great progress to build upon. But there’s much more to do.”

These drugs don’t work for everyone. And the incidence of melanoma has been rising for 30 years.

Enter MD Anderson’s Moon Shots Program, designed to accelerate development of new ways to treat and prevent cancer.

A dual focus

MD Anderson’s Melanoma Moon Shot is focused on saving lives in two ways.

To extend the benefits of new treatments, one flagship project takes a closer look into the molecular defects that drive melanoma and develops innovative clinical trials.

The other flagship aims to protect children and teens from melanoma by reducing their exposure to ultraviolet rays from the sun or indoor tanning.

New hope from clinical trials

“Our integrated analysis of melanoma helps us understand why some patients respond to treatment and some don’t,” says Michael Davies, M.D., Ph.D., associate professor of Melanoma Medical Oncology and co-leader of the Melanoma Moon Shot. “We’re developing new therapeutic approaches based on that knowledge -- in particular, new combinations of drugs.”

Cutting-edge clinical trials include:

• Combining two targeted therapies before surgery compared to surgery first, the standard of care, for stage III melanoma.
• Using T cells to treat patients whose disease has resisted other options. T cells are immune system attack cells taken from the patient’s tumor, grown in the lab and then reinfused – along with a drug that prevents PD1, a brake on those T cells, from halting their attack.
• Combining targeted therapies or immunotherapies in clinical trials for patients whose melanoma has spread to the brain.
• Giving immunotherapies as single agents or a combination before or after surgery for stage III melanoma. This trial includes biopsies before treatment, during treatment and after surgery to understand how these drugs work and find ways to identify patients who will benefit from them.

A moon shots platform is extending this longitudinal biopsy approach to 28 clinical trials in 11 types of cancer, including melanoma, over the next two years.  A recent ground-breaking study in stage IV melanoma found that indicators of immune response seen in biopsies taken early after treatment begins with a PD1 inhibitor predict whether a patient’s tumor will respond to the drug.

New research by Davies and his colleagues helps us better understand how mutations in a known tumor-suppressing gene called PTEN play a role in blocking T cell attacks on cancer. Their findings point toward a new combination therapy for melanoma, which the team is pursuing.

Reducing melanoma risk for future generations

Research shows childhood sunburns raise the risk of developing melanoma later on. So, our moon shot researchers and experts take a multipronged approach to prevention.

“We know avoiding indoor tanning and minimizing overexposure to the sun can reduce melanoma risk,” says Jeffrey Gershenwald, M.D., professor of Surgical Oncology and co-leader of the Melanoma Moon Shot.

Moon shot and platform members served as the primary clinical and scientific resources for the Texas Legislature in 2013, providing expert testimony and educational information about indoor tanning and cancer risk. That year, Texas became the fourth state to adopt legislation prohibiting the use of tanning beds by those under age 18. Fifteen states now have such laws, and MD Anderson has played an important role in sharing lessons learned and educating policymakers in other states about the benefits of the law.

Additionally, Ray and the Sunbeatables, an evidence-based sun safety program for preschoolers developed from our Behavioral Science research, has been made available to preschools across the U.S.

Ray and the Sunbeatables are five superheroes who help children learn through songs, art and science activities, and other lessons. The curriculum debuted in 2015, reaching 2,639 preschoolers in six states. It will expand this summer through an alliance with the CATCH Global Foundation, a charity that promotes healthy lifestyles for children. Expansion of the program into elementary school is also underway.

“Children have fun learning about sun safety during curriculum activities, and this motivates teachers and parents to stay engaged and continue teaching and practicing sun safety to protect children,” says Mary Tripp, Ph.D., instructor in Behavioral Science and a developer of Ray and the Sunbeatables.

A longer version of this story originally appeared in Messenger, MD Anderson’s bimonthly employee publication.