Ten years after he first discovered cancerous brown marks growing on his shoulder, Michael Martin learned the skin cancer was back. He already had the melanoma removed surgically twice, but the cancer came back a third time, and it had spread.
Now the cancer was on his lung — the cancerous cells were surgically removed — and in his brain, a complication that can be deadly or lead to disabling side effects.
Martin received a combination of immunotherapies as part of a clinical trial at UNC Lineberger. This form of treatment directs the body’s natural defense system to fight the melanoma.
He also received radiation treatment directed at the tumors and to his brain to clear the melanoma that persisted. The treatment was difficult and there were complications, but Martin reports he has been recurrence-free since August of 2016.
“Without the skill and expertise that he brought, I would not be here today,” Martin said, thanking his oncologist, UNC Lineberger’s Stergios Moschos, MD, a nationally recognized melanoma researcher and associate professor in the UNC School of Medicine Division of Medical Oncology along with the other physicians and staff.
Advances in treatment have made it possible to manage metastatic melanoma as a chronic disease, said UNC Lineberger’s David Ollila, MD, the James H. and Jesse E. Millis Distinguished Professor in the UNC School of Medicine Division of Surgical Oncology and co-director of the melanoma program.
There are a number of checkpoint inhibitors — immunotherapy drugs that release the “brakes” in the immune system — that have been approved by the U.S. Food and Drug Administration. Follow-up data from clinical trials found that with a combination of ipilimumab and nivolumab, 58 percent of patients with advanced melanoma were alive three years after treatment.
In addition to immunotherapies, a number of targeted treatments approved since 2011 have increased doctors’ arsenal of weapons they can use against the disease.
Ollila said with these treatments and others he has seen major gains in survival for patients with metastatic melanoma since he was in training. The five-year relative survival rate for patients with melanoma that has spread to distant sites is 24.8 percent in the United States, according to data from the National Cancer Institute.
“There’s no doubt we have started to create a new generation of survivors over the past eight years,” Ollila said.
The work is not finished, said UNC Lineberger’s Nancy Thomas, MD, PhD, the Irene & Robert Alan Briggaman Distinguished Professor and chair of the UNC School of Medicine Department of Dermatology.
“We’ve seen a lot of change and improvement in treatment in the past few years, and it’s continuing to evolve,” Thomas said.
Since not all cancers will respond to immunotherapies, Thomas said the “million dollar question” is how to turn a “cold” tumor, which has a poor response from immune cells, into a “hot” tumor that will respond.
If researchers can identify features of a patient’s tumor that could help predict long-term survival or response to a therapy, that could help them improve treatment.
Thomas led a recent study, published in The Journal of Investigative Dermatology, that confirmed certain inherited genetic features are linked to a person’s risk for melanoma.
Finding better ways to treat melanoma once it has spread to the brain has also been an active area of research.
Moschos was involved in a national, multi-institution clinical trial that evaluated the impact of using immunotherapies for patients whose melanoma had spread to the brain. The results, published in the New England Journal of Medicine last year, showed the treatments generated a “meaningful response.” More than a quarter of patients showing a complete response, which is the disappearance of all signs of cancer.
Moschos is also teaming up with UNC imaging researchers to perform first-in-human clinical trials that track the immune infiltrate into metastatic melanoma.
Another area of research, said UNC Lineberger’s Frances Collichio, MD, professor in the UNC School of Medicine Division of Hematology/Oncology, is into potential treatment combinations that could deliver the effect of immunotherapies, but with fewer toxicities.
Collichio echoed the need for biomarkers – signals that can help physicians predict which patients will respond to which treatment “We want to figure out who these people are and get them the right treatment,” she said.
In addition to thanking his doctors, Martin thanked his family – his wife of 24 years, Trina, and his two daughters, Tara and Taylor. He also received support from unexpected places. On a return flight from getting a second opinion about his care, a stranger asked if he could pray for him.
“He took my hand, and the guy next to me put his hand on his shoulder,” he said. “The person behind put their hands on the shoulders of the people in front of them. Nobody complained or said anything.
Martin said the experience stuck with him, although he never found out the person’s name or where he was from.
“To this day, I hope that I’m that kind of person and can help people out.”