Source: National Cancer Institute via Wikimedia Commons.
Cancer is a scary disease regardless of its type, but for those suffering with melanoma, a malignant form of skin cancer, it's been an especially frightening couple of decades.
According to statistics from the American Cancer Society, about 76,100 new cases of melanoma are expected to be diagnosed this year (it's a bit more common in men than women). More worrisome, while incidence of six of the seven most common types of cancers in the U.S. declined between 2000 and 2009, the rate at which melanoma is being diagnosed in people increased during this period by nearly 2% per year. This is concerning since melanoma, despite accounting for only 2% of all skin cancers, is responsible for a good portion of skin-cancer deaths.
The seven surprising states where melanoma incidence is the highest
With this in mind, my initial suspicion, and perhaps your own, is that states which are rich with sunshine, like California, Florida, or Hawaii, for example, should be the most likely to see the highest incidence of melanoma. However, according to the Centers for Disease Control and Prevention, which ranked melanoma incidence per 100,000 people, this isn't exactly the case. In fact, I'd refer to the seven states with the highest incidence of melanoma as downright shocking. Based on the CDC's data these seven states are:
- Utah (34.1 incidences per 100,000 people)
- Delaware (30.3)
- Vermont (28.1)
- Minnesota (27.5)
- Idaho (27.5)
- Oregon (27.0)
- Washington (25.7)
Age-adjusted incidence rates for melanoma of the skin. Incidence rates per 100,000 people. Source: Centers for Disease Control and Prevention.
As a Washington resident, I often hear the "We must only get rain" quips about my state everywhere I vacation. But, the CDC's data clearly shows that melanoma is a disease that can strike anyone and anywhere, and that it's no laughing matter.
Treating melanoma can also be a costly venture for patients and the healthcare system as a whole, too. Based on statistics from the National Cancer Institute, the estimated cost of melanoma treatments was a whopping $2.36 billion in 2011.
There's good news, too!
However, there's good news lying within all of these statistics as well. Long-term data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program shows that five-year survival for melanoma patients improved from just 82% between 1975 and 1977 to 93% between 2002 and 2008. Educating the public about melanoma certainly has helped, but pharmacologic improvements in treating melanoma also appear to be playing a role in improving patients' overall survival and quality of life -- and improving patients' quality of life is the ultimate goal of drug developers.
With that in mind, let's take a look closer at some of the newest melanoma therapies focused on improving quality of life and extending survival, and also glance at a new type of treatment pathway that may hold even more promise in the future.
Source: GlaxoSmithKline via Flickr.
These drugs are improving lives
At the moment, the big three in treating late-stage melanoma, the most dangerous type of skin cancer, are Roche's (RHHBY -2.24%) Zelboraf, Bristol-Myers Squibb's (BMY -0.27%) Yervoy, and GlaxoSmithKline's (GSK -0.92%) combination therapy Mekinist and Tafinlar.
Of these three treatments, Bristol's Yervoy has been around the longest, gaining approval from the Food and Drug Administration in March 2011. The study that allowed Yervoy to be approved showed an improvement in median overall survival for advanced melanoma patients of 3.5 months (10 months) compared to the median overall survival of the control arm, which was 6.5 months.
I understand that may not sound like a lot, but consider for a moment that these patients had failed each prior traditional melanoma treatment they had taken and surgery was not an option. In that context, a 3.5-month improvement is a big leap in the right direction of improving patient survival, and also a reason why Yervoy is on pace to handily top $1 billion in sales this year. Yervoy is also being studied in a number of other cancer types.
Roche's Zelboraf was approved not long after Yervoy, in August 2011, also on the basis that it significantly improved advanced melanoma patients' median overall survival. However, unlike Yervoy, Zelboraf focuses on a very specific type of melanoma where the tumors express a gene mutation called BRAF V600E.
Source: Roche.
At the time of Zelboraf's approval by the FDA, patients in the control arm lived a median of eight months, and 64% of them were still alive. Comparatively, a median overall survival on Zelboraf-treated patients hadn't been reached, though 77% of trial patients in the Zelboraf arm were still alive -- an impressive improvement.
GlaxoSmithKline's combo therapy of Mekinist and Tafinlar was approved most recently. Both drugs were approved as monotherapies in May 2013, though Glaxo's intent all along was to maximize their benefit as a combo therapy, which was achieved when the FDA approved the combo in Jan. 2014.
Similar to Zelboraf, Mekinist and Tafinlar focus on specific mutations known as BRAF V600E and BRAF V600K. As a combination therapy, 76% of advanced melanoma patients with one of these aforementioned mutations saw their tumors shrink or disappear. Furthermore, the duration of the response lasted a median of 10.5 months.
Ultimately, you may never have heard of these drugs before, but one thing is clear: Patients' overall survival is improving.
An exciting new treatment pathway
There's more good news. In addition to a handful of newly approved drugs advancing patients' quality of life, a new class of cancer drugs known as immunotherapies may allow survival statistics to tick even higher.
Rather than focusing on tumor proliferation, cancer immunotherapies are vaccines that retrain your immune system how to recognize and attack cancer cells. Specifically, anti-PD-1 immunotherapies are garnering a lot of attention as of late -- and for good reason since they've been incredibly effective in clinical studies.
Source: Merck.
Without getting overly technical, anti-PD-1 inhibitors help the body's immune system identify and thereby kill cancer cells. The two encouraging experimental therapies targeted at advanced melanoma worth closely monitoring are Merck's (MRK 0.10%) Keytruda and Bristol-Myers Squibb's Opdivo.
Both drugs burst onto the scene in 2013 after reporting impress overall response rates for advanced melanoma in excess of 50% right before the Annual Society of Clinical Oncology's meeting. Keytruda was approved by the FDA on Thursday for patients with advanced or unresectable melanoma who aren't responding to other drugs.
Opdivo has demonstrated encouraging results and is already approved in Japan for unresectable melanoma. An investigation into Opdivo's effectives released by John Hopkins and Dana-Farber earlier this year indicated that 62% of patients taking Opdivo were still alive one year after starting treatment, while 43% were still alive two years later. Furthermore, investigators noticed a durable response in patients even after they had stopped taking the vaccine.
Source: Adam Scott via Flickr.
One step at a time
Treating cancer really is a one-step-a-time process, but with each advancement, we move one step closer to a hopeful cure. Although melanoma diagnoses have been on the rise for the past three decades, the data is crystal clear that we're seeing slow but steady improvements in terms of patient response and survival. The end result is that patients as a whole are living longer than ever following a melanoma diagnosis, and it has lent hope that this upward trajectory in patient quality of life will continue for many more years to come.
