LIVESTRONG: Melanoma Group

Stage 4 Melanoma

posted by LynnLuc on 9:34 pm

Hi, I am Lynn
I was diagnosed with Stage 4 Melanoma in June 2009 and given 6-9 months to live. I am still here! The long and the short of it  is I have been NED since March 26, 2010! I am blessed!

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My melanoma website; resources and research;

New to group

posted by CatherineB1 on 1:15 pm

 Hi
My name is Cathy and in 2007 I was diagnosed with Melanoma. Had surgery to remove a mass on my shoulder blade that was stage 3. I am being checked every three months and have had pre melanomas removed.

New to site, group, and this disease.

posted by SoloDad on 11:34 am

 Hello all.
I am a 50-year-old single father, avid cyclist, occasional runner. Just diagnosed Stage 3 melanoma. Am really scared and feeling overwhelmed by everything.
First question I have for group is this: If you had to choose between axillary lymph node removal/dissection or Interferon A as first course of treatment, which would you choose and why?
Any words of encouragement would be appreciated. I am really frightened and down right now. 
-SoloDad

Correction...

posted by CraniumCrusader on 11:21 am

Guess it was two months ago today...calendars and clocks don't seem to fit in right now....L

Everyday We Get a Little Stronger

posted by CraniumCrusader on 11:16 am

I am new to the Livestrong Blog but unfortunately not new to the world of stage IV metastatic melanoma.  My two sons and I lost their Dad, Craig,  two months ago.  Craig and I were married for 17 years; our two sons are now ages 10 and 19.  Even though we divorced about 4 years ago, we remained close for our boys.  Our divorce took us through a rough patch or two, however, we both picked up the pieces and remarried and life was going surprisingly well and everyone was adjusting...humor intact.  Then last October (2009) Craig had a grand mal seizure that took him to the emergency room and subsequent medical tests showed that Stage IV melanoma had metastisized to his brain and lungs.  Craig gave it every ounce of fight he could this past year and tried everything his doctors recommended.  He wanted more than anything to live his life watching his sons continue to grow.  He wanted to see graduations and grandchildren.  He was in the prime of his career as an engineer and scientist as well.  On May 12, Craig passed away.  It seemed to happen so quickly as just ten days before we all participated in the 5K in D.C. in The Race For Hope.  We called ourselves Craig's Cranium Crusaders and we wore Survivor Orange T shirts that the Webelos den Craig was leader of helped us design.  We all miss Craig so very much.  It seems unreal at times...each passing day the void seems to swallow us up at times and I picture myelf and the boys going out of our way to walk around the void so we don't fall in.  Our hearts ache knowing Craig is gone and he is never coming back.  Each day  I always give the boys a special hug for Craig.  Sometime we remember him and sometimes it makes us laugh out loud.  Sometimes we just think of him together in slience.  We try to remember the special moments we all had with Craig.  The memories  we share with each other help us get a little stronger everyday...it's just going to take a while.  Lynn  

Caretaker

posted by caretkr on 2:27 pm

For almost a year I have been a caretaker to my husband of 45 years. He was diagnosted with Metastatic Melanoma  in August of 2009. 25 years prior to that he had a malignant melanoma on his inner calf which was excised at Sloan Kettering and at that time his nodes in the groine area were removed showing no cancer. Testing at that time was not as sophisticated as it is today because apparently something lay dormant for all those years. The tumor in his abdomine was detected when it was about the size of a sausage and unresectable so we were told. Following biochemo at MD Anderson, and Taxel at Baylor nothing worked and his tumor grew larger and others poped up everywhere. After much research by our family we discovered Ipilumumab which looked hopeful. Our daughter called all the sites participating in the trial that were within a 6 hour driving range of our home and our physician's nurse faxed his records to the ones that had openings. Unfortunately many trial sites move at a much slower pace for acceptance than our needs allowed so our daughter tried places that were out of state and that we had family or friends living in the vacinity. She found a trial on a Thursday, we flew to NY on Saturday, visited with the doctor on Monday and started on the trial drug on Friday. My point in writing this is that when you or a loved one has cancer don't settle for what is being offered in your hometown if it is unsuccessful in slowing down or aleveating your cancer. Go for the gold standard of drugs that is available and knock on the doors of those that have them until one opens. When dealing with cancer you have to take of the gloves and fight for survival. Although most doctors and treatment centers mean well, you and only you are going to get the treatment that you need and want by reading, investigating and searching out all that you can find on your particular problem. We are fighting the good fight and god willing we will succed or at least  he will progress to a more comfortable state of well being.

MELANOMA: NEW THERAPY WITH IPILIMUMAB, VIDEO INTERVIEW PROF.A.EGGERMONT #ECCO15ESMO35 September 2009

posted by Jimmy_B on 5:31 pm

We are seeing the fruits of our Labor

Video interview with prof.Alexander Eggermont, Ecco Oncology President at 15 Ecco Esmo 34 European Oncology Congress in Berlin, september 2009.



This backs up my Theory and my Paper "Melanoma and the Magic Bullet (Monoclonal Antibodies)"

How do you find a specialist in Melanoma?

posted by Jimmy_B on 5:26 pm

Last Night I went to a Gilda Club Meeting on Melanoma. One Patient there asked "how do you find a specialist in Melanoma?" I believe whole heartedly that one must find the best team Leader to take you up Mount Everest. He/she is the only Clinical Oncologist that can guide you off the the Mountain. I could not recall this website, so I figured I would post it now. http://www.melanomacare.org/centers.shtml
Jimmy B

Melanoma_Missionary

MelanomaCare.org - care centers page

trying to decide

posted by maukahale on 11:00 pm

Hi everyone, three months ago a mole on my chest, simply a nuisance up to that day, was identified and removed by my derm. it came back Stage IIb, they did a Sentinel Lymph Node extraction and took another chunk of my chest off. Results: inconclusive yet enlarged cells in the center of one of the three nodes taken. Prognosis - take all the rest of the nodes and do a year of Interferon. I', active, cycle, windsurf, run, always moving and I'm concerned with the effects of Lymphodemia. I'm single, no kids, no one relying on me so I'm OK with risk. My question to you all that have been through this is what are the effects of getting the rest of the left armpit nodes out, not too freaked about the Interferon.

Questions on Where to Start

posted by SuzyParker on 11:03 am

Hi, a very good friend of mine was experiencing problems with vomiting, cramping, etc.  As a result, he  underwent surgery for partial small bowel obstruction.  Long story short, the word at this time is the mass that was removed appears to be metastatic melanoma and he was advised to contact a certain doctor ASAP.  The earliest he can be seen is late September, and obviously time is of the essence.  Does anyone on the board have any idea how to be seen sooner rather than later - is there any way to contacting the MDs mentnioned on this board or anyone who can refer a patient directly.  From what I've read,once MM has spread to the small bowel, prognosis appears to be grim and every moment matters.
Any suggestion is greatly appreciated.
SP

Mike Brockey's Melanoma Story

posted by PHaldon on 9:15 am

My name is Mike Brockey and I have Stage IV Malignant Melanoma. I was diagnosed in late December 2008 when I had a mole removed from my neck. My sentinel lymph node was positive while 40 others that were later removed showed no sign of the cancerous beast. In late April 2009 I starting experiencing cramping in my abdomen. There was enough pain that I felt I should bring it to my doctors attention. A CT scan on May 05, 2009 showed that I had metastatic disease with multiple lesions on my liver, spleen and left adrenal gland. Within two weeks I started an IL-2 regimen at Johns Hopkins Medical Campus is Baltimore Maryland under the careful watch of Dr William Sharfman. After two courses of treatment, I had another CT scan that shows some signs of shrinkage and other signs of new development and growth. The official result is tumor progression and IL-2 is alone is no longer being offered. I've learned of new options including one trial called Adoptive Cell Therapy run by Dr Steven Rosenberg at the National Cancer Institute. In an attempt to get as many options on the table as possible, I traveled to Pittsburgh and met with Dr John Kirkwood at the Hillman Cancer Institute. Here I learned of more excited treatments including a cancer vaccine that targets the Gp100 antigen and a new experimental drug that is administered with High Dose Interferon. This was especially interesting to hear since outside of clinical trials, Interferon is not FDA approved for treating metastatic melanoma. I'm now in a research period where I need to weight the pros and cons and figure out which treatment to take. I'm blogging out my experiences to keep my friends and family up to date at www.sMelanoma.com. 

Unknown

Melanoma Missionary

posted by Jimmy_B on 8:03 am

Good Information for Melanoma and different Therapies, web links

Melanoma_Missionary

Jimmy_B's Journey with Melanoma

posted by Jimmy_B on 12:07 pm

Hello, my name is Jimmy B. I am a family man with a lovely wife Dee and two children Jess and Christopher. Here is my story of Melanoma.
Last July (2005)I was riding my bicycle to work at the Eastman Kodak Research Labs about 3 miles from home. I was wearing a knapsack to carry my things to and from the labs. I started noticing an ache on my back. I asked my wife to take a look at it. It was just a mole. So I decide to go to the dermatologist. To make the log story short, it was cancer. It took about a month and a half to get it biopsied . (Sept. 26 2005) I contacted a surgical oncologist and on October 27 2005 I had a wide incision to remove the tumor off my back. I also had a PET scan and a sentinel lymph node biopsy done and it showed no cancer except the localized one on my back. I knew from my research that I would be needing adjuvant therapy. So I started communicating with Sloan Kettering, University of Pittsburgh Cancer Center, and a couple of others including the Wilmot Cancer Center at Strong. They all recommended to start with Interferon treatment. In the meantime, my back got infected and it took until Feb. 14 2006 to heal. On March 6 2006, I started the High Dose Interferon treatment that was to last 4 weeks with daily infusions. The treatment lasted only 2 ½ weeks because my blood sugar went completely out of control. I also have type 2 diabetes.About 2 weeks after the interferon treatments, I noticed my right lymph node growing to golf ball size and they were aching. I had them biopsied (April 4 2006) and 9 out of 11 nodes were cancerous. On April 24th , I had my lump nodes removed under my right arm. This had move me from a stage 3 to a stage 4. The cancer was spreading quite rapidly. Strong did not have any specialists in the field of malignant melanoma. So, I was in contact with Dr. John Kirkwood in Pittsburgh. So with my oncologist approval, my wife and I went down to Pittsburgh and had a consultation with Dr. Kirkwood (June 12, 2006) Kirkwood wanted another PET scan (June 16 2006) to see if the cancer was contained to my lymph nodes. The results showed 4 tumors on my back, one under my right arm, and two spots, one in each lobe of my lungs. It wasn’t good.So, On July 10, 2006, I started my clinical trial of Dicarbazine and Patrin cycle 1. Each cycle is 21 days. On day 3, I am injected with dicarbazine at the Hillman Cancer Center in Pittsburgh. On the 11th day I go back to have a check up. Twice a month I traveled to Pittsburgh at least with this trial. I started my 2nd cycle on July 31 2006. On August 17 I had a CT scan and the report showed new tumors in my lungs so they stopped the Dicarbazine trial.On September 6th, I had another CT scan and MRI for the next trial which was Anti-CTLA-4. On September 13 I had my first infusion. On October 8, 2006 My wife noticed two new growths on my back. It was confirmed on October 11th it was new tumors.Dr. John Kirkwood has decided that IL 2 Interlukin 2 would be next course of action. I have completed another round of tests (CT scan, Pulmonary Function, and a Nuclear Stress Test). The CT scans shows 40+ nodules in my lungs ranging from 15mm to less than 5mm.
I am slated to be High dosage IL-2 on November 1st 2006.
I am presently washed out an IL-2 clinical trial that started in November 1, 2006. On the fourth cycle I had a heart attack and the doctors determined to abort the IL-2 on February 2, 2007. On August 23 2007 there was no change to the tumors in my back or lungs but also no growth. In October 24 2007 I got the word that the tumors and the lung nodules were shrinking. In April 14, 2008, the 40 + nodules in my lungs decrease to 2. In July 2008, the nodules in my lungs were undetectable and the ones on my back were all but one gone. Presently, CT and MRIIn November 2008 show no signs cancerous activity. I am stabilized for the time being.
 
In my carepages, I have included  articles and clinical trials that I have gone though. There is alot of Medical information on my carepage to help others. We are all in this together.
www.carepages.com
cp: jimmybreitfeller
 I am presently under the care of Dr. John M. Kirkwood at the Hillman Cancer Centre in Pittsburgh.
If you want to know more,please log onto my carepage. Thanks and keep your chin up

“ Just Diagnosed With Melanoma………Now What ? “

posted by Jimmy_B on 11:39 am

                            The ‘phases’ that most melanoma patients seem to go through (in this author’s opinion) are: DISCOVERY, DIAGNOSIS and finally TREATMENT. These ‘phases’ very closely linked to physician visits when the information about melanoma diagnosis and treatment are shared with the patient. While superficial melanoma treatment is fairly straight forward, more advanced stages of melanoma (again in this author’s opinion) require more physician and patient interactions (“visits”) especially in the DIAGNOSIS and TREATMENT “phases”.The following Question / Answer format will help you find the information you need about your diagnosis and treatment as well as provide you with links to important sites for more information on melanoma.
• Important 1st Visit (Discovery Phase) Questions to ask your Physician
o Why do you think I have melanoma? o What is MY melanoma Stage ? (Has it been determined?) o Do I need more tests to determine MY Stage ? o If I need more tests – what tests are they ?
Possible Tests that you may undergo
• CT Scan - looks for melanoma in abdomen (bowel + liver) and chest (lungs and lymph nodes)• PET Scan – looks for ‘metabolically active’ areas in the body which may be melanoma • MRI Scan – Used (primarily) to determine if the brain has any melanoma involvement• Bone Scan – uses radioactive material to find if any bone involvement with your melanoma• Blood Work – non-specific indicator that melanoma maybe involved in several organ systems• Sentinal Node Biopsy – looks for involvement of lymph nodes that melanoma may spread to from its primary site• Ultrasound – use of sound waves to try to make a diagnosis of melanoma (usually in solid organs)
Simplified Staging Guide to Melanoma*
Stage 0 In situ melanomaStage I No ulceration (< 1mm depth)Stage II 1- > 4 mm depth (with or without ulceration)Stage III Lymph node involvementStage IV Distant mets to skin, subcutaneous or lymph nodes; or mets to any visceral Organs (lung / liver / brain / bone / etc)
* American Joint Committee on Cancer Staging System for Cutaneous Melanoma J Clin Oncol 2001; 19:3548-3636. Lippincott Williams & Wilkins. Why do you need to know your melanoma Stage ?
• It determines if you need a surgical approach to your melanoma• It determines if you need further testing during your surgery (sentinal node biopsy)• It determines if you will need adjuvant therapy after surgery• It determines if surgery is not indicated and other therapies (gamma knife / bio-chemotherapy etc) is needed in the place of surgery
Important Tip #1
As it is most likely that you have been in some ‘shock’ given the discovery of melanoma, it is important to bring another person with you to take notes on what is said or suggested during this 2nd physician visit. These can then be reviewed after the visit.
• Important 2nd Visit (Diagnosis Phase) Questions for your Physiciano What is MY Stage of melanoma ? (and what does that mean)o Given my Stage of Melanoma, what are you recommending will my 1st treatment (or surgery ) be?o Will my surgery / medical treatment be done here or at another center?
Simplified Melanoma Staging / Treatment Plan ChartStages of Melanoma
Stages of Melanoma Treatment Plan(s)
Stage O (in situ) Excision
Stage I (primary < 1mm) Excision (Some centers will do CXR lab work)
Stage II  (deeper invasion) Excision + SNB? * Adjuvant therapy
Stage III  (LN involvement) * Excision? * No therapy? * Adjuvant therapy
Stage IV (Diffuse melanoma) * Depends on site(s) Involved? * Surgery vs. Biochemo,? * Radiation, gamma knife, etc

* Note that all the these therapies are somewhat controversial as to which is the “RIGHT” therapy for advanced stage melanoma patients.
Important Tip #2
Before starting any surgical or treatment plans (and ESPECIALLY in more advanced disease in which treatments maybe more controversial) – you need to understand your diagnosis and all the various options for your Stage of melanoma. In other words, before you undergo ANY treatment, you need to do YOUR homework and understand YOUR options before deciding with your physician (usually at a 3rd visit) what the plan for YOUR melanoma treatment will be.
• Important Information You want to find answers to when doing YOUR Homework” prior to your 3rd (Treatment Phase) physician visit
• What seems to be ‘consensus’ for YOUR stage of melanoma ? o Excision, sentinal node biopsy, lymph node removal, etc• What seems to be ‘controversial’ for YOUR stage of melanoma ? o No therapy, adjuvant therapy, radiation, bio-chemotherapy, etc• How do the major melanoma centers approach YOUR stage of disease ? o What is their ‘rationale’ for their suggested therapy• Are the only options for YOUR stage of melanoma ‘clinical trials’ ? o This may apply primarily to advanced stage patients who have already undergone surgery / therapies and are having recurrence of melanoma  Where to go to starting getting the information YOU needWebsites for Melanoma Informationwww.nccn.org – National Comprehensive Cancer Networkwww.Cancernet.nci.nih.gov – National Cancer Websitewww.cancer.gov/cancerinfo/wyntk/melanoma – NCI sitewww.melanoma.org – Melanoma Research Foundationwww.mpip.org – Melanoma Patient Information Pagewww.skincancer.orgwww.melanomacenter.orgwww.clinicaltrials.org
The Two Minute drill in Melanoma Cancer and Care
Take Care

 

You're listening to Patient Power sponsored by M. D. Anderson Cancer Center

posted by Jimmy_B on 11:32 am

You're listening to Patient Power sponsored by M. D. Anderson Cancer Center.
Treatment for Melanoma
Andrew Schorr:
Welcome back to our live webcast. We're going to spend the second half hourtalking all about treatment. What's standard therapy? Where do we go fromthere? Now, you we understood from Dr. Hwu, who is our guest with us, who ischairman of the department of melanoma medical oncology at M. D. Andersonabout surgery and hopefully that's it for a lot of people, but unfortunately there arepeople where that isn't it. And then we need to go on, as you started to say, Dr.Hwu, to systemic therapy. So help us understand what that's all about and whatsome of the options are. And we've been getting in questions from people whohave more advanced cancer, like stage IV, and want to understand what's availablefor them as standard therapy and also where your research is headed that youmight offer people in clinical trials.So, first, help us understand the standard approaches that you have available.
Dr. Hwu:
Okay. So as we were talking about if the disease has spread to the lymph nodesbut nowhere else we can remove the lymph nodes, and then the standardtreatment in that setting--it's called adjuvant therapy--is interferon alpha. And thatworks by stimulating the body's immune system to try to stimulate those immunecells throughout the body to try to rid the body of tumors that might be hiding outin different areas of the body. So that's the standard treatment.The cutting edge clinical trial that we have is using vaccine therapy, and that's away to more specifically stimulate the body's soldiers called T cells. And with thosevaccines we hope to increase the number of those circulating T cells in the body tothen go out and seek potential tumor hiding out. Those vaccines are best used, Ithink, at early stages where we're trying to prevent a recurrence.Now, you mentioned that some patients come with more advanced disease such asalready spread to the lungs, to the liver or other parts of the body, and in that casewe would go with other systemic therapies. The standard therapies in this case arechemotherapies. The one that's FDA approved is called dacarbazine. That's anintravenously administered drug. There is also an oral form called temozolomide.And those are the standard agents that we use for disease that has spread to otherparts of the body.However, many times it doesn't work well, and if we see a regression of disease it'snot long-lasting. So we have a couple of broad therapeutic approaches that we'reworking on at this point. One is to stimulate the body's immune system, and theother is to try to understand these signals that are turning that tumor on and thenturning them off with appropriate medications. First I guess we can talk about theimmune therapies.
Andrew Schorr:
Sure. Now, I just want to go over something so everybody understands. So whenyou develop cancer, inappropriate cells, your immune system has let you down,because I always have this image of like a bug zapper like you might have in thesummertime out on your back porch that's trying to kill those bugs that would beundesirable. Well, in a sense isn't our immune system, maybe our T cells too, likea bug zapper, in a way, looking for errant defective cells and getting rid of them,clearing them out, and when we develop cancer our immune system let us down,was blinded somehow?
Dr. Hwu:
Yeah. We basically have an immune system to fight against viruses and bacteria.That's why we evolved an immune system. And the trick about our tumor thatmakes it so hard for the immune system is the tumor comes from our own cells.So usually the immune system is trained not to attack our self, so when the selfgoes back and becomes a cancer that sometimes confuses the immune system.It's possible that many times the immune system is successful at killing thatcancer. Of course we would never see those patients in the clinic because theywouldn't have cancer. So it's possible that all the patients we see to some extentthe immune system has failed to recognize that cancer and that's why the cancer isgrowing.
Andrew Schorr:
So there you are. You have immunotherapy you're working on to get the immunesystem going again or to recognize the cancer it missed the first time. So take usthrough where you are now in helping either retrain the immune system or giving ita helping hand.
Dr. Hwu:
So our standard therapy to stimulate the immune system is with Interleukin 2.That is a natural protein made by our body's immune cells that stimulates andactivates any immune cells that are there. So that therapy can actually causeregression of diffuse metastases sometimes lasting a long time, even years. Andthat's probably because when we can get this therapy to work it probablystimulates what's called memory cells, and those memory cells stay around foryears and years can continually battle that tumor from coming back.The issue with that therapy, though, is that it works about 15 percent of the time,meaning 85 percent of the time we don't see a response, and we're trying to figureout who it works with and who it doesn't, but we don't know that at this point. Andit can be quite toxic. We have to give that in the intensive care unit. Althoughpatients that have a good performance status, meaning they don't have otherdiseases, can often tolerate the Interleukin 2 therapy. But the reason we give it isbecause if we can get it to work it can work for a very long time. But our goal is toget immune therapies that work in more patients of course. So we're trying anumber of clinical trials at this point.
Andrew Schorr:
Take us through some of that.
Dr. Hwu:
Well, one kind of therapy that we have is a combination of chemotherapy withInterleukin 2 and interferon all together. That's called biochemotherapy. We thinkthat stimulates the body's immune system because the chemotherapy destroys thetumor and probably releases antigens, and then we drive that immune responsewith the natural proteins Interleukin 2 and interferon. That treatment is alsoassociated in some settings with disease free intervals that can last years, meaningthat patients can have no disease ten years out if it works in this setting. Theresponse rate is about 30 percent, with about half of those lasting at least for anumber of years.Our most recent therapies involve T cells. In every melanoma tumor lesion thereare some immune cells trying to do the job. They are in the tumor but obviouslythey're not doing a good enough job because the tumor is growing. So what we'velearned to do is take those tumors, grow out the immune cells in the laboratory tobillions, and then give them back, along with Interleukin 2. We call that T celltherapy. And the response rates to that have been in the order of 50 percent. Sothat's really the most effective therapy that we have to date for disease that hasspread, (metastatic melanoma).We hope to try to improve the duration of the responses that we're seeing andmake it more effective and less toxic. It's another therapy--because it's given withInterleukin 2, it that has to be given in the intensive care unit as well. So we'reworking on ways to improve this therapy and we're also trying to generalize thesescientific principles to other kinds of cancer such as breast cancer and colon cancer.Vaccine Therapy
Andrew Schorr:
Some people have heard about vaccines that have been in development formelanoma, and some of the early ones just haven't panned out. You still have faithin vaccines. Where are you at M. D. Anderson with that, maybe later generationsof vaccines that could help lower the risk of recurrence of melanoma?
Dr. Hwu:
That's a good point. I think there are many different flavors of vaccines, and manyof the vaccines that have already undergone big trials were developed 20 or 30years ago, so they're not our latest. We've learned a lot about the immune systemsince then, and so that allows us to really be much more molecular and targeted inour ability to stimulate the immune system. We've learned exactly what theimmune cells can recognize on a melanoma, and we've made those molecules inlarge numbers, and we give those to patients as vaccines, and I think it'spotentially much more effective in stimulating the body's immune cells.We do know that if we compare the patient's circulating immune cells before orafter the vaccine we see in the vast majority of patients a lot more immune cellsthat can recognize and kill the tumor after the vaccine compared to before thevaccine. So we have a lot of hope now for our current generation of vaccines thatstimulate the body's immune response.We're also giving vaccine helpers, called vaccine adjuvants, that simulate viral orbacterial infection. Because that's why we have an immune response. Our immunesystem gets very activated when it thinks there's a virus or bacteria. When you getthe flu the reason you have a fever is not because of the flu it's because of yourimmune response against the flu. So we're taking little bits and pieces that looklike viruses and mixing them also with our vaccines to try to trick the body intothinking that there's an infection going on, and hopefully we can then harness thepower that the immune system has normally against viruses and bacteria andtrigger that against the tumor.
Andrew Schorr:
Dr. Hwu, I'm going to fire some questions at you that we've been getting in, butjust one last thing to put it into perspective to folks. Some of the approachesyou're talking about are going on only at M. D. Anderson as you help lead the wayin research, right? So if somebody chooses to come to M. D. Anderson and hearabout clinical trials, sometimes these are trials that are just starting at M. D.Anderson, have not gone around the world yet. Is that right?
Dr. Hwu:
Absolutely. Many of the studies that we're doing are just offered at M. D. AndersonCancer Center. We have a vast variety of studies. Some of them are standardtherapies that can be obtained at other places, but we have a large menu of choicesthat we can tailor to a patient's own individual needs and many of those are onlyavailable here, such as our T cell therapy trial.
mdanderson.org/patientpower© 2008 M. D. Anderson Cancer CenterMDA050608/0514/AS/jf All Rights Reserved
 I hope I don't getting in trouble for posting it. It is not like I am making money off of it. I am just trying to spread the word.
If you need help, Do your HOMEWORK
A stage 2 can turn into a stage 3 and then a stage 4. The path that you take may or may not lead you in the right direction, So please, do your HOMEWORK.

Next Generation of Immunotherapy for Melanoma

posted by Jimmy_B on 11:28 am

Next Generation of Immunotherapy for MelanomaJournal of clinical Oncology Jul 10 2008: 3445-3455
John M. Kirkwood, Ahmad A. Tarhini, Monica C. Panelli, Stergios J. Moschos, Hassane M. Zarour, Lisa H. Butterfield, Helen J. Gogas
From the University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, PA; and the First Department of Internal Medicine, University of Athens, Athens, Greece
Corresponding author: John M. Kirkwood, MD, Hillman Cancer Center, Research Pavilion, Suite 1.32, 5117 Centre Ave, Pittsburgh, PA 15213-2584; e-mail: kirkwoodjm@upmc.edu
Purpose: Immunotherapy has a long history with striking but limited success in patients with melanoma. To date, interleukin-2 and interferon-alfa2b are the only approved immunotherapeutic agents for melanoma in the United States.
Design: Tumor evasion of host immune responses, and strategies for overcoming tumor-induced immunosuppression are reviewed. Several novel immunotherapies currently in worldwide phase III clinical testing for melanoma are discussed.
Results: The limitations of immunotherapy for melanoma stem from tumor-induced mechanisms of immune evasion that render the host tolerant of tumor antigens. For example, melanoma inhibits the maturation of antigen-presenting cells, preventing full T-cell activation and downregulating the effector antitumor immune response. New immunotherapies targeting critical regulatory elements of the immune system may overcome tolerance and promote a more effective antitumor immune response. These include monoclonal antibodies that block the cytotoxic T lymphocyte-associated antigen 4 (CTLA4) and toll-like receptor 9 (TLR9) agonists. Blockade of CTLA4 prevents inhibitory signals that downregulate T-cell activation. TLR9 agonists stimulate dendritic cell maturation and ultimately induce a more effective immune response. These approaches have been shown to stimulate acute immune activation with concomitant appearance of transient adverse events mediated by the immune system. The pattern and duration of immune responses associated with these new modalities differ from those associated with cytokines and cytotoxic agents. In addition, vaccines are being developed that may ultimately target melanoma either alone or in combination with these immunomodulatory therapies.
Conclusion: The successes of cytokine and interferon therapy of melanoma, coupled with an array of new approaches, are generating new enthusiasm for the immunotherapy of melanoma