Cancer: This War Is Personal

President Nixon declared a "War on Cancer" in 1971, the funding and will behind which paved the way for the establishment of an autonomous National Cancer Institute (NCI).

In the coming months, the Journal of Drugs in Dermatology (JDD) will provide more information on an “International Initiative for the War Against Skin Cancer” between the International Society for Dermatologic Surgery (ISDS) and the Skin Cancer Foundation (SCF), with an initial meeting in Nicaragua.

This issue of JDD includes a special focus on skin cancer, which is fitting, considering that the NCI estimates that there are about 11.4 million Americans alive today who have a history of cancer. Noting the 1,529,560 new cancer cases that were predicted for last year, the "good" news is that the five-year relative survival rate for all cancers is 68 percent, which is up from 50 percent in the mid-to-late 1970s.

Skin cancer is the most common form of cancer in the United States (U.S.), leading to over 3.5 million cases in two million people diagnosed annually.

As we know, the most common form of skin cancer is basal cell carcinoma (BCC), which affects approximately two million Americans each year; more that one of three new cancers are skin cancers—the vast majority of these are basal cell carcinomas.

Over 700,000 new cases of squamous cell carcinoma (SCC) are diagnosed every year, making it the second most common skin cancer. In terms of melanoma, the most serious form of skin cancer, 120,000 new cases are diagnosed each year.

Hope is On the Horizon

What is encouraging is that BCC and SCC are almost always curable when detected and treated early, although it is, of course, best to prevent in the first place.

As far as melanoma is concerned, encouraging patients to reduce their risk and to be alert for atypical moles is critically important. For those patients who present with melanoma or develop it, surgery is of course the main first-line treatment option; for more advanced disease, chemotherapy, radiation and immunotherapy are all part of our armamentarium.

Two new studies emphasize that patients at high risk for melanoma benefit from a follow-up program that can detect the cancer early.

Treatment Options

Recent clinical trial results suggest that an experimental drug (RG7204, aka PLX4032) that targets a malfunctioning protein produced by the B-RAF gene prolonged survival of patients with metastatic melanoma.

To assess whether the drug prolonged lives, Roche/Genentech (the manufacturer) was asked to compare survival on both arms of the trial (B-RAF drug and conventional chemotherapy). On January 19th, the FDA asked Roche/Genentech to conduct the analysis sooner than scheduled initially so that patients on the chemotherapy arm (dacarbazine) can cross over if the BRAF drug is clinically superior.

The manufacturer has initiated a Patient Access Program (PAP) at several cancer centers in order to make the drug available for melanoma patients with previously untreated metastatic melanoma who are not enrolled in the study.

In the meantime, a biologics license application (BLA) 125377 with the proposed trade name YERVOY (ipilimumab) was submitted to the FDA by Bristol-Myers Squibb (BMS) for the treatment of advanced melanoma in patients who have received prior therapy.

What may be encouraging to patients and dermatologists is that the Oncologic Drugs Advisory Committee Meeting that had been scheduled for February 9, 2011 was cancelled on December 30th because "the issues for which the FDA was seeking the scientific input of the committee have been resolved."

In addition, on January 25th, GlaxoSmithKline (GSK) announced the roll-out of two phase 3 studies in advanced or metastatic melanoma patients. These studies will assess the safety and efficacy of two investigational agents, GSK2118436 and GSK1120212, in stopping or slowing progression of skin cancer in patients whose tumors contain a B-RAF V600 mutation.

Cancer is personal so our battle against it must be personal, too, one we fight in our offices, in hospitals, in laboratories and in operating rooms.

Our weapons are not only the latest pharmaceuticals and radiotherapies but also the power of the human spirit, the battle for our patients' hearts and souls that we will never, ever let this disease win.