Wednesday, July 10, 2019

Melanoma patients and the development of additional cancers

Well, hell!  Sorry, Julie.  But, this one's for me and you!!!

Melanoma patients with additional primary cancers: a single-center retrospective analysis.  Dimitriou, Mangana, Curioni-Fontededro, et al.  Oncotarget. 2019 May 21.

Background: Recent progress in the diagnosis and treatment of primary and metastatic cutaneous melanoma (CM) has led to a significant increase in the patients` expectancy of life. The development of additional primary tumors (APT) other than CM represents an important survival issue. Results: Of a total of 1764 CM patients, 80 (4.5%) patients developed APT. For tumors diagnosed after CM, there was a 2.7 fold excess risk for APT compared to the swiss german population. A significantly increased risk was noted for female breast (SIR, 2.46), male larynx (SIR, 76.92), male multiple myeloma (SIR, 11.2), male oesophagus (SIR, 10.8) and thyroid on males (SIR, 58.8) and females (SIR, 38.1). All thyroid cancer cases had a common papillary histological subtype and a high rate of BRAFV600E mutation. Melanoma was the primary cause of death in the vast majority of patients. Methods: We used the cancer registry from the Comprehensive Cancer Center Zurich (CCCZ) and retrospectively analyzed patients with CM and APT between 2008 and 2018. We calculated the risk of APT compared to the Swiss German population using the standardized incidence ratio (SIR). Conclusions: Patients with CM have an increased risk for hematologic and solid APT. Long-term follow-up is indicated.

So, in this review of 1,764 patients with cutaneous melanoma, 80 of them (4.5%) developed additional primary tumors.

If we had to "beat" the odds, Julie, then why couldn't we have been one of Bernie's top 5% wealth mongers rather than part of this cancer co-op??????!!!!!  Bahaha!!!  Oh, well.  Though we don't like, we can deal, right???  Despite our sucky odds, there is beauty...

...still.  Wishing you my best, my friend.  Much love and shalom, les


  1. Unfortunately my husband fits in this category also. Both bladder & prostate cancer in last 18 months. We just found out yesterday that melanoma was found in a Lymph node after a 4 year response from Yervoy. We are now in talks with the Doc with what his next treatment options should be. Any suggestions.

    Thank you, Jewel

  2. Sorry that the two of you have had to endure more crap-ola!!! You'd think melanoma would be enough, right??? I put my thoughts for him up on MPIP, but will copy them here as well for you or any others who may be in need:

    Sorry you are dealing with all of this Jewel and Ken. I put together a primer a bit ago about melanoma treatments and it still holds for the current FDA approved standard of care treatments and explains a lot of what I would be thinking about if I were in your shoes:

    Tumor testing for genetic mutations is important. BRAF status will determine whether targeted therapy is an option, so that is a must do and really should have been done on his prior tumors - you can check and see if they did it. But given any melanoma patient who has progressed on or after standard treatment...and even more so given Ken's development of additional cancers....tumor testing for even more unusual mutations would be super important. For instance, Maureen's husband (of this board) is being successfully treated for his melanoma, after finding no positive results from standard remedies, with a drug usually used for HER-2 breast cancer:

    Given that Ken's tumor is in an isolated node, he sounds like an excellent candidate for an intralesional (or intra-tumoral injection ) treatment. They are covered in my "primer". The patient must have a tumor that is accessible for injection and it sounds as though he does. There are several different types and we have learned that they work best when combined with a systemic therapy like nivolumab (Opdivo) or pembrolizumab (Keytruda). There are a growing number on this board who have done well with them. Just below your post is the latest example: Here are a ton of reports that I have put together re intralesionals from my blog:

    Radiation is a very good option for localized melanoma when combined with immunotherapy. So that may be a good way to go. That is covered in the primer, but here are lots of additional reports:

    The ipi/nivo combo is a good idea as well. It has the highest response rates going among immunotherapy. It could also be combined with radiation so that would certainly be something to consider.

    Beyond those more "approved and usual" approaches there were these out of ASCO this year:

    Things like TIL and IL2 are out there as well. However, I would probably be looking at some of the options above as first line choices. However, it never hurts to discuss all potential treatments with your doc. Hope this helps. The search bubble here and on my blog are very helpful. Melanoma sucks great big green stinky hairy wizard balls, but there is hope!!! Hang in there. Ask more questions should you have the need and I'm sure the Edster will chime in with an appropriate vid or three. I wish you both my best. Celeste