Melanoma is a tricky disease that often comes back when you least expect it. Just like a sneaky burglar who breaks into your house when you’re not looking, melanoma can hide in your body and then suddenly reappear. That’s exactly what happened to one of my patients, who thought she had beaten the disease years ago, only to discover that it had returned.
But here’s the thing: we now have a new weapon in our arsenal to fight melanoma, and it’s a game changer. It’s called immunotherapy, and it’s like unleashing an army of superheroes to attack the cancer cells in your body.
Traditionally, we used to operate on patients first to remove the cancer, and then we would give them immunotherapy to optimize their best chances of preventing the disease. A large, randomized study published in NEJM not too long ago by Dr. Eggermont et al. demonstrated a significant improvement in preventing relapses when compared to a placebo. Was it possible that we could improve upon this recently established new standard of care simply by changing the sequence of when we operate?
A recent study published in the New England Journal of Medicine has turned this approach on its head. The study found that giving patients immunotherapy before surgery can actually be more effective in preventing the cancer from coming back compared to waiting until after the surgical resection!
Think of your immune system as a team of soldiers fighting against an enemy army of cancer cells. Upfront surgery for stage 3 melanoma is like taking out most of the soldiers (lymph nodes) before the battle even begins. By doing this, you might weaken the team’s ability to fight the cancer army effectively. However, by using immunotherapy to activate the immune system first, it’s like giving the soldiers a powerful weapon (PD-1 inhibitors) to enhance their ability to recognize and kill the enemy before sending them into battle. This increases their chances of success and victory against the cancer army.
That’s exactly what we’re doing with immunotherapy. By giving patients a powerful drug that activates their immune system to attack the cancer, we’re creating an army of superhero immune cells that can seek out and destroy any remaining cancer cells in the body. And then, once the army has done its job, we can go in and remove any remaining tumor with surgery.
This approach has been shown to be 15-20% more effective in preventing cancer from coming back compared to the traditional approach of surgery first, then immunotherapy. That’s a huge difference, and it means that patients like my own have a better chance of beating melanoma for good.
Of course, like any superhero army, immunotherapy does come with its own risks and side effects. That’s why we always have a thorough discussion with patients to weigh the benefits and risks before we decide on a treatment plan. In my patient’s case, we decided that the benefits of using immunotherapy first were worth the risks, and we’re hopeful that she will continue to be cancer-free for many years to come.
So, if you or someone you love is facing melanoma, don’t be afraid to ask your doctor about the latest treatments and approaches. With immunotherapy, we’re turning the tables on cancer and giving our patients a fighting chance to beat this sneaky disease.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
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