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“Maricle” on 34th Street

Melanoma_patientPenn Trials Shine New Light on Advanced Melanoma Treatment

The statistics on melanoma are staggering: it’s one of the fastest growing cancers in the United States and around the world, and the top cause of deaths related to skin cancer in this country.  The American Cancer Center estimates that more than 68,000 people were diagnosed with melanoma last year; 8,700 died from the disease.

Fortunately, there is new hope for patients with melanoma.

(Photo: Left to Right, Lydia Giles, BSN, Lynn Schuchter, MD, Joanne Maricle (patient), and Suzanne McGettigan, MSN, CRNP)

For the first time after a drought spanning 10 years, the FDA approved a new drug treatment for advanced melanoma -- Yervoy, a drug that stimulates the immune system to attack tumors. Additionally, several clinical trials using new agents that target a specific genetic mutation carried by some melanomas yielded unprecedented results in extending overall survival and improving quality of life in patients with advanced melanoma.

Finding the molecular mechanisms that drive melanoma development and progression are key targets for developing new drugs to combat this disease – and an important area of clinical research at Penn. In particular, identifying a broken BRAF gene, which acts as a stuck gas pedal driving tumor growth, led to targeted therapies that put the brakes on this process, bringing new hope to patients. “Up to 60 percent of melanomas harbor a BRAF mutation,” according to Suzanne McGettigan, MSN, CRNP, a nurse practitioner in the Abramson Cancer Center’s melanoma program.

Compared to systemic chemotherapy, which affects all rapidly dividing cells -- and often causes harsh side effects including nausea and hair loss -- BRAF-targeted therapies target only the cells with the mutated BRAF gene. This treatment can show amazingly fast results: “We’ve had patients that within a day of starting treatment noticed shrinkage in palpable lesions,” said McGettigan.

Penn currently treats approximately 450 melanoma patients a year. Joanne Maricle is one of them. Under the care of Lynn Schuchter, MD, chief of Hematology-Oncology, for five years, Maricle has participated in three clinical trials at Penn. “Dr. Schuchter always has multiple treatment options,” said Maricle. “Whenever it was time to move to another treatment, there was one available. She knows me, she knows my melanoma, and she knows what’s best for me.”

In the first trial, the Penn team took cells from Maricle’s tumor to generate a vaccine. In the second, Maricle received the now FDA-approved drug Yervoy (also known as ipilumumab), and in the third, she received an oral BRAF inhibitor, after determining that her melanoma contained the BRAF mutation. She has also used more conventional chemotherapies between the trials.

“Dr. Schuchter’s team is outstanding,” said Maricle. “There’s never a time that I call her that I don’t get a call back the same day, sometimes within a couple hours. There’s a sense of urgency about my care. I know I’m still alive because of them.”  After a rewarding career, Maricle is now retired and enjoys spending time with friends and her family: Ron, her husband of 35 years, her daughter living nearby, and her son who recently completed a year of service in Iraq. She is actively involved with Gilda’s Club Delaware Valley.

Schuchter and her team have helped Penn become a national leader in putting these new drugs to use in clinical practice, working with pharmaceutical companies and other cancer centers involved in national trials. The team -- which includes McGettigan, research coordinator Mary Carberry, clinical research nurses Joanne Ciconte, BS, CCRP, and Lydia Giles, BSN, and Ravi Amaravadi, MD, of Hematology-Oncology -- is currently seeking new patients with BRAF-mutated melanoma, and participants for clinical trials investigating the use of other targeted agents.  For more information on Penn’s melanoma clinical trials, go to http://www.penncancer.org/patients/clinical-trials/melanoma-trials/.


Note:

When melanoma is diagnosed early, and the cancerous cells stay only at the outer layers of the skin, the five-year survival rate is greater than 90%. Yet once melanoma has spread beyond the nearby lymph nodes, the average life expectancy drops to less than one year. Most melanomas are identified on the surface of the skin. Pay close attention to subtle changes in moles and seek a skin cancer screening by a dermatologist.

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