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Pathways to Discovery: Spring 2012

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UChicago Expertise Makes a Difference for Melanoma Patients

More than half of our patients have some kind of clinical benefit now with the new therapies, which is extraordinary compared to where we were a few years ago.
—Thomas Gajewski, MD, PhD

As an aerobics instructor, Irene Cornwell knows how to motivate people to push their bodies to new levels. Her upbeat attitude proved invaluable during the most trying time in her life—when she faced cancer.

In 2005, the fit mother of three saw her family physician about a lump on her neck. A surgical biopsy revealed it was melanoma, the most serious type of skin cancer.

Within 24 hours of her diagnosis, Cornwell met with doctors at UChicago. A positron emission tomography scan revealed that the cancer was at Stage 3A, meaning it had infiltrated the lymph nodes. After surgery to remove the nodes in her neck, Cornwell underwent treatment with interferon, an immune therapy.

A Positive Outcome
The side effects were brutal. Flu-like symptoms and fatigue kept Cornwell in bed for 12-13 hours per day. What she said helped her morale was teaching water aerobics to senior citizens once a week.

She also credited the support of her family, friends, and employer, as well as her care team at UChicago. She recalled how her nurse coached her over the phone as she gave herself her first home injection of interferon.

Now, 7 years later, Cornwell, who lives in southwest suburban Frankfort, comes to UChicago for her yearly appointment and has maintained the status of "no evidence of disease."

She is one of the lucky ones. Since her cancer did not metastasize to other organs, she had a good shot at beating it. In patients whose disease has advanced
past the lymph nodes, however, surgery is not an option—and more aggressive
therapies are needed.

The prognosis has typically not been good for these patients, but that is rapidly changing. Researchers have made great advances in studying the tumor's biology
and understanding how it evades the host's immune system. Armed with that
information, researchers are able to offer effective new therapies.

New Therapies for Melanoma
Two breakthrough therapies for metastatic melanoma were approved last year— ipilimumab, an immune therapy, and vemurafenib, which inhibits the B-Raf enzyme involved cell growth. Researchers at UChicago contributed to the development of both of these drugs. The results are encouraging.

About half of advanced cases have the B-Raf mutation and can be treated
with vemurafenib. The majority of those patients see their tumors shrink, according
to research published in The New England Journal of Medicine last year.

With ipilimumab, only 10%-15% of patients experience tumor shrinkage but
about 40% of patients are alive at the 1-year mark, and 20% survive to at least 2

"More than half of our patients have some kind of clinical benefit now with
the new therapies, which is extraordinary compared to where we were a few years
ago," said Thomas Gajewski, MD, PhD, professor of medicine, who treated Cornwell.

He added that there are additional new drugs in development that may be even
more effective.

"We have to keep figuring out the reason why the tumor sneaks through so we know which new drugs to add," he said. The new melanoma therapies are a prominent example of personalized therapy, in which the treatment is based on the biology of the tumor, rather than a one-size-fits-all model.

Despite new therapies, Dr. Gajewski cautioned that melanoma incidence is on the rise. People with light hair, light skin, and light eyes are at increased risk for sunburn and sun damage mutations. Sunburn during childhood or teenage years seems to increase a person's risk for melanoma.

Cornwell, who is a redhead, remembered tanning—or burning—on Oak
Street Beach as a teen. "Nobody knew in those days," she said. "Now we know, and
we can take care of the next generation."

John and Irene Cornwell