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Melanoma Survival Rates Haven't Budged in 30 Years

Grim outlook for a deadly disease revealed at cancer meeting

SUNDAY, May 15, 2005 (HealthDay News) -- Despite dramatic advances in the fight against many types of cancer, one form of the disease seems to have eluded almost all attempts at treatment.

The survival prospects for those with advanced melanoma have not improved over the past three decades, despite scientists' best efforts, according to research presented Sunday at the American Society of Clinical Oncology annual meeting in Orlando, Fla.

"There has not been a substantial change in survival with metastatic melanoma. This is very true," said Dr. Vijay Trisal, an assistant professor of surgical oncology at City of Hope Cancer Center in Duarte, Calif.

"It's disappointing, but it doesn't surprise me," added Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

Neither Trisal nor Lichtenfeld were involved with the study.

Melanoma, a form of skin cancer, is one of the deadliest and most aggressive of all cancers. According to the American Academy of Dermatology (AAD), the incidence is increasing at a steady clip: one in 62 Americans now have a lifetime risk, which is a 2,000 percent increase from 1930.

"The rate of rise of melanoma is immense," Trisal said. "It is the fastest-growing cancer we see in the U.S."

While there have been some improvements in the treatment of stage I and II melanoma, Trisal added, melanoma that has spread has been more intractable.

According to the study authors, only 35 percent to 50 percent of people with stage III melanoma and 5 percent to 10 percent with stage IV disease will achieve long-term survival. And surgery, they stated, is still the only treatment that has "stable and predictable success."

The only chemotherapy that works is interferon, and that has, at best, only a 15 percent to 20 percent response rate. "That means tumor shrinkage. It's not a cure rate," Trisal noted.

"We have produced a lot of adjuvant therapies, but they don't work," acknowledged study author Dr. Shawn E. Young, a surgical oncology specialist at the John Wayne Cancer Institute in Santa Monica, Calif. Adjuvant therapies refer to treatments given to a patient after the initial treatment, which is usually surgery.

For this study, the researchers identified 822 patients who had been diagnosed and treated for stage III melanoma as defined by the American Joint Committee on Cancer.

None of the participants had been involved in experimental protocols such as melanoma vaccine trials.

The researchers found no differences in survival except in the most recent group of patients, and that may have reflected improvements in staging rather than any real survival differences, Young said.

The finding stands in stark contrast to other cancers. But, as Trisal pointed out, the major advances in breast and colorectal cancer, along with other malignancies, have occurred with chemotherapy, radiation or biological therapies.

In melanoma, there are no such proven treatments.

"You sow a seed and you see the fruits of that coming out 15 years later, 10 years later," Trisal said. "I think the amount of research that went into melanoma development 15 years back was minimal. We had not recognized melanoma as a serious threat."

Experimental therapies, such as vaccines, are so far not showing the promise experts had hoped.

On the positive side, however, melanoma is both preventable and detectable. When caught early, the five-year survival rate is at least 91 percent, according to the AAD.

"It is highly detectable," Trisal said. "That is where the big difference is. With stage III breast cancer, there is still a reasonable chance. With melanoma stage III, there is very little chance. Stage I or II detection is the most important thing."

More information

The American Academy of Dermatology has more on melanoma.

SOURCES: Shawn E. Young, M.D., fellow, surgical oncology, John Wayne Cancer Institute, Santa Monica, Calif.; Vijay Trisal, M.D., assistant professor, surgical oncology, City of Hope Cancer Center, Duarte, Calif.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; May 15, 2005, presentation, American Society of Clinical Oncology, Orlando, Fla.
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