Metastatic melanoma is definately one of the Cancers That Suck.
We basically have the same treatment options in 2010 as they had back in 1975… and not because we have chemotherapy/immunotherapy that works super great, no reason to change it. Our treatment options just suck, with horrible consequences– Say you have 100 friends that are diagnosed with Stage IV metastatic melanoma today. One year from today, only about 25, 26 of those friends will still be alive.
Out of 100.
Survive one year after diagnosis.
Maybe fewer (this paper Im reading says 25.5%, Wikipedia says 9-15%).
Melanomas expression of ERV proteins might help us develop new therapies/vaccines in the future, but weve got a vaccine available right now that, apparently, cures some Stage IV metastatic melanoma!
They had a study group of 50 people, Stage III to Stage IV (most were Stage IV)… 13 people were cured. “NED”– No Evidence of Disease.
Statistically, they should have been dead within the year.
How did they do this???
A modified Herpes Simplex Virus-1. Regular ol HSV-1 that we are basically all infected with, causes cold-sores in some people? Yeah, scientists gutted out some bits of it (keep it from going into neurons, make it need something cancers make lots of), added immune-stimulating bits (a chemical messenger that REALLY pisses off macrophages).
This modified virus was injected directly into melanoma lesions every two weeks for up to 48 weeks (24 doses). Now, remember these patients were metastatic– yes, they had ‘skin cancer’, but that cancer had spread, to the liver/lungs/anywhere.
Even though the virus was injected into the ‘skin cancer’, the liver lesions, the lung lesions– they were all killed too. Scientists aspirated where the lesions used to be, and all there was was necrotic tissue (dead cancer).
Here is an example of one patient:
Patient 703 was diagnosed in November 2004 with a 10-mm ulcerated lesion on her posterior left shoulder, which was followed by regional progression in August 2005. After three cycles of temozolomide, she experienced progression with retroperitoneal adenopathy, at five subcutaneous sites in the left and right shoulder, in the lung, and with indeterminate lesions in the liver. She received the first injection of JS1/34.5-/47-/GM-CSF in February 2006 into one deposit in the left shoulder only. Within 2 months, this became difficult to palpate. At 3 months, the liver lesions became more distinct and numerous on CT. Treatment was continued into the minimally palpable area until 8 months, by which time all lesions had resolved, including in the liver and lung (Figs 1 and 2). Biopsy of the injection site at injection 15 (the final injection) showed necrotic debris and residual ghost cells with extensive lymphocytic infiltration with follicular center formation. This patient remained off all therapy with no evidence of disease 40 months after her first dose of JS1/34.5-/47-/GM-CSF.
And it doesnt matter if you are already HSV-1 positive, this still worked.
And while 13/50 were apparently cured entirely, the overall 1-year survival percentage popped up from 25.5% (or 9-15% via Wikipedia) to 58% (58 of your 100 friends with metastatic melanoma are alive next year instead of 25), and 40% in the group with Really Really Bad Metastatic Melanoma.
WHY AM I JUST NOW FINDING OUT ABOUT THIS???
The immunology behind this vaccine for interested parties:
Nature paper from 2003 describing the modified HSV-1: