The Future of Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

The future of breast cancer treatment

The next 20 years will bring more targeted therapy for the treatment of advanced breast cancer, and will most likely see a decline in the use of chemotherapy.

Special drugs will continue to be developed that attack special “targets” that exist only in breast cancer cells. These drugs, we hope, will spare the patient’s normal cells, thus avoiding many of the side effects we have come to expect from chemotherapy.

Drugs with names like PARP inhibitors and MTOR inhibitors will become part of our everyday language, and more drugs that target HER-2 like trastuzumab will be released in the very near future.

Twenty years from now, many things about breast cancer treatment will have changed again. Tomograms may replace mammograms as the standard method of breast cancer detection,surgeons may not need to remove lymph nodes at all, and radiation therapy may become shorter in duration. Perhaps chemotherapy will have become a thing of the past.

Whatever the case, treatments will be better, more patients will be cured, and in every respect, there will be less suffering for patients at every stage of treatment.

Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.

Watch conference presentations from the 2011 Life After Breast Cancer conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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More Advances in Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

Advances in surgery for breast cancer

Surgeons began using a technique in the mid-1990s called the sentinel node procedure to evaluate whether a breast cancer has spread to the lymph nodes under the arm.

For almost a century, the standard of care included removing a large number of lymph nodes from the underarm of most breast cancer patients in an operation called an axillary dissection. This procedure left many patients in pain, disabled, or with a swollen arm.

The sentinel node procedure allows the surgeon to detect the first lymph node in the underarm. If that lymph node contains no cancer, then the surgeon doesn’t need to perform the axillary dissection: if the first lymph node is cancer-free, the other lymph nodes will almost always be free of cancer as well.

Using this technique, hundreds of thousands of patients have avoided unnecessary axillary dissections.

Advances in radiation therapy for breast cancer

Radiation treatments for breast cancer, particularly in those women who do not choose a mastectomy, have also advanced during the last 20 years.

Partial breast radiation describes several techniques in which the radiation is applied only to the portion of the breast where the cancer was found, rather than the whole breast. Until recently, whole-breast radiation had been the standard of care. Partial breast techniques are not appropriate for all women, but are being offered to patients with increasing frequency.

At the present time, radiation oncologists are exploring more targeted, shorter treatment periods in the hope that many patients can finish treatment in as little as three or four weeks, rather than the current six or seven.

Adjuvant therapy for breast cancer

Most women who have early stage breast cancer have adjuvant therapy after surgery.

Adjuvant therapy describes drug treatments that are given for a period of time after surgery in order to reduce the risk of recurrence or spread of the breast cancer.

Patients may receive several months or years of adjuvant therapy in the form of chemotherapy, hormonal therapy or both.

The most significant advance in the adjuvant therapy of early stage breast cancer came in 2005 in the form of a substance called trastuzumab, or Herceptin®. Trastuzumab is an antibody that attacks HER-2, a protein that is present in large amounts on certain breast cancer cells.

Only 20 percent of breast cancer patients are HER-2 positive (have too much of the protein), but these cancers can be very aggressive and spread quickly and often. Patients treated with this antibody for a year, along with several months of chemotherapy, reduce the risk of their cancer spreading by 50 percent.

Nearly every patient with HER-2 positive invasive breast cancer now receives trastuzumab in addition to chemotherapy..

In 2006, we began using a special test called the Oncotype DX® assay in patients who had cancers that were considered hormone-sensitive, particularly women whose hormone-sensitive cancers has not spread to the lymph nodes.

Oncotype is a diagnostic test that can provide information about the biological activity of the specific tumor. Along with other information, the test results can help in making decisions about whether or not to include chemotherapy in the treatment plan and indicate how likely it is that a woman’s cancer may return in the future.

For many years, patients with hormone-sensitive cancers that have not affected the lymph nodes received both chemotherapy and hormonal therapy. The Oncotype assay enables us to determine which of these women really need the chemotherapy and determine those who can do just as well without it.

Up to 50 percent of women with this type of breast cancer don’t need chemotherapy at all.

Hormone therapy for breast cancer

Even the way in which we use hormonal therapy for early stage breast cancer has changed.

Hormone therapy works by blocking the actions of certain hormones that may trigger cancer growth, preventing the body from producing hormones that may trigger cancer growth, or eliminate hormone receptor in the body.

For many years, the drug tamoxifen was prescribed for most women who had hormone-sensitive breast cancers and it was very effective in reducing the risk of recurrence or spread of the cancer.

In late 2001, we began to prescribe a new type of pill called an aromatase inhibitor. Aromatase inhibitors work better in women who have entered menopause at the time they are first diagnosed with breast cancer.

Tamoxifen remains the best choice for premenopausal women with early stage breast cancer.

Chemotherapy for breast cancer

Over the years, the use of chemotherapy for treating patients with early stage breast cancer has changed considerably.

In general, courses of chemotherapy are now shorter, lasting from 12 to 18 weeks instead of 24 weeks or even longer. Different drugs, particularly paclitaxel and docetaxel, are used in almost every patient who receives chemotherapy. Many of the most dreaded side effects of chemotherapy, particularly nausea and the risk of infection, have decreased considerably as a result of the changes we have made in the last 20 years.

Advances in treating advanced breast cancer

The treatment of advanced (metastatic or stage IV) breast cancer has seen drastic changes in the last 20 years.

Six new chemotherapy drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced breast cancer since 1992, and several other chemotherapy drugs used for other types of cancer are given routinely to breast cancer patients as well, with some success.

For patients with hormone-sensitive breast cancer, the aromatase inhibitors mentioned above have proven very useful, as has the drug fulvestrant.

Special compounds such as pamidronate, zoledronate, and denosumab are used routinely in women whose breast cancer has spread to the bones. These compounds are not cancer treatments, but protect the bones against the injuries that the cancer can cause.


Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.


Watch conference presentations from the 2011 Life After Breast Cancer conference.


Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Reiki for Cancer Patients

Kimberly Fleisher, MEd and Reiki master, is the founder and director of The Reiki School + Clinic in Philadelphia. She has been practicing Reiki since 1995.  Kim specializes in Reiki education, particularly in the healthcare field and is the team leader for Penn Medicine's Volunteer Reiki Program, providing Reiki sessions to patients receiving cancer treatments.

For patients undergoing treatment for cancer, the stress can be overwhelming. Finding tools that help you stay calm are invaluable. 

Reiki is a gentle therapeutic practice that originates in Japan. Reiki is facilitated through light touch and is an easy addition to most medical treatments to help many cancer patients handle the stress of cancer treatment.

If you or someone you love is receiving cancer treatment at Penn, you may be eligible to receive free Reiki sessions through the volunteer Reiki program. 

Here are five ways Reiki practice can help reduce stress during cancer treatment:

Reiki sessions are balancing.

After receiving a Reiki session, it’s not uncommon for the recipient to say, “I feel like myself again.” 

Reiki creates an opportunity for patients to restore inner harmony and a sense of connection with their inner selves that might seem lost during the whirlwind of cancer treatment. 

One cancer patient recently remarked after a session “…it connected me to a place inside myself that I forgot all about.”

Reiki sessions create a space for you to slow down and relax.

During a Reiki session, patients sit comfortably or lie down while the practitioner places their hands gently on or right above different areas on the body for several minutes at a time. During a Reiki a session, there is nothing that a patient has to do. It’s a space for the patient to rest, and to focus on their well being.

Zen Master Thich Nhat Hanh often refers to the importance of stopping as a way to cultivate inner healing:

“At first, ’stopping’ may look like a kind of resistance to modern life, but it is not... Humankind's survival depends on our ability to stop rushing. Stopping is not only to stop the negative, but to allow positive healing to take place.”

Reiki sessions are nurturing.

How often do you allow yourself the space to be cared for? During a session, patients are totally immersed in the experience of care through the light touch of the practitioner’s hands.

Most people report that sessions are very soothing and supportive. Whether someone learns Reiki practice to treat him or herself, or receives a session from a trained practitioner, the time spent practicing Reiki creates a nourishing space for healing. 

A patient noted: “It had a very calming effect on me. I could actually feel my body relaxing. I was able to let go of a lot of my anxiety.”

Reiki sessions are non-invasive.

Reiki is a completely non-manipulative and non-diagnostic adjunct to conventional care. A practitioner doesn’t press, poke or ask a patient to ingest something. They don’t talk about cancer, or how to fix cancer.  They don’t need to know specific information about your cancer treatment, or any other thing that’s going on with you, and they won’t touch you anywhere where you don’t like to be touched.

A Reiki practitioner simply places their hands on or slightly above your body in spots where you are comfortable being touched and they allow the session to unfold naturally. 

Reiki sessions promote well being while giving patients the opportunity to be completely in control of the session, empowered to receive only what feels good to them.

Reiki sessions can help with sleep and restoration.

Most people know that rest and sleep are critical components for allowing the body to heal. One of the most commonly reported benefits heard from clients is that Reiki sessions help them sleep better. 

People often find Reiki sessions restorative and rejuvenating. When you sleep better and feel rested, you feel better in general and are then more capable of dealing with life’s stressers. 

If you are interested in receiving a Reiki session while receiving chemotherapy or radiation therapy treatment at the Abramson Cancer Center, please notify your nurse.

View the 2011 Focus On Integrative Medicine and Wellness Conference.

Learn about other integrative medicine and wellness services offered at the Abramson Cancer Center.

To learn more about Reiki practice please visit Oncolink’s Reiki Basics.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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New Treatments in Chemotherapy for Mesothelioma

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Focus On Mesothelioma Conference. In this blog, she recaps the conference. You can view all the presentations from the conference here.

At the 2011 Focus on Mesothelioma Conference, Thoracic Surgeon and Conference Chair, Joseph Friedberg, MD, illustrated how the Penn Abramson Cancer Center’s multidisciplinary approach to cancer treatment extends to mesothelioma patients.

"Mesothelioma is not a disease for which there is one treatment,” he said, “It requires a team of experts using different modalities to develop the optimal treatment plan for each patient."

Advances in Chemotherapy for Mesothelioma

There are two major treatment approaches that are creating better outcomes for mesothelioma patients.

1. The use of more aggressive, innovative surgical techniques to treat primary pleural mesothelioma.
2. Greatly improved options for chemotherapy.

Oncologist James Stevenson, MD, associate professor of medicine, discussed ways in which patients of different ages, gender, backgrounds and stages of their disease have all benefitted from the personalized, multidisciplinary approach to treating their mesothelioma. Every patient receives multiple treatments and all have survived for a number of years. These patients are not exceptions or unusual anecdotes. They represent the kinds of patients and the results that clinical programs such as the one at the Abramson Cancer Center expect to obtain.

The introduction of the drug Alimta® (pemestrexed) has in Stevenson's words, "changed the landscape" for treating pleural mesothelioma.

Alitma is more effective and less toxic than drugs that were previously used, and can be combined with other drugs.

Alimta also has another unusual advantage: Many drugs used to treat cancer work well for a period of time and then become ineffective as the cancer develops resistance to the drug. Once a cancer becomes resistant, the drug no longer works. Alimta, however, can be used to induce a remission. A patient can discontinue treatment and have the option of going back on Alimta if the cancer recurs with a good chance that the drug will be effective again. Clinical trials are also under way to determine whether Alimta can be used for long periods of time as maintenance therapy, or as a means of controlling the cancer as a chronic condition.

Learn more about mesothelioma treatment at the Abramson Cancer Center.

Watch all the presentations from the 2011 Focus On Mesothelioma Conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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New Treatments for Mesothelioma Help it Evolve to Chronic Disease

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Focus On Mesothelioma Conference. In this blog, she recaps highlights from the conference. You can view all the presentations from the conference here.

Traditionally, mesothelioma has been considered a complex disease that is difficult to treat. But the experts at Penn’s Abramson Cancer Center emphasized the real potential for new treatments for mesothelioma at the 2011 Focus On Mesothelioma Conference.

While there is no cure for mesothelioma, new treatments for mesothelioma have advanced to the point that it can be managed as a chronic disease, one that patients live with for a number of years.

The importance of taking a healing approach, addressing the needs of the whole person through integrative medicine, and developing an individualized treatment plan were the dominant themes of the conference

Mesothelioma as a Chronic Disease

"I know what patients hear when they are diagnosed with this disease," said Joseph Friedberg, MD, thoracic surgeon. "They hear this is incurable and that there are no effective treatments, but we are changing that. We have many patients who are living longer, quality lives."

A key to this progress is the Abramson Cancer Center’s multidisciplinary approach to treatment. Experienced experts from a wide variety of fields including surgery, medical oncology, radiation oncology, pulmonology, pathology, radiology and a variety of supportive care fields care for patients with mesothelioma and pleural disease.

In his opening address to the conference, Abramson Cancer Center Director, Chi Van Dang, MD, PhD, recognized the Penn mesothelioma and pleural program as one of the most comprehensive in the nation and that it has the complete team of experts working together.

Each speaker echoed that same sentiment, urging patients to be seen in a center that has specialized expertise in the diagnosis and treatment of mesothelioma. When treating patients with mesothelioma or pleural disease, Penn Medicine pleural specialists offer more treatment options than most other health systems across the country and around the world.

Penn Medicine's Mesothelioma and Pleural Program and Penn's Abramson Cancer Center bring together internationally renowned experts in medical, surgical and radiation oncology and pulmonology who collaborate in the diagnosis, treatment and research of mesothelioma and pleural disease.

Learn more about mesothelioma treatment at the Abramson Cancer Center.

Watch all the presentations from the 2011 Focus On Mesothelioma Conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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What Happens After You Survive Childhood Cancer?

Melanie Gaffney is a proud childhood cancer survivor, and a contributor to the Focus On Cancer blog.

Today she is cancer-free, but lives with the after effects of her cancer treatments. In addition to being a mom and a wife, she operates a small marketing and graphic design boutique called Melanie Gaffney and also founded Mason’s Mission to raise awareness and funds for Chiari malformation research, a neurological disorder that affects her son. Read more about Melanie here.

Watch for Melanie’s blogs here, and connect with Melanie on Twitter.

For survivors of childhood cancer, the great news is that you survived cancer. But is that the end? Is it really over? Can you stop focusing on your health all the time?

Depending on the type of cancer and the treatments you received, probably not.
There are about 350,000 childhood cancer survivors in the United States. As survivors age, they can experience late effects and long-term medical complications as a result of the treatments that saved their lives.

Today, because of advances in treatment, about 80 percent of children treated for cancer survive five years or more. But the treatments that saved your lives can also cause health problems that may not show up until years later.

In fact, 30 years out, survivors are at more risk of dying from treatment-related illness than from cancer recurrence . Because childhood cancer survivors are living longer, their long-term health and these late effects are issues for most of their lives. Childhood cancer survivors’ aftercare and watchfulness for late effects must be as specialized as the cancer treatments they received as children. Late effects may involve more than one part of the body and range from mild to severe.

The main factors that contribute to possible late side effects include the types of treatment you received, the drugs used in chemotherapy, and the amount and location of radiation and surgeries.

This is why it’s important to find a great primary care physician and a multidisciplinary survivorship program.

Below are some of the effects childhood cancer survivors may experience:

• Bone density issues
• Thyroid problems
• Hearing loss
• Vision problems
• Dental problems
• Lung, liver or kidney problems
• Heart problems
• Fertility issues
• Second cancers
• Emotional issues
• Neurological issues

My Own Survivorship Journey
I didn’t realize I needed a survivorship program until my mid-twenties. I knew I had some physical limitations as a result of my childhood cancer, but I considered them to be minor. I was invincible! I truly believed that since I had beaten cancer, nothing else would ever happen to me. In some sense I felt I had paid my dues and could live like everyone else. This made sense to me as a teenager and sadly even into young adulthood. I ignored any and all signs that my body was telling me that I was, in fact, not invincible.

I was told that fertility and carrying a child may be an issue. Although I am sure other late side effects were probably mentioned when I was younger, these were the only two that I noted. So when I did get pregnant, to say I was totally shocked is an understatement. After the bliss and excitement of finding out I would have a baby came the rush of fear. My cancer came back to haunt me. The moment I remembered I wasn’t like everyone else was when I called my oncologist when most women are calling their obstetrician.

I was referred to the Living Well After Childhood Cancer Survivorship Program at the Abramson Cancer Center. After many tests, pokes and exams I received my first diagnosis of my late-term cancer treatment effects; heart disease (cardiomyopathy) due to chemotherapy, restrictive lung disease due to radiation therapy and an increased risk of breast cancer because of the amount and location of the radiation.

Like many survivors, I also faced some emotional issues like anxiety and dealing with the uncertainty that many cancer survivors deal with - the thought that my cancer may come back.
My life changed when I received my test results. Today, I try to spread knowledge and reach out to childhood cancer survivors about these late side effects. While fundraising for a cure and treatment is important, (without it there wouldn’t be survivors), there also has to be awareness and research to help support those survivors.

I am so excited to be attending the Stupid Cancer Boot Camp in Philadelphia on November. I can’t wait to listen to the speakers, learn more about survivorship and hopefully meet and share stories with other childhood cancer survivors.

The Abramson Cancer Center is part of the LIVESTRONG™ Survivorship Center of Excellence Network, a group of eight Comprehensive Cancer Centers that have been chosen to lead the effort across the country in clinical care and research with cancer survivors of all ages.

Learn more about the Living Well After Childhood Cancer Survivorship Program.

Learn about managing cancer treatment side effects.

Learn more about long-term follow-up guidelines for childhood cancer survivors.

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Patients Show Resilience in the Face of Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the last of a series of four blog posts.  

Bernie Parent addressed the Abramson Cancer Center's Focus On Melanoma Conference on the topic of resilience — overcoming fear with purpose. Judging by the warm reception given to former Flyer goalie, Parent's contributions to two Stanley Cup winning seasons in the mid 1970s have not been forgotten. 

But for me, the real meaning of resilience became clear listening to the patients who participated in the panel discussion that followed his talk.

As I listened to the four panelists, so varied in age and background, yet sharing a common diagnosis, I thought of the program that aired last year on SHOWTIME®, called "The Big C." It purported to be a brave, gutsy, straight-on look at what it means to face a diagnosis of stage IV melanoma.  The main character, a 40-ish school teacher in Minnesota, learns she has the disease and decides to change her life, But she accepts her fate based on a single chest X-ray from a single physician (who looks like he barely finished high school). She doesn't tell a soul, not her husband, her son or a best friend, nor does she seek treatment.  I watched it twice and it made me too angry to watch again.

The voices heard at the conference could not be more different than this TV creation.  These were people who were fighting their cancers. They had formed a tight partnership of trust and hope with their treatment teams and endured multiple painful and debilitating treatments.  Every one in their own way had found meaning in the struggle.  No one suggested that there was a simple formula for becoming and remaining resilient.  They spoke of grief, anger and denial, but also of love, determination and the strength they draw from what may seem like life's smaller joys: a card from a friend, playing catch with their son.  Regardless of the state of their disease, each was deeply grateful for a continued existence, and every one of them expressed profound appreciation for the support and love provided by their friends and family.
 
Alice, the youngest of the group, was only 29 when she was diagnosed five years ago, long after Parent's heroics on the ice. She attributed some of her resilience to a form of denial, to "refusing to believe in her own end" as she put it.  She summed up the feelings of the group, and of so many people who have traveled down the cancer pathway with these words.

"I learned that despite having cancer, life marches on.  Things are still happening around you, work, vacations, babies, weddings," Alice said.  "I learned to accept the reality of the disease as a part of my life, but not as something that defines me. I will give what is due, but I won't let it become who I am."

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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Delivering Personalized Medicine for Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the third in a series of four blog posts.  

One of the key concepts in medicine today is "personalized medicine."  What few people may realize is that the emerging ability to talk about individual profiles for specific cancers results entirely from the type of research being done by people like Jessie Villaneuva, PhD, and Robert Vonderheide, MD. Drs. Villaneuva and Vonderheide presented highlights of their research at the Abramson Cancer Center's Focus On Melanoma Conference.

In the last few years, it has become possible to begin identifying subsets of patients based on the molecular characteristics of their cancers, and tailor new treatments to match those specific profiles.

Identifying these molecular characteristics is critical in treating many cancers, and increasingly so in melanoma.  Mutations in the BRAF gene occur in approximately 50 percent of patients with advanced melanoma and provide a valuable target for new therapies.  These therapies, however, are only effective for those who have the BRAF mutation.  The same principle holds true for other less frequent mutations. 

Finding this target has major implications for both developing new drugs and for delivering treatment to patients with melanoma.  It means more drugs are needed to hit multiple targets and that new drugs are likely to be more potent and more specific.  They will work better and be less toxic but in smaller populations of patients.  It also makes it critical that patients be aware of the need to collect sufficient tumor tissue to allow for molecular profiling of their tumor so they can receive the therapies designed to work best for their type of cancer.  Tissue collection is vital both at the time of diagnosis and if and when metastatic disease occurs as cancers often change their genetic profiles as they grow and spread.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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Advancing Cancer Research

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the second in a series of four blog posts.

Cancer research has become increasingly complex.  It is almost impossible for even the most educated non-scientist to understand the incredibly intricate mechanisms that drive normal and abnormal cell growth, and the language used to describe these phenomena is essentially foreign to all but those trained in biology, chemistry and genetics.  But, as science becomes more difficult to understand, it is also becoming more important.  It wasn't all that long ago that basic and clinical research were considered two separate worlds. Today, the gap between the lab and the clinic is narrowing, and the path between them is a two-way street. 

The presentations of Jessie Villaneuva, PhD, and Robert Vonderheide, MD, at the Abramson Cancer Center's Focus On Melanoma Conference, made it clear just how important research is in advancing the treatment of melanoma, and cancer in general.

Dr. Villaneuva researches cancer at the Wistar Institute, an independent basic research institute located on the Penn campus.  For many years, Wistar has had a top melanoma research program and maintained a highly productive collaboration with the clinical researchers and oncology team at Penn Medicine. Wistar researchers have been among the leaders in identifying specific genetic mutations that regulate cell growth along complex pathways.  For melanoma, these "broken" genes include BRAF, PTEN and several other less frequent mutations.  As Dr. Villaneuva pointed out, understanding the precise mechanisms that turn cell growth on and off is leading to new therapies. 

Basic research at the Wistar Institute and other leading centers is also critical in tackling the problem of drug resistance.  The pattern is all too clear, and too predictable.  A new cancer-fighting agent is identified.  A substantial percentage of patients respond to the drug, sometimes dramatically. But at some point, the drug becomes ineffective.  The cancer starts to grow again as the malignant cells develop ways of eluding or circumventing the action of the anti-cancer agent. 

Dr. Villaneuva described the efforts under way to understand the molecular mechanisms that lead to drug resistance and develop the next level of combination therapies to anticipate and overcome this huge challenge to successful cancer therapy.

For decades, researchers have known that melanoma is in many ways influenced by the body's immune system.  Dr. Vonderheide characterized this as an ongoing struggle between "the immune system versus melanoma."  

Immunotherapeutic approaches to treating melanoma have been consistently intriguing, promising — and disappointing. Melanoma appears to be capable of "waiting out" the body's natural immune response.  But researchers keep returning to this area, and now with their remarkably increased understanding of the complexities of the immune system, their work is bearing rich new fruit.   Immunotherapeutic approaches are the heart and soul of the new agents that are emerging for melanoma treatment. 

According to Dr. Vonderheide, these new approaches can either accelerate or activate the body's natural immune responses against the abnormal cell growth of melanoma, or "hit the brakes," actually slowing down the immune response to allow more effective interventions with vaccines and other cellular therapies.  While the immunotherapy work is proceeding on multiple fronts, the most exciting results are in the area of monoclonal antibodies, including ipilimumab, and several other targeted therapies in early stages of clinical trials.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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The Relentless Fight Against Melanoma

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the first in a series of four blog posts.

Dr. Lynn Schuchter

Relentless. That word was used a lot at the Eighth Annual Focus on Melanoma Conference sponsored by Penn's Abramson Cancer Center (ACC). It was the word Lynn Schuchter, MD, used to describe Lorraine Gordon's quest to educate patients and physicians about melanoma and its treatment. Lorraine received the ACC Advocacy Award at the conference. *

Relentless. It has also been used to describe melanoma, a disease that for many years has resisted all attempts to improve its treatment and outcomes: until now. The clear message that Dr. Schuchter and her colleagues delivered to the more than 300 conference attendees is that the explosion of new knowledge and new treatments for melanoma are "changing the landscape" for patients at every stage of the disease: especially for those patients with advanced or metastatic melanoma.

Oncologists are rightfully wary about expressing too much enthusiasm for emerging new therapies. They have seen too many promising clinical trials end in disappointment. Physicians know that progress, when it does occur, is frequently measured in added weeks or months of life, not cures.  They are keenly aware that even the most positive results are tempered by the reality that behind every curve lurks the problem of acquired drug resistance, the seemingly inevitable ability of cancer cells to outsmart the approaches used to stop their growth.  But this time, the excitement is real. The optimism is grounded in the growing body of evidence from clinical trials that employ new knowledge and new agents.

As Dr. Schuchter's timeline indicated, progress has been frustratingly slow and elusive, dating all the way back to the identification of the first melanoma patient in the United States in the late 1800s.  In fact, not a single new drug had been approved by the FDA for treating melanoma in more than 20 years.  If surgery failed to eliminate the melanoma, interferon and interleukin, the mainstays of therapy for metastatic disease, were both highly toxic and limited in their effectiveness.

That scenario has changed dramatically in the last five years with the introduction and approval of three new agents with demonstrated effectiveness in treating advanced and high-risk melanoma.  The future is even brighter with the prospect of several new drugs currently in the research pipeline, two of which have reported remarkably promising results from clinical trials in 2011 alone.

The Value of Cancer Education

Just 20, or even 10 years ago, it was very difficult to find information about melanoma or its treatment. Today, the problem is no longer getting information; it is getting good information, and even more so being able to interpret it.  The value of an event such as the Focus On Melanoma conference is having an enormous amount of cancer information and education all in one place. The Focus On conferences, sponsored by the Abramson Cancer Center at the University of Pennsylvania, allows patients and families to get informed and interact with nationally recognized leaders in the clinical oncology and research fields.

A conference like this illustrates the ongoing, irreducible need for patients and their health care teams to interact, to communicate, and to merge information with perspective.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

* Lorraine Gordon is the wife of Roger A. Gordon, who lost his battle with melanoma. An educational fund was created in his name at the Abramson Cancer Center. Money from the fund was used to create a melanoma awareness brochure and treatment video.

Learn more about melanoma treatment at Penn Medicine.

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