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Let’s change the conversation together and shed some light on #melanoma. #NotJustSkinCancer

Melanoma Awareness Campaign_IG1

A skin cancer diagnosis can be scary. This is especially true for those affected by melanoma, the deadliest form of skin cancer, which claimed the lives of over 1,150 Canadians last year. However, while a new survey shows that the majority of Canadians say they understand the severity of skin cancer and fear a diagnosis, personal anecdotes and online dialogue suggest a different mindset. Images and posts about excessive tanning have become increasingly prevalent on social media, with hashtags such as #SkinCancerHereICome and #SkinCancerDontCare, illustrating that for some, skin cancer is viewed as a slight danger rather than a life-threatening reality.

It is important to understand that not all skin cancers are created equal. There are three different types of skin cancers with varying degrees of severity, and while most can be cured if found and treated early, those that spread beyond the surface of the skin can be complex and difficult to treat.

For this reason, Save Your Skin Foundation participated alongside the Melanoma Network of Canada to develop #NotJustSkinCancer, a video to help shed some light on the very real challenges and fears that come with a melanoma diagnosis, and provide hope to other Canadians facing a similar situation. The video features Canadian patients who have experienced a melanoma diagnosis firsthand and have realized that melanoma is not just skin cancer.

Click here to view the video: https://youtu.be/eZiBnB-B8-g

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unBeach Party!

Missed the 2016 unBeach Party? Catch up through the photos on our Facebook page here:

PARTY PHOTOS

UNBEACH STUDIO PHOTOS

And make sure you get your tickets for the 2018 Gala!

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Don’t miss the party of the year at the Vancouver Aquarium on Wednesday, May 18, 2016. #unBeach

Save Your Skin Foundation’s unBeach Party will raise funds for skin disease and skin cancers on Wednesday, May 18th at the Vancouver Aquarium. This first annual party for 300 guests takes place during Melanoma Awareness Month and will include themed cocktails and canapés, an exclusive silent auction, beach volleyball, entertainment, a surprise guest host – and all to the beat of our unBeach playlist (which will be available for download next month!).

The 2016 unBeach Party’s goal is to raise enough funds to roll out a critical awareness campaign on sun safety to schools throughout Canada and to support other important 2016 patient support initiatives. Funds raised at the 2016 unBeach Party will ensure better awareness, prevention and detection of skin disease and skin cancers within elementary schools across Canada.

Skin cancer is the most common type of cancer. It is also one of the most preventable. Over 80,000 cases of skin cancer are diagnosed in Canada each year, more than 5,000 of which are melanoma, the mostly deadly form of skin cancer. There are more new cases of skin cancer each year than the number of breast, prostate, lung and colon cancers COMBINED!

Skin cancer is caused by overexposure of the skin to UV radiation. The most common sources of UV radiation on the skin are the sun and artificial tanning beds. Though skin cancer is preventable and most often treatable, it remains the most common form of cancer.

For 2016 unBeach Party sponsorship inquiries, tickets or questions, please contact Karran at karran@saveyourskin.ca or call 1-800-460-5832.

Space is limited, get your tickets today!
Eventbrite - The unBeach Party

EVENT DETAILS

Don’t miss the party of the year! #unBeach

Date: May 18, 2016
Location: Vancouver Aquarium, 845 Avison Way
How to Get There: The Vancouver Aquarium is located in beautiful Stanley Park. Directions and parking details can be found here
Attire: Business casual beach attire

Tickets
Individual tickets are $100 and a group of 10 tickets is $1,000. Partial tax receipt issued after the event. To purchase tickets, please contact Karran Finlay at karran@saveyourskin.ca or call 800-460-5832 or purchase online here.

Event Details

6:30 pm Party Starts!
Silent Auction, Beach Volleyball, unBeach Playlist Beats, Sunscreen Sampling and more!
7:30 pm Special Guest Welcome
9:30 pm Raffle Draw

Silent Auction

Silent auction items to be listed soon!

Raffle

Raffle prizes to be announced soon!

Sponsorship

The Save Your Skin Foundation invites you to partner with us as a sponsor of The unBeach Party. We offer monetary sponsorship involvement at a variety of levels. If you would like to discuss a sponsorship opportunity, please contact:

Karran Finlay
Save Your Skin Foundation
Tel: 778-988-8194
Email: karran@saveyourskin.ca

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Key Takeaways from the Canadian Melanoma Conference

The Canadian Melanoma Conference (CMC) took place February 19-21, 2016 in Whistler, British Columbia and was a uniquely Canadian perspective on the landscape of Melanoma as it is happening in Canada now.  Attended by medical oncologists, dermatologists, pathologists, surgeons, radiologists, molecular biologists, industry partners and patient groups the Canadian Melanoma Conference is an opportunity to review and explore new therapies and to understand what’s coming next in the treatment of melanoma.

 Here are some key takeaways from that conference:

We understood at the Society for Melanoma Research Congress (SMR) last November in San Francisco that LDH levels play an important role in response rates in both the BRAF mutant positive population and the wildtype, and while no long term data on overall survival is available yet in the ipilimumab + nivolimumab combination therapy, early findings suggest that patients with both high and low LDH levels are having the same response to this combination therapy.  High LDH levels in patients, which correlate with aggressiveness of the tumour, demonstrated resistance to long-term response from targeted and immune therapies. Whereas patients with low disease burden are seeing great outcomes on therapy.  To view the SMR report go here.

There are distinct gender differences in melanoma, including different tumour types and different tumour sites (men are more likely to develop melanoma on the backs and trunks whereas women are more likely to develop melanoma on the legs.) An epidemiology study of melanoma by Dr. Thomas Salopek identified that globally, women are twice as likely to have melanoma between the ages of 15-50 (during menstrual years) which have researchers asking what role estrogen plays in the development of melanoma. There is also a spike in incidence in men after the age of 50, there is not a clear understanding of why this is happening.

Resident Dr. Paul Kuzel presented on the epidemiology of pediatric melanoma in Canada from 1992-2010.  Melanoma is the most common primary cutaneous malignancy diagnosed in patients under the age of 20.  Unlike adult melanoma, pediatric (those under the age of 18) melanoma rates remain stable.  Same distribution data between genders is seen in pediatric melanoma under the age of 15, after the age of 15 there are despairing differences in gender incidence of melanoma.

Melanoma patients are showing high rates of usage of mental health services in with use and rate of services depending on treatment administered. A study by Dr. Timothy Hanna showed a substantial burden on mental health services in advanced melanoma patients.

Sequencing was again a hot topic and data coming in the next year will provide treating clinicians more information on what to use and in what order when treating patients.

Standard of Care for the treatment of metastatic melanoma varies depending on what province you live in, with most patients having access to ipilimumab as a first line treatment, while doctors and patients in Québec are still on a regiment of dacarbazine (DTIC – chemotherapy). Dr. David Hogg expressed concern on the use of DTIC for the treatment of metastatic melanoma an felt that standard of care for the treatment of metastatic melanoma should be clinical trials (to find out more about clinical trials go here).

To see Kathy Barnard’s thoughts on why it’s important for patient groups to attend CMC go here 

To here my thoughts on CMC go here 

A full report on CMC will be available within the coming weeks.

Sabrina
Executive Director, SYSF

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We Need to Get Julie Home

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Kathy Barnard on why getting Julie home is important to her…

When I heard Julie’s story this past weekend, it hit me personally- in so many ways.  Firstly as a mom, and secondly as a wife but also because as a Melanoma patient, I know all too well what this family is experiencing.

Having failed to respond to any other treatment options available to me, and let’s be honest, there weren’t that many, and very few had ever had any sort of successful response rate, I found myself in Edmonton, Alberta, in 2006 undergoing treatment in a clinical trial. I was on round six when things went terribly wrong. I can still remember seeing the look of fear on my husband’s face as doctors and nurses were scrambling to get me stabilized.  I remember the conversation in the room of having to move me to another hospital with a critical care unit. And all that kept going through my mind is, I can’t be here – I need to be home in B.C. with my two boys, my family. Please get me home. I wanted to be able to click my heals together and be home.

Julie’s story is all to familiar, a reminder why I started this foundation 10 years ago, how lucky I was, how real this disease is. We need to get Julie home to her six year old son, Adam, to her family. She needs to be home.

Thank you to so many of you who have already given to the GoFundMe campaign to get her home. Julie is booked on a Medivac flight on the morning of March 2nd, 2016. She’s almost there Adam! Your mom is almost home.

Please help us to keep spreading the word and donate, if you can: https://www.gofundme.com/juliecrawford

Update as of Tuesday, March 1st at 5:30pm PST: So many of you have supported and reached out and let us know you are thinking of Julie and her family and following her story. The community has been incredible. We’ll post updates and related news articles here so that the SYSF community can stay updated.

CBC: Spruce Grove mom got her wish to die near family, Final wish was to be transported home to be with her son on his seventh birthday.

CBC: Gofundme campaign helps Alberta mother come home to die – Julie Crawford to be medevaced home today to celebrate son’s seventh birthday

Huffpost Alberta: Julie Crawford’s Dying Wish Granted As She Flies Home For Son’s 7th Birthday

Edmonton Journal: Dying Edmonton-area woman flown home on medical flight funded by friends and strangers

CTV Edmonton News: Getting Julie home to her son on his birthday

Calgary Metro News: GoFundMe page raises cash to fly dying Alberta woman home

CHQR AM770: Fundraiser to medivac terminally ill mother home for final wish

CKNW: Crowd funding initiative launched for Edmonton woman with inoperable cancer

AM730: Crowd funding initiative launched for Edmonton woman with inoperable cancer

Thank you,

Kathy Barnard

Founder & President, Save Your Skin Foundation

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What is a Patient Advocate?

A patient advocate is someone who looks out for the best interests of a patient. A patient advocate speaks out in favour of a cause or idea such as ensuring there are more and better treatments and services available.

Governments always have dozens of projects and causes competing for their attention and their funds. It’s a cliché to say that “the squeaky wheel gets the grease,” but it’s also often true.

But an advocate can’t just make noise and expect results. It’s vital to know:

  • what to say
  • how to say it
  • who to say it to
  • when to say it

Effective patient advocates need to be well informed and have clear and plausible requests that are brought to the right people at the right time. Good advocacy can make very important positive change.

Advocacy is also important in shaping public opinion about issues, since public opinion is the major driver of government policy.

Recent changes to laws to ban children from tanning salons and the raising of public awareness about the dangers of tanning salons for everyone are examples of how advocacy has made a big difference for skin safety in Canada.

How to Become a Patient Advocate

Save Your Skin Foundation does many advocacy activities, such as meeting with and sending information to government officials. If you would like to help us with these activities in your area, we’d love to have you join us.

We can discuss the things you can help us with, and provide you with some tips, training and information that will make you an effective patient advocate.

To get started, send an email to natalie@saveyourskin.ca. You can also download a copy of Save Your Skin Foundation’s 2016 Advocacy in Action package here: SYSF 2016 Advocacy in Action

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What “Patient Advocacy” Means to Me

Guest post by Natalie Richardson

Until last year I thought the phrase “patient advocacy” was terminology for action that other people take in the distant lots of big city hospitals, or with pickets across Parliament Hill. People throwing big words at medical problems, fighting for the sick or the silenced, major meetings in far-away boardrooms deciding how millions of pharmaceutical dollars would be spent on some ambiguous research study. Things that really didn’t apply to me.

Quickly I have learned that patient advocacy is a term much closer to home, and it is not obscure at all.

It happens all across Canada and the world, and it applies to anyone experiencing a health situation in any form. It is what people do when they bring awareness to a medical occurrence. Whenever a patient, or a family member or health care professional on a patient’s behalf, or a group speaking about a particular disorder lends voice to their concern, they are taking action as an advocate to inform and support, helping patients and their families get access to information and the health services they need.

Patient advocacy helps someone like myself for example, in the methods that a group such as Save Your Skin Foundation uses, to ensure people with melanoma and other skin cancers have access to all of the treatments and health services they need.

Even though the field of melanoma treatment is rapidly growing this day in age, patients still struggle with receiving timely access to new medications as they are discovered, quite often due to budgetary constraints.

Bringing voice to these real and urgent concerns is important in shaping public opinion about issues, since public opinion is the major driver of government policy. By highlighting a subject to a government party or representative(s), there is at least a chance that a portion of funding may be viewed necessary to facilitate the completion or approval of a new treatment or development in care for the given subject, in this case a deadly disease.

There are several ways to carry out patient advocacy, as I have learned from Save Your Skin Foundation (SYSF). Meeting with and sending information to government officials is one piece of the puzzle. SYSF even makes it easy to send a letter to provincial representatives as well as the Federal Health Minister, with form letters available on their website easily downloaded from their “Who are You Surviving For” program page. Every letter matters. Speaking engagements and writing pieces, fund raising walks and social media campaigns also contribute to awareness and engagement.

A melanoma diagnosis no longer needs to be considered an automatic death sentence for Canadians, should we be able to receive equal access to treatments as they come along. And I was able to say that out loud just last week at Queen’s Park; I was able to address members of the Legislative Assembly of Ontario personally, along with Save Your Skin Foundation. Face to face I was able to share my experience with the limitations of melanoma treatment as it stands today. The response was warm and caring, and I feel genuinely hopeful that my small part in delivering this message may help myself and others receive timely and equal access to melanoma treatment in future. I feel that somewhere along the path even one of those representatives may remember my face when choosing their voting direction for funding.

I was fortunate to have received the treatment for my metastatic melanoma that I did, solely due to the randomization process in the clinical trial in which I was enrolled. I had only a 50/50 chance of receiving

the new drug, and I shudder to think I may not be here to write this now, had I not been on the correct side of that coin toss. I got modern immunotherapy merely because I happened to be in the right place at the right time. There is so much growth in melanoma treatment right now, potentially life-saving medicines are just out of reach for myself and other patients.

Advocating to the government for awareness can help close that gap. I have written to our Federal Health Minister, and I have personally relayed my experience to my local elected Minister of Provincial Parliament, and I encourage others to do so as well. Not only on my behalf and that of my daughters, but on behalf of the thousands of other Canadians who fight metastatic melanoma.

All of this effort means the world to my family and I, we actively participate when we can, and we appreciate others who do so as well. Our Oncologists do everything they can, but they are still at the mercy of treatment availability, as patients are.

Efforts in patient advocacy reduce the chances of my falling through any cracks in our health care system. Patient advocacy means someone is looking out for my family.

Natalie Richardson

February 22, 2016

 

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Consultation on the basket of services

In its mandate to assess the performance of the health and social services system, the Commissioner decided to undertake work on Québec’s basket of insured health and social services, that is, publicly funded care and services.

By carrying out this work, the Commissioner would first like to inform public debate by highlighting citizens’ values and concerns regarding the basket of services in an initial report on the issue. The report will also guide policymakers in their decision making by enabling them to take citizens’ values and concerns into account.

Call for personal accounts

A call for accounts is underway and will end on March 20, 2016. The Commissioner encourages anyone who would like share their experience to submit a personal account through an online questionnaire.

The accounts will be made public. However, confidentiality will be maintained in order to protect respondents’ anonymity, in compliance with the provisions of the Act respecting Access to Documents Held by Public Bodies and the Protection of Personal Information (CQLR, c.A-2.1).

http://www.csbe.gouv.qc.ca/enquete/index.php/564586

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British Columbians’ grave concerns over expansion of BC government’s Reference Drug Program

As members of the BC Better Pharmacare Coalition (BPC), the Save Your Skin Foundation would like to share this important message.

Across Canada, public and private drug plans are increasingly using reference-based pricing policies to contain costs. Under reference-based pricing, drug plans reimburse the cost of the reference drug or drugs in a medication class. Most often, this is the most inexpensive drug in a class.

The BC government is expanding its program for reference price and reference product through Reference Drug Program (RDP) Modernization. This means that the government is deciding not just the price it will pay for a medicine, but which medicines physicians can prescribe, if patients want BC PharmaCare to cover the cost and if patients want the cost to count toward their Fair PharmaCare deductible.

As patient advocates for more than 20 years, we are very concerned that these policy changes – as past experience shows us – will adversely affect thousands of patients, in particular, our most vulnerable patient populations: the elderly and low-income. Changing a stabilized patient’s medication, strictly based on a government medication- pricing scheme with cost containment as the prime consideration, is contrary to evidence-based medical practice. BC patient organizations fully support a ‘patients first’ approach, and so should government. Policy should preserve and uphold the intent of a health care system to deliver precision medicine and respect the complexity of therapy choices being made between patients and their physicians.

The BC experience with RDP

The Reference Drug Program was introduced in British Columbia in 1995. An economic study in the Canadian Medical Association Journal, published in 2002, revealed that BC’s reference-based pricing policy pushed costs to other parts of the health care system, generating negative health outcomes for the elderly and low-income patients. Subsequent research published in 2003 in the BC Medical Journal demonstrated that the RDP was not effective in slowing pharmaceutical spending and consumers had to pay for more out-of-pocket.

In 1996, patient groups got together and formed the Better Pharmacare Coalition (BPC) in response to the government’s introduction of reference-based pricing policy in BC. One of these patient groups, the Canadian Society of Intestinal Research, led a study 2009 study that showed changing medication against doctor’s orders, which BC PharmaCare predicted would preserve $42 million in the drug budget, actually cost the BC government $43 million more, a difference of $85 million over three years. This policy actually resulted in an increase in the drug budget itself, as patients used more medications when switched than they did before switching.

When a disease is under control using a specific medication, the old adage rings true: “don’t fix what isn’t broken.” Non-medical medication switching drives, not saves, costs. Hidden costs of switching stable patients to cheaper therapies include increased visits to hospital emergency rooms, loss of adherence with switched medication, new side effects with the switched medication, necessitating additional prescriptions, and loss of or reduced disease control.

The BC government recently approved amendments to the Drug Price Regulation on December 17, 2015 that will expand the Reference Drug Program in ways that give patients grave concerns.

In anticipation of this expansion, the BPC engaged Insights West, a full-service marketing research company, to conduct an online poll, which found British Columbians oppose expansion of the Reference Drug Program. A resounding 82% are concerned that administrators of the BC PharmaCare program will be implementing a policy that tells physicians which medications they can prescribe for patients, even if it goes against physicians’ opinions of the best care for their patients.

The BPC poll also found that 76% of British Columbians were concerned about changing BC PharmaCare’s Reference Drug Program to specify a ‘reference product’ that patients must take, or they will have to pay the difference out-of-pocket to stay on their current therapy. It is important to note that the concerns are higher among PharmaCare users and those with a history of chronic disease in their household.

Patients are drawing their own line in the sand. The government needs to understand what doctors already know – patients are unique and they cannot be treated with a cookie cutter policy approach. Government should make every effort to meaningfully consult with Better Pharmacare Coalition members and the 2 million patients they represent in BC, when contemplating any change that will touch even one patient’s life. We are ready, willing, and able to work by their sides to get it right for BC patients.

Cheryl Koehn, Founding Member, Better Pharmacare Coalition/President, Arthritis Consumer Experts
Gail Attara, Gail Attara, Better Pharmacare Coalition member and CEO of the Gastrointestinal Society

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Better Pharmacare Coalition poll reveals British Columbians oppose changes to planned expansion to BC government’s Reference Drug Program

Patient Poll on RDP Final

Better Pharmacare Coalition eager to work with government to get it right for patients

VANCOUVER, Feb. 9, 2016 /CNW/ – A recent Better Pharmacare Coalition (BPC) poll1 has found that British Columbians oppose expansion of the Ministry of Health’s Reference Drug Program based on concerns that expansion could compromise patient health.

The BC government has approved amendments to the Drug Price Regulation that will expand the Ministry of Health’s Reference Drug Program (RDP). In anticipation of this expansion, the BPC conducted an online poll, which found a resounding 82% of British Columbians are concerned that administrators of the BC PharmaCare program will be implementing a policy that tells physicians which medications they can prescribe for patients, even if it goes against physicians’ opinions of the best care for their patients.

“We are very concerned about senior and low-income patients’ health with the expansion of the Reference Drug Program as they are typically the first to feel the negative consequences of policy reform. When the BC government’s planned policy is enacted, these vulnerable individuals and other patients relying on BC PharmaCare will not be able to afford their current medication, medication that is keeping them well or from declining health,” said Cheryl Koehn, BPC founding member and president of Arthritis Consumer Experts. “Changing a medication in a stabilized patient strictly based on an expanded government pricing scheme is contrary to best practice in today’s policy development environment. We fully support a “patients first” approach and so should governments. Policy should preserve and uphold the health care system’s desire to deliver precision medicine.”

Starting June 1, 2016, the BC government will create three new reference drug categories – Angiotensin Receptor Blocker (reduces high blood pressure), Proton Pump Inhibitor (treats GERD/heartburn), and Statin (lowers cholesterol) – and begin transitioning patients from one to another medication in these groups, which could immediately put their health at risk. By December 1, 2016, the new policy will be in effect.

The BPC poll also found that 76% of British Columbians were concerned about changing BC PharmaCare’s Reference Drug Program to specify a ‘reference product’ that patients must take, or they will have to pay the difference out-of-pocket to stay on their current therapy. It is important to note that the concerns are higher among PharmaCare users and those with a history of chronic disease in their household.

“The BPC has been clear from its inception and through consultations with the BC government’s Pharmaceutical Task Force, that Reference Drug Program expansion will reduce quality health care at the individual level. An economic study,2 conducted after RDP was introduced in BC in 1995, revealed that the policy pushed costs to other parts of the health care system, generated negative health outcomes for the elderly and low income patients.

A 2009 study led by the Canadian Society of Intestinal Research3 showed that changing medication against doctor’s orders, which BC PharmaCare predicted would preserve $42 million in the drug budget, actually cost the BC government $43 million more, a difference of $85 million for BC,” said Gail Attara, BPC member and CEO of the Gastrointestinal Society.

“The government needs to understand what doctors already know – patients are unique and they cannot be treated with a cookie cutter approach. Government should make every effort to meaningfully consult with our coalition’s members when contemplating any change that will touch even one patient’s life. We are ready, willing, and able to work by their sides to get it right for BC patients,” added Attara.

About Better Pharmacare Coalition

The Better Pharmacare Coalition was formed in 1997 in response to BC PharmaCare policy development not being reflective of current medical literature, best clinical practices and the needs of patients in BC. The coalition works together to call for appropriate access to evidence-based medicines that are proved effective and needed by patients in BC. The member organizations include: Arthritis Consumer Experts, Atypical Hemolytic Uremic Syndrome Canada, BC Lung Association, BC Schizophrenia Society, British Columbia Coalition of Osteoporosis Physicians, Canadian Arthritis Patient Alliance, Canadian Society of Intestinal Research, Canadian Osteoporosis Patient Network, Crohn’s and Colitis Canada; Gastrointestinal Society, Kidney Foundation of Canada, Mood Disorders Association of British Columbia, MS Society of Canada, BC Division, Pacific Hepatitis C Network of BC, Parkinson Society British Columbia, Prostate Cancer Foundation BC, Save your Skin Foundation, and The Arthritis Society, BC and Yukon Division. More information is available online at www.betterpharmacare.org.

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1 BPC engaged Insights West to conduct an online survey in December 2015 to determine British Columbians’ opinions on BC PharmaCare and in particular their opinions on the expansion of the Reference Drug Program. Results are based on an online study among 858 adult British Columbians. The data has been statistically weighted according to Canadian census figures for age, gender and region. The margin of error (which measures sample variability) is ±3.4 percentage points.
2 Aslam Anis. Why is calling an ACE an ACE so controversial? Evaluating reference-based pricing in British Columbia. Canadian Medical Association Journal. 2002; 166(6):763-764.
3 Skinner BJ, Gray JR, Attara GP. Increased health costs from mandated Therapeutic Substitution of proton pump inhibitors in British Columbia. Alimentary Pharmacology and Therapeutics. 2009;29(8):882–891.

SOURCE Arthritis Consumer Experts

Image with caption: “Patient Poll on RDP (CNW Group/Arthritis Consumer Experts)”. Image available at:http://photos.newswire.ca/images/download/20160209_C7043_PHOTO_EN_616353.jpg

For further information: Kelly Lendvoy, Vice President, Communications & Public Affairs, Arthritis Consumer Experts, 604.379.9898

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Highlights from Society of Melanoma Research Congress, San Francisco November 18-21 2015

Clinicians don’t understand what’s happening and why it’s happening- but they are trying to understand.  How is immunotherapy working, what causes resistance, how will sequencing be undertaken, what does the future look like- will biomarkers increase predictably of which treatment strategies will be more effective for which patients, are there more biomarkers to be researched, what role will oncolytics play in the treatment of melanoma and what therapies will emerge in the neo-adjuvant and adjuvant setting. What is understood is that melanoma is not one disease but various diseases. And with so many variables existing when dealing with melanoma, the key will be to have a variety of treatment options to create the best possible patient outcomes.

Increasingly the notion of the right treatment for the right patient at the right time is being adopted, however an understanding of the biology of the tumour and its environment is necessary in order to put this into application. Immunotherapy is expected to work in 30% of the patient population- while there is not a clear understanding of why it works in some patients and not in others, it is clear that a better understanding of pathways and biomarkers are going to be an important area of research.

Targeted therapy will continue to have an important role to play in the treatment of metastatic melanoma and while targeted therapy activates an immediate response in a BRAF mutation population, sequencing is still not fully understood. When time is of the essence what will treatment will physicians use? 

Biomarkers are going to be critical for future success of melanoma therapeutics- will there be a way to make predictions based on these biomarkers rather than waiting for three years for clinical benefit or loss to emerge for clinical trials. Research increasingly suggests that tumour expression can be scored prior to treatment, including PD-L1, CD8 T cells, and markers of activation or inactivity in the tumour cell.  

BRAF inhibitor based therapies continue to be the most impactful by far. Currently all clinical evidence has been performed on the V600 mutation population which represents 45% of patients with advanced melanoma.  Another 5% of BRAF mutations exists and are not currently being studied.

Updated results from three randomized trials of the recently FDA approved combination of vemurafenib (Zelboraf) in combination with cobimetinib (Cotellic) substantially improving overall survival rate as well as progression free survival and response rate. Similar results are seen in the Dabrafenib (Tafinlar) combination with trametinib (Mekinist) which was approved by the FDA two years ago and based on two large randomized trials.  This data set is also allowing researchers to see longer term outcome data.

Factors affecting outcome include patient disease burden, serum LDH (which correlates with aggressiveness of the tumour).  Patients with high LDH levels can benefit from the treatment but unlikely to be long-term respondents.  Whereas patients with low disease burden are seeing great outcomes on this combination therapy.  These factors hold true for both targeted therapies and immunotherapies as well.

LDH has a predictive ability and a lot of work needs to be done for patients presenting with high HDL levels.

While BRAF inhibitors have significantly enhanced melanoma treatment an understanding of BRAF resistance mechanisms to devise treatment regimens that provide durable tumour control is still necessary. Scientists are attempting to learn the mechanisms of resistance from static biomarkers before deploying patients to therapy. An understanding of the baseline features of tumours and adaptations of tumours during therapy that make them resistant will determine which patients are likely to develop resistance and should receive more aggressive treatments.

Despite recent advances in the treatment of metastatic melanoma through targeted and immunotherapy, the majority of patients do not achieve a durable response. Research efforts to better understand responses are underway, and numerous molecular mechanisms of resistance to targeted therapy have been identified.

See What Dr. Reinhard Dummer, University of Zurich has to say here

Dr. Winson Cheung, BC Cancer Agency presents Highlights from SMR here

Participation at the Society for Melanoma Research Congress was provided by funding received from Novartis Canada.

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