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adjuvant treatment

Adjuvant therapies in melanoma – a guide to navigate treatment options

As part of Melanoma Awareness Month, Save Your Skin Foundation proudly partnered with the Melanoma Network of Canada to create a patient guide on navigating adjuvant therapies for melanoma. Download your copy HERE!

What is Stage III melanoma?

Stage III melanoma has spread to the lymph nodes. Stage III can be divided into 4 categories based on the evolution of the tumour and the extent of the spread to the lymph nodes. These categories are classified as A, B, C and D. These 4 categories are used to determine prognosis and treatment of the melanoma.

What is primary treatment for Stage III melanoma?

Surgery may be recommended once diagnosis is confirmed. The goal of surgery is to remove the cancer and the affected lymph nodes to minimize the risk of the cancer returning.

What is the genetic mutation of the tumour?

The tissue that was removed during surgery will be tested for specific gene mutations. Certain mutations can alter a gene. For example, approximately half of all melanomas have a mutation in the BRAF gene. Identifying associated gene mutations can help determine if additional treatment options such as targeted therapies are recommended.

Once you know the stage of the melanoma, you can discuss next steps of care with your health care professional.  Click here to view the complete guide detailing treatment options and FAQs for your appointment with your Medical Oncologist:

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SYSF Webinar – Melanoma Treatment FAQs: Do’s, Don’ts, and How to Manage Side Effects

 

Recording available! 

Join us to hear the latest updates on current immunotherapy and targeted therapy treatments for melanoma and non-melanoma skin cancers in Canada. 

Dr. Smylie and Dr. Iafolla will hold a panel discussion on recommended dietary and lifestyle habits while on treatment, as well as managing toxicities from fever and pneumonitis to dermatologic complications from immune checkpoint inhibitors.

Presenters:

  • Dr. Michael Smylie, Medical Oncologist, Cross Cancer Institute, Professor, Department of Oncology, University of Alberta, Edmonton
  • Dr. Marco Iafolla, MD, MSc, FRCPC, Assistant Professor, University of Toronto, Medical Oncologist, Genitourinary and Cutaneous Site Lead, William Osler HS

Click HERE to view the recording!

 

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PeerVoice – Advances in Adjuvant Melanoma Therapy

We are pleased to announce that the PeerVoice activity entitled ”Advances in Adjuvant Melanoma Therapy: Working Together To Improve Outcomes’’ has now launched online.  SYSF is proud to endorse this work, and applauds the valuable work put into this educational resource.

This initiative features two expert panel discussions, verbally presented by:

Michael Smylie, MBCHB, FRCPC, Edmonton, Alberta

Joël Claveau, MD, FRCPC, Quebec City, Quebec

Carolyn Nessim, MD, MSc, FRCSC, FACS, Ottawa, Ontario

Presentation 1: Adjuvant Melanoma Therapy: Optimizing the Care Pathway

Presentation 2: Adjuvant Melanoma Therapy: Experts Appraise the Evidence

These verbal interview-style presentations are also available as downloadable transcripts, click here to view or read the presentations: PeerVoice: Advances in Adjuvant Melanoma Therapy

PeerVoice activities are designed to fill the unmet needs of the medical community by reporting information pertaining to clinically relevant advances and developments in the science and practice of medicine.  This independent learning activity is supported by Merck Canada Inc.

 

NEW! December 2019:  Minding the Melanoma Patient With Brain Metastases: Updates to Personalize Care

Listen to the recording, and/or download the presentation, by:
Marcus Butler, Medical Oncologist, University of Toronto  |  Princess Margaret Cancer Centre

Raising the Bar With Immunotherapy for Melanoma and Kidney Cancer: Strategies to Enhance Care. This independent learning activity is funded by Bristol-Myers Squibb Canada Co.

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SYSF Webinar: Treatment Options for Melanoma Patients in the Adjuvant Setting

Join us for this free webinar, which reviews the latest news and clinical data related to melanoma treatment in the adjuvant setting, as presented in the 2018 conference season.

‘Adjuvant’ refers to patients with a stage II or stage III diagnosis. The majority of adjuvant patients typically undergo surgery to have their tumour(s) removed, but are not given immunotherapy or targeted therapy to prevent recurrence of the disease despite a known high-risk of relapse and mortality. Melanoma is an aggressive cancer; stage III melanoma means the cancer has spread from skin cells into the lymphatic system, and poses a dangerous risk for spread to organs, which is what depicts a stage IV diagnosis.

Dr. Claveau shares his key insights into what the landscape of adjuvant melanoma immuno-oncology treatment looks like for the near future in Canada. Dr. Adrian Gunaratne details the science behind targeted therapy and what is coming for Canadian melanoma patients in the adjuvant setting with a BRAF positive mutation. The discussion continues with a patient and a caregiver both having had treatment access challenges in the adjuvant melanoma setting, and how their experiences impacted their lives and that of their families.

Presenters:

  • Dr. Joel Claveau, Medical Oncologist, Hotel-Dieu de Quebec, Université Laval, Quebec City, QC
  • Adrian Gunaratne, PhD, Medical Science Liaison – Solid Tumors, Novartis Pharmaceuticals Canada
  • Natalie Richardson, Adjuvant Melanoma Patient, Managing Director, Save Your Skin Foundation
  • Eyyub Hajiyev, Caregiver to a loved one recently diagnosed with melanoma in the adjuvant setting

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National Post: Therapeutic Spotlight on Immuno-Oncology

On September 26, 2018, you may have seen a special insert in the paper version of the National Post across the country, featuring eight pages of informative articles about immunotherapy, an innovative treatment proving successful in several cancer indications.  This special content is the result of a collaboration between sponsoring funders, patient group representatives, and the folks at a group called Patient Diaries.  Over the years, Patient Diaries has coordinated several series such as this, raising awareness of various diseases and their effective treatments.                                                        This time they chose to highlight Immuno-Oncology.

Researchers and clinicians treating metastatic melanoma have been seeing success with these therapies for about ten years, but the growing use of and experimentation with them in recent years has been the topic of discussion at countless oncology conferences and treatment centres around the world.  In fact, just last month the 2018 Nobel Prize in Physiology or Medicine was awarded to James P. Allison and Tasuku Honjo for their discovery of cancer therapy by inhibition of negative immune regulation: immunotherapy.

Save Your Skin Foundation openly discusses the need for access to these treatments by melanoma patients across Canada, and we jumped on the opportunity to be the primary patient group sponsor of this feature, sharing our collective patient experience with these therapies. On page six of the insert there was an article in which both Kathy Barnard and Natalie Richardson of Save Your Skin were interviewed.  We were also given half a page to display informative anecdotes about ourselves and raise awareness of our ongoing support of skin cancer patients.

In addition to the paper version of the Therapeutic Spotlight, a digital space has been placed on the National Post website.  SYSF awareness spots and our patient video from May 2018 can be seen throughout the Immuno-Oncology board – please feel free to take a look around.  There are additional informative articles about innovative treatments for lung cancer, leukemia, and breast cancer.

There is also a blog written by Natalie Richardson, melanoma survivor and Managing Director of SYSF, discussing the barriers to treatment access that many Canadian patients face.  Click here to read the blog: Cancer Patients Receive Unequal Treatment Depending on Stage or Postal Code

To see what else SYSF is talking about, click here to visit our MEDIA page!

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Adjuvant Patient Survey: here is the full report!

In September 2018, Save Your Skin Foundation (SYSF) conducted an anonymous survey of melanoma patients in the adjuvant setting (diagnosed at a stage lesser than stage IV).  This survey, titled “Melanoma Treatments in the Adjuvant Setting,” was open globally, and we received responses from all over Canada as well as from the United States, New Zealand, and Australia.

The survey consisted of 28 questions, which ranged between multiple choice, multi-selection, and write-in, and participants had the option to skip any question. The goal of the survey was to assess the impact melanoma has on patients and their families and caregivers, and get a picture of the treatment plan of the average melanoma patient, what treatment access limitations they have encountered, and what they look for in potential treatment options.

The responses to this survey were used to inform SYSF submissions to provide direct patient feedback as treatment recommendations to pCODR and INESSS.  We provided these submissions with all of the patient comments to support the message that melanoma patients in the adjuvant setting need access to immuno-oncology treatments to prevent their disease from growing into a stage IV diagnosis.

Thank you to all participants who took the time and care to share their perspectives.  We have every hope that the drugs in the pipeline for adjuvant will be approved in every province and territory in Canada.

To read the full Survey Report, please click HERE To request any additional information about the survey please feel free to email info@saveyourskin.ca

 

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SYSF Survey! Melanoma Treatments for Adjuvant Patients

Save Your Skin has the opportunity to submit patient feedback to the pCODR process for the two treatments coming to the Adjuvant setting for Melanoma patients in Canada.  To learn more about the drug approval process and our involvement as a patient representation group, please visit our page: “Let’s Chat: Patient Submissions and Discussion

We believe the ability of stage I, II, and II melanoma patients to receive innovative treatments is key to survival, and to the reduction of progression to stage IV disease.

To inform our upcoming submission, we have created a short survey and request that any and all patients touched by melanoma complete the survey to have their voices heard.  This survey is open globally, to all stage melanoma patients at any point in their journey; but we request that IF you are a metastatic patient taking the survey, but were diagnosed at stage 1, 2 or 3 could you please take some time to remember back to those days and fill in what you can in the survey pertaining to those times.  Were you offered a treatment, were you advised to “wait and watch” and what were those times like for you and your family.

This anonymous survey is now closed.  We thank all who shared their time and experience in responding to the survey.  Stay tuned for news of our completed submission to pCODR and INESSS.

If you have any questions or feedback about this topic or the survey itself, please email info@saveyourskin.ca

Thank you! 

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A Patient’s Perspective on the World Congress of Melanoma

In October I traveled to Brisbane, Australia to attend the 9th World Congress of Melanoma, a joint meeting with the Society for Melanoma Research.  To be there as a melanoma patient was an incredible honour, and to be there as a representative of Save Your Skin Foundation was even more so.  I have been working with Save Your Skin for over a year; after a couple of years of volunteering as a patient advocate and blogger as I recuperated from my surgeries and treatments, I turned my professional interests into full-time support of this Foundation that does so much for melanoma patients.

Ever since I was diagnosed with metastatic melanoma in 2014, I have been hungry for information about this disease, and I had always wanted to attend this conference – my medical Oncologist can attest to that, as every year I would schedule my appointments with her immediately after the conference so I could grill her about all the latest news.  This year she did not attend, but I did.

It was an incredibly educational and inspiring experience, and I have much to report.  So much so, that I have taken this long to write a blog to update our website, because I have found it to be a great challenge to put into words a summary of all that I learned at the WCM2017.

I will start off by reporting that if, after reading this piece, you still have questions as to specific information you might like to learn more about, please comment below or email me and I can get you details on what you would like to know. 

 

We can provide you access to watch recordings of many of the sessions I saw in person, plus others that are available on the WCM website.  We will also share this on our social media: should you wish to receive more information than what I am able to summarize in this blog, please reach out and we will provide.

Approximately 1,500 delegates attended this Congress, and they included Medical and Surgical Oncologists, Dermatologists, Skin Specialist-Physicians of varied backgrounds, Researchers, Pharmaceutical Company Reps, General Practitioners, and a smattering of Patient Advocacy Groups (such as SYSF).

At the Opening Ceremonies of the Congress, attendees were given an extensive presentation on the history of melanoma research in Australia and other centres, the epidemiology (the branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of the source and cause *) of melanoma and non-melanoma skin cancers, and their relation to the carcinogen solar ultra-violet.

It was an interesting account of skin cancer statistics in Australia, and a comparison of melanoma to other skin cancers behaviours, namely their response or reaction to “solar circulating factor.”  In this session I learned that there is a COMPLETE ban of sunbeds in Australia.  I also learned that the Congress was being held in the sunny state of Queensland, Australia, which – sadly – has been dubbed the “melanoma capital of the world.”

As an aside… it was spring-weather cloudy the entire week we were there so there were many jokes throughout the sessions that we were all gathered in the melanoma capital of the world and with no risk of exacerbating any skin cancer what with all the rainy cloudy skies!  There are countless interesting roof and overhead structures all around Brisbane to protect residents from the sun, though that week they served well to protect from the rain.

Also in this address was mentioned the importance of early detection in skin cancer – “delay can be deadly.”  There was discussion of advancement in diagnosis of melanoma in situ, and an update of the efforts of targeted screening for melanoma: targeted screening fails as it only gets a minority of the population – even patients with no risk factors develop melanoma.  Dermatologists and General Practitioners are the real heroes in early recognition, said Dr. Harold Kittler, but also people and their family members are key to prevention and early detection.

Also in this session were introduced the NEW “F and G’s” of the ABCDE’s of skin cancer detection. 

F = Firm and G = Growing.  More on this to come – SYSF is currently updating our materials to reflect the complete ABCDEFG method of skin cancer detection.

I was also pleased to observe an introduction to teledermoscopy and clinical methods including the use of our very own Canadian-invented MoleScope™ – a huge photo of it right up there on the big screen! In the poster displays I also found the published study about MoleScope™ and its use in Canada, for more details please see their website.

Throughout the rest of that day and the next three, I attended sessions which I will list below.  There were so many open for attendance, so I tried my best, but I still didn’t hit all of the ones I would have liked to attend.  I have notes for each, and most are recorded, so enter here the reminder that if you would like more detail on a specific session, please email me any time and I will connect you with the details.  (We are not permitted to post them all openly, plus there are so many we couldn’t possibly fit them all on our website.)

Surgical Oncology: Primary Melanoma Management

Margins of excision, current recommendations and controversies, Follow-up surveillance after wide excision for melanoma, Margins of excision – special situations

Actinic Keratosis: Novel Treatments

New insights into photodynamic therapy

(Note – in a recent meeting with a local Dermatologist I learned that the new and best tool for Derms is photodynamic therapy, but it is not covered in some provinces, namely Ontario)

Treatment of Basal Cell Carcinoma – Successes and Opportunities

Molecular landscape of basal cell carcinoma, Management of side effects of hedgehog inhibitors, Beyond hedgehog pathway inhibitors

Advances in Merkel Cell Carcinoma

Early studies of Merkel cell carcinoma: challenges and progress – Symposium, Doctor Helen Leonard

Immunotherapy for MCC: progress and problems – Symposium, Professor Paul Nghiem

This was a fascinating session to attend, as we got to witness first-hand two clinical research teams meeting each other in person for the first time. Dr. Leonard and Dr. Ngheim have been working together for years, and for the first time got to discuss their wok in person.  More on this here: OncLive SMR Coverage: Immunotherapy Infuses New Hope Into Merkel Cell Carcinoma Care

 

Surgical Oncology: Management of Stage III Metastatic Melanoma

Update of the results from the Multicentre Selective Lymphadenectomy Trial II, Natural history of patients with a positive sentinel node followed with active surveillance, Experience with neoadjuvant therapy for patients with advanced nodal metastases.

This session was personally interesting – and very moving – for me, as I WAS this brand of patient in 2014.  I have read the “new-found” controversy about the very surgery I had (Complete Lymphadenaectomy), and I have often wondered if I really had to have that terrible and invasive surgery to my right groin.  It was the best-known treatment for stage III melanoma at the time, remove the affected lymph nodes and then treat with interferon (in Canada).

I would have appreciated having the option to avoid complete lymph node dissection in favour of systemic therapy.  Systemic therapy (such as the ipilumumab I did end up receiving on a clinical trial in the adjuvant setting) offers alternative to invasive, costly, painful surgery.

I was riveted watching Dr. Coit present his evidence and very passionate argument on this topic.

This session was all about finding balance between medical and surgical oncology and individualized treatment of stage III melanoma, and it will stay with me for a very long time.

 

Friday and Saturday sessions included these:

Treatment of Advanced Squamous Cell Carcinoma

Risk classification of cutaneous SCC, Systemic therapy of advanced SCC, New approaches in the treatment of advanced SCC (immunotherapy)

Staging, Surgery and Targeted Therapies for Melanoma

The new AJCC melanoma classification, and Surgery for stage 4 melanoma patients: is it still worthwhile?

Fascinating information in these sessions – in fact, in January 2018 the new melanoma staging guidelines will come into effect.  Watch for SYSF to post a blog then and discuss this topic in more detail. It will also be included in our webinar series for 2018.  It is estimated that 6% of stage III melanoma patients will be up-staged due to the new guidelines.

Sunscreen: Bioavailability and Toxicity

Public health implications of sunscreen use, Sunscreen testing in Australia, Should nanoparticles be used in sunscreens? and, Toxicity of zinc oxide particles in sunscreens: myth or fact?

LOTS more to come from Save Your Skin Foundation on this topic as well.  We will bring light to the controversy over the use of sunscreen and how it is more healthful to use sunscreen to prevent skin cancer, than to not wear sunscreen and be at risk.

 

Another moving session was one on a topic consistantly discussed by Save Your Skin Foundation:

Patient Support and Survivorship

Melanoma: A clinician’s perspective, Symposium, Dr. Caroline Robert

Melanoma: a patient perspective, Symposium, Leisa Renwick

The survivorship conundrum, Symposium, Fiona Bennett

Living with melanoma – a patient plan, Symposium, Valerie Guild

Roundtable Discussion including our very own collaborator Dr. Reinhard Dummer

 

Closing sessions detailed the following:

Future Perspectives and Congress Highlights

Keynote Address: Unsolved questions in melanoma genesis, Genetic testing for skin cancer in 2017 and beyond, Highlights in melanoma from 2017.

It was an honour to see in person the likes of top melanoma researchers and clinicians such as Dr. Axel Hauschild,  Prof. Georgina Long from Society of Melanoma Research, and many other leading physicians in the field.

Some of the highlighted sessions were expanded upon with coverage from the below publication, please feel free to click this link for more articles: OncLive Coverage of SMR 2017

Following the closing sessions of the World Congress of Melanoma I worked with the Global Coalition for Melanoma Patient Advocacy for an additional day and a half, on initiatives that will be supportive of the melanoma patient population around in the world in 2018.  More to come on that!

For more information on anything you have read here, please feel free to contact natalie@saveyourskin.ca

And a generous thanks to our sponsors ~ Funding for my travel to and attendance at the WCM2017 was provided in part by the generous funders of Global Coalition for Melanoma Patient Advocacy, Melanoma Research Foundation, and Save Your Skin Foundation.  My deep gratitude for the opportunity to attend this event is echoed by my dedication to the patients who need the information I learned.
Thank you!

 

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