Self-exams can be critical in spotting melanoma, other skin cancers
With warm summer days around the corner, it’s important for everyone to protect themselves and stay safe in the sun. This year in Colorado, an estimated 1,920 people will be diagnosed with melanoma of the skin. Most skin cancers are caused by an influx of exposure to ultraviolet (UV) rays, which come mainly from the sun, but also sources like indoor tanning beds and sun lamps.
Physician Spotlight from Western States Cancer Research
Dr. Ryan Weight, DO, Oncologist
Interview by WSCR-NCORP Staff Member, Laura Gabbay
What role as an oncologist do you play in any given cancer, specifically melanoma and other skin cancers, research clinical trial?
As a medical oncologist providing care to patients with advanced cancer such as melanoma and other skin cancers, my role is best described as a director or navigator, one who provides guidance to patients based on knowledge and accumulated experience. For instance, medical oncologists are often the providers that identify clinical trial opportunities and present these options to patients who need treatment beyond the standard of care. If the patient elects to enroll on a clinical trial it is then our responsibility to oversee the patient’s care while on trial. For example, we will evaluate patients while on study including monitoring and reporting side effects in addition to determining if the clinical trial is working for the patient in the way that we hope it will. As oncologists, we decide with the patient when it is time to discontinue the clinical trial if the treatment is not working or there is an untoward side effect. We ensure that the best possible care is provided to the patient while maintaining the integrity of the clinical trial.
COVID-19 and Patients Receiving Anticancer Immunotherapy.
SARS-CoV-2 and the resulting respiratory tract infection COVID-19 has upended our society and forcefully changed the way we care for patients. Since the emergence of the virus in early 2020, there have been questions surrounding the risk posed to patients with a cancer diagnosis and the safety of anticancer therapies. The desired effect of immune checkpoint blockade (ICB) drugs is to activate the innate immune system (t-cell subset) to recognize cancer cells as foreign and harness the immune system to eradicate disease. But can this heightened state of immune awareness result in a protective effect against pathogens like viruses and bacteria? Or is the potential inflammation generated from immune activation detrimental to those exposed to infectious pathogens?
Three large, retrospective cohort studies regarding the clinical impact of COVID-19 on patients with cancer have been published2,3,4. The largest report up until September 30, 2020, comes from the COVID-19 and Cancer Consortium (CCC19), which reported 30-day all-cause mortality for 928 patients from the United States, Canada, and Spain with laboratory confirmed SARS-CoV-2 and a diagnosis of invasive or hematologic malignancy between March 17, and April 16, 2020. Of those receiving anticancer therapy, only 16% (38 patients) had received immunotherapy, including ICB, allogeneic stem cell transplant, or adoptive cell therapy. The authors did not report the mortality risk for those patients receiving immunotherapy, however, type of malignancy, type and recency of anticancer therapy, and surgery were not associated with an increase in all-cause mortality.
The TERAVOLT study focused on patients with thoracic malignancies in Europe and North America. The results published in Lancet Oncology July 2020 reported on 200 patients, of which 74% (147 patients) were on therapy at the time of COVID-19 diagnosis. Thirtyfour patients were receiving ICB alone at the time of COVID diagnosis and, importantly, these patients did not show an increased risk for hospitalization (OR 0.51, 0.16-1.56) nor risk of death (OR 1.39, 0.52-3.64) by univariable analysis (3). A third study reflecting a single institution’s experience of COVID-19 and cancer reported no increase in ICU admission or death in 102 patients receiving cytotoxic chemotherapy and 18 patients receiving immunotherapy(4). Collectively, these findings suggest that ICB is not a strong risk factor for hospitalization or death in patients with cancer who have been infected with SARS-CoV-2.
The medical community is continuing to learn how to manage cancer patients amidst the COVID-19 pandemic. Mechanistically, immune checkpoint blockade drugs would not be expected to independently put cancer patients at risk of contracting COVID-19. The data presented here and our knowledge to date does not suggest that patients receiving these medications are at increased risk of a hyperinflammatory response to COVID-19, which might place a person at risk for hospitalization or death. It is recommended that providers thoughtfully consider the use of ICB for the treatment of malignancy as we navigate the many challenges surrounding patient care during the COVID-19 pandemic.
1. Failing et. al. Safety of influenza vaccine in patients with cancer receiving pembrolizumab. JCO Oncology Practice. 2020 July; 16(7):e573-e580.
2. Kuderer et. al. Clinical impact of COVID-19 on patients with cancer (CCC19) a cohort study. Lancet Oncology. 2020 May; 395:1907-18.
3. Whisenant et. al. TERAVOLT: Thoracic Cancers International COVID-19 Collaboration. Lancet Oncology. 2020 July; 21(7):914-922.
4. Jee et. al. Chemotherapy and COVID-19 outcomes in patients with cancer. JCO. 2020 Aug; 38:1-9.
Can patients’ gut microbes help fight cancer?
A healthy gut microbiome seems to be required for immuno-oncology therapies designed to turn up the body’s immune response to attack tumors. Researchers have many “black boxes” to fill in on how gut microbes directly or indirectly influence the T cells unleashed by immune checkpoint inhibitor therapies. But several groups are betting that microbiome-based therapies can help more patients respond to immunotherapies and become one of the biggest breakthroughs in cancer treatment in decades.