Skin Cancer: In the Eyes of a Researcher

Skin Cancer: In the Eyes of a Researcher

07.07.11 | By Kate Connors

This week, I had the chance to speak with Dr. Marc S. Ernstoff from Dartmouth College's Dartmouth-Hitchcock Medical Center. Dr. Ernstoff, a leading oncologist and melanoma researcher, took the time to explain to me some of the latest advances in the field.

Tell us how you became involved in melanoma research?

I started my research career in 1981 in melanoma and kidney cancer. From a biology point of view, the two diseases don't have anything to do with each other, but therapeutically, they are both historically treated with immunotherapies.

My research with melanoma extends not just to treatment, but also to risk factors, to how to prevent it, and how to predict when a patient is at risk for recurrence. In fact, this is an area that has been largely unstudied. It wasn't until January this year, in the Journal of Clinical Oncology, that researchers clearly demonstrated that regular sunscreen use decreases the risk of getting melanoma in the first place. We already recommended it, but had no clear documentation to prove it. This was the first study that intends to make a major impact on how we care for ourselves and our children.

How is the way in which we research melanoma changing?

We've been looking at new approaches in treating melanoma in recent years. It's long been recognized that effective melanoma treatments would be immunogenic, so research in that area goes back decades. Now, we're continuing study in the role of immunology and exploiting the immune system in some way in order to advance treatments.

As we've now learned more about the immune system, we recognize that there are checkpoints in the inhibition of the immune system that represent important ways to modify patients' immune responses to cancer. We've made some progress in this, developing antibodies to those checkpoints, and we really feel that this technology can become another tool.

Are these immunotherapies specific to melanoma?

There is some data that these immunotherapies could potentially be useful for cancers such as kidney, prostate and lung cancer. We're beginning to understand that even in these cancers, immunogenic approaches may be successful, but the challenge is to identify the biomarkers for success.

We have also seen that other therapies, such as recent advances in cellular therapies for prostate cancer, demonstrate how pharmaceutical companies can generate clinical grade technologies that benefit patients and may potentially represent promise for melanoma research.

Outside of immunogenic treatments, where is oncologic science heading?

One promising area of research builds on understanding the growth pathways of tumor cells, which have molecular pathways that allow them to grow independently. A decade ago, we made progress in identifying one of the commonly acquired mutations associated with some melanoma patients. That understanding allowed us to move forward in trying to block the pathway.

At first, our efforts were disappointing. However, we focused on targeting the agents we were working on and ended up with significant immune responses. We hope that technologies like this will move into our armamentarium to fight melanoma.

So what is next for melanoma research?

One question now is why people fail in the pathway targeting treatment. Do they fail because they have another type of activation of the same pathway? Or is it because they have activation of another growth pathway?

We're also looking at how to figure out which patients are at a high risk for relapse. If you look at clinical data, there are patients that will be free of melanoma for five years, 10 years, even 20 years or longer, and then have a relapse that can kill them. So we want to be able to better predict relapse in order to help prevent it through behavior modifications, regular screenings that allow early diagnosis and early removal, etc.

We want to figure out a way to put people into complete remissions that are durable. That's the home run we're all aiming for.

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