Contents
Immunotherapy is a breakthrough in the treatment of melanoma. Agata, who was hospitalized with a very advanced disease, found out about it, and today everything indicates that she got rid of it for good. Not so long ago, the prognosis for her would have been very pessimistic.
Immunotherapy in the treatment of melanoma
A decade ago, the median survival time for patients with advanced melanoma was less than a year – today they can even recover. Patients can benefit from modern treatment at every stage of the disease, and one of the key elements of the entire treatment process is immunotherapy.
– Until a few years ago, patients diagnosed with advanced melanoma did not have many treatment options. Using the old methods, we achieved 2-3 percent. survive 5-10 years. Today the situation is different – changes in the drug program, both systemic and those related to e.g. reimbursement of immunotherapy has changed the treatment outlook for patients. We get 40 -50 percent. This is a qualitative leap. A revolution has taken place in recent years, thanks to which we can offer our patients the best treatment that does not differ from world standards, and thus extend their lives by up to several years – says Prof. dr hab. n. med. Piotr Rutkowski, chairman of the Scientific Council of the Czerniak Academy.
Agata found out about her illness when everything started to fall into place in her life: the long-awaited son was born and any day they were to move to a new home.
– The diagnosis was a shock for me – nobody in my family had ever suffered from cancer. I couldn’t believe I had melanoma. I remember my first conversation with the doctor in a vague manner, luckily my husband was with me, who asked about everything. I left the office confused. In one moment my whole world collapsed, the future became uncertain. I needed time to mature to this diagnosis – says Agata.
Time for immunotherapy
Treatment began with an operation involving removal of lymph nodes. Then the pandemic started – and we all know what that meant back then. It was then that the mother of a young patient started to work, and she arranged for her to visit the Warsaw Institute of Oncology.
– Prof. Rutkowski opened our eyes to what kind of opponent we are dealing with. He said that the operation is only the beginning, and now we have to start high-class treatment, but if we approach it solidly, we really have a chance to get out of it – recalls the patient.
Agata took 10 cycles of adjuvant immunotherapy. This therapy is based on stimulating the patient’s immune system to fight the cancer. It became famous in 2018, when prof. James P. Allison and Tasuku Honjo received the Nobel Prize for their contribution to the development of this method of treatment.
– There has never been anything like this in medicine before. So far, in metastatic disease and in most solid tumors, there was no question of a 15-year survival, let alone a cure. It turned out that we found a way to teach our immune system to fight cancer. Immunotherapy works very cleverly, not directly on the tumor, but on the cells of the immune system, which are either blocked by the tumor or deceived by it, which makes them inactive – explains Prof. Piotr Rutkowski.
Immunotherapy is not for everyone
Each stick has two ends – immunotherapy can simultaneously unblock the immune system in such a way that it works against the patient’s body and complications arise.
And unfortunately, they happen quite often.
– While there is much good to be said about immunotherapy and it really is a breakthrough therapy, we must remember that it is not a treatment for everyone.. We make the decision to use it based on many premises. It must also be made clear that in order to be treated with immunotherapy, you must have experience and a qualified team, it cannot be done everywhere, if only because about 50% of patients have patients may develop serious complications that require specialist treatment in a hospital – warns prof. Rutkowski. – Of course, we know how to manage these complications, so the balance of benefits and losses is on the benefit side, but you need to know how to proceed in such a situation – adds the specialist.
Agata was very lucky. Though she was very scared and was initially unconvinced about immunotherapy, it eventually turned out to be the right choice.
– During the therapy, I had no side effects that would prevent me from functioning normally. I took up all the household and childcare duties – says Agata. – Today my disease is dormant and I enjoy every day when I can live, work and watch my child grow up. Thanks to immunotherapy, I got a second life – he says.
World standards available for Polish patients
The cooperation between the doctor and the patient is very important, without it there will be no success.
– Not everyone is treated as rosy as Agata’s, so we have to work closely together, and the patient must understand what we want to achieve together – points out Prof. Rutkowski.
Experts often emphasize that what the attending physician will offer the patient at the very beginning of the treatment is crucial for the entire therapeutic process. The progress that has been made in recent years in cancer therapy, including the treatment of melanoma, gives great hopes to patients and their relatives – thanks to the constantly implemented system changes and the provision of modern treatment, Polish patients gain more and more opportunities to extend their lives, which does not have to be different quality from the life of a healthy person. Because – like almost every modern treatment – immunotherapy is an expensive therapy, therefore the decision to reimburse it was very much anticipated.
As prof. Rutkowski, currently the situation of patients with melanoma is really good: all drugs used in this disease, which have the highest level of effectiveness and recommendations according to American and European indications, are also available and reimbursed in Poland. We have 30 centers treating patients with advanced melanomas and they have access to immunotherapy everywhere.
Success can get you into trouble
Access to modern treatment in each voivodeship is very good news, because those treated with immunotherapy should not travel much. The proximity of a specialized center is also of great importance given the risk of complications.
Experts point out, however, that thanks to the greater effectiveness of the therapy, the number of chronically treated patients is growing year by year, while the number of nurses and doctors is not increasing.
– There was no such thing before and I think that it is already being discussed in all hospitals. We have a problem of success in medicine, a phenomenon already present in the West. We want the patient to be treated in the best possible way and it succeeds, the therapies we offer change the treatment into long-term treatment, which means that from year to year we have more and more patients who need to be serviced. With an increasing number of indications for immunotherapy in oncology, in about three years we will have a problem with the medical staff – believes prof. Rutkowski.
It is worth adding that the success of immunotherapy has resulted in ongoing studies checking the validity of using this form of therapy in other cancers, an example of which is the recent registration by the European Commission of nivolumab in the adjuvant treatment of patients with urothelial carcinoma. Patients with esophageal, gastric and colorectal cancer and pleural mesothelioma are already waiting for access to reimbursed immunotherapy treatment.
Monika Wysocka (PAP). Source: Conference “Immunotherapy saves lives!” of April 28, 2022