Melanoma has been hitting the headlines recently with the release of the 5 year results of the checkmate 67 trial for combination immunotherapy drugs (ipilimumab and nivolumab) which shows the drugs can stop or reverse the progression of advanced melanoma in more than one in two patients. This is truly ground breaking when you consider that less than 10 years ago only one in 20 Stage IV patients survived for 5 years or more and most faced a life expectancy of between 6 to 9 months. My Oncologist led the trial and here he is at the European Oncology Conference (ESMO) discussing the trial results
However, whilst impressive progress, immunotherapy doesn’t work for around 50% of patients and it can have seriously life debilitating side effects; there are still far too many melanoma patients are still succumbing to the disease. There is so much work still to be done and that’s why the fundraising to support the melanoma research at the Royal Marsden is so important (more details on the melanoma research later). The team working on the research is pictured here led by Dr Samra Turajilic, Dr Lewis Au and Dr Lavinia Spain who all work with Professor Larkin.
I was recently back at Marsden HQ and my latest scan results were good now 21 months on from starting Dab/Tram it continues to keep my melanoma under control for which I am hugely grateful. At my latest consultation I met the new team of registrars who have recently joined the melanoma team. After hearing my results I was asked “So Shiona how are you” and my response was “Well we’ve booked to go to Peru” at which my doctor replied “Most patients when I ask that question would answer with how they are feeling from a medical perspective and any side effects experienced but you have gone straight to the important things” I was then feeling slightly embarrassed but I hadn’t experienced any side effects in the previous month and did have questions about the drugs I am on and the high altitude in Peru. I was also thinking perhaps I had not made the best impression on the 3 keen new junior doctors who I had just met for the first time. Anyway my Oncologist knows me well and David was finding it all rather amusing. I guess it did show I am getting on with my current “living in the present life”.
The living in the present can be hard as anyone going through stage IV cancer treatment will know. I have gone from the utter fear of planning anything early last year due to bad side effects and cancelling trips to now feeling lets just book the trip. I like to have scans close to going away on holiday for peace of mind and also of course the insurance company requires it too. Recently though I had a sharp reminder of how quickly I can go from feeling well to feeling awful. A couple of weeks ago I was attending my lovely brother in law and gorgeous new sister in law’s wedding in Manchester. It was a stunning day with beautiful September weather and so much fun seeing all the family and partying at the wedding. We returned to London the following evening and at 3am on Sunday morning I woke up bolt upright feeling awful knowing I was going to be sick and that was the start of a horrible 36 hours of vomiting and diahorrea that I wondered if it would ever stop. I couldn’t get my head off the pillow all day on the Sunday, as I was feeling so awful. At one point David said to be don’t you think you might feel better if you come downstairs so I dragged myself out of bed and went downstairs only to be running to the bathroom 5 mins later. It definitely wasn’t the alcohol from the wedding, as I don’t drink anymore. Although I was feeling awful, I didn’t have a fever and I knew if I phoned the Macmillan hotline at the Marsden on a Sunday I would probably get sent to A and E so decided to just hang on and see how I was by Monday morning. The following morning I had stopped being sick and the D and V was under control so no need for an unscheduled trip to Marsden HQ. I think I just caught a vomit bug as Dave’s cousin it materialised had caught the same bug. Anyway it has certainly made me rethink any long bus trips planned in Peru and also remember how quickly I can go from feeling good to very unwell.
Over the last couple of months since finishing the Welsh 3000’s there has been a lot more time to see family and friends as I treasure spending time with them and I know that it may sound a bit of a cliché but its what’s important in life. There has been a lovely trip to Scotland to see my parents and also some of the Scottish family, Anne and Fred’s Golden Wedding Celebration Party in Derbyshire, a trip to Salcombe with my good friend Jen, the Hadcroft wedding in Manchester and a girls trip to Hertfordshire to celebrate Liz’s bday. Here are a few pics from the recent adventures.
The Shomelanoma fundraising has also received a boost over the last couple of months. Anne and Fred (David’s Aunt and Uncle) celebrated their Golden Wedding Anniversary and had a party to celebrate which was a lot of fun. Their guests generously donated to the melanoma research at the Royal Marsden rather than give gifts and an incredible £730 was raised so huge thank you to Anne and Fred plus all of their guests for their generous donations.
Next up the Shomelanoma team will once again be running the Royal Parks Half Marathon. We have a big team this year including David, Matt, Fraser, Chris, Tony, Christy, Ronan, Thomas and Jo who are all training hard and will be taking to the parks of London on Sunday 13 October. If you would like to support them full details are below and BIG thank you to all of you, look out for the photos in the next blog.
Thanks to all of your generous support we are now less than £1k away from the Team Shomelanoma £50k fundraising target which is just incredible and I have to say a massive thank you again to everyone of you that has taken part in a fundraising event or donated to support all of the various challenges. The funding is being allocated to support the melanoma research programme and here is the latest update from Dr Lavinia Spain.
The Melanoma Research Programme is currently working on samples collected from 2 complementary studies, involving >300 patients. The first, Melanoma TRACERx (TRAcking Cancer Evolution through therapy (Rx)), is a research study aimed at transforming our understanding of cancer heterogeneity (differences in cancer genetics from cell to cell even within the same patient) and evolution (how cancer evolves over time within the same patient). Through longitudinal analysis of genetic information, Melanoma TRACERx ultimately seeks to understand how and why melanomas progress as well as examine the variation in response to treatment. The second is the PEACE study, a national post-mortem study enabling sampling of tumours at multiple metastatic sites.
At present we are focused on cohort of 14 cases for analysis, leveraging samples obtained through both studies. Between 10 and 70 samples have been collected from each patient. In a normal study, usually only 2 to 3 samples are collected. This now means the team has around 500 – 700 patient samples to analyse. With this depth of data we hope to answer important questions about immunotherapy and tumour heterogeneity, making a unique contribution to the scientific literature. Both DNA and RNA samples have been extracted for sequencing, a process that can take up to two months to prepare accurately and to the required standards of quality. Using the latest genetic sequencing technology hundreds of patient samples have been sequenced. This data is now being interpreted by our team’s bioinformaticians based at the Francis Crick Institute. This is a specialist role which applies information technology to analyse the vast amount of biological data. The aim is to identify specific mutations or proteins that influence immune response which can be investigated further. The analysis of the preliminary data is currently on-going.
The team aim to publish their preliminary data in a leading scientific journal in order to significantly advance our basic understanding of why there may be heterogeneity in tumour response to immune therapies. Over the next 12 – 18 months the team aim to complete their final analysis of the data collected.
In parallel we are continuing with a number of other results projects: 1) collecting blood samples from a large cohort of patients in order to evaluate how tumour DNA circulating in the bloodstream may be used to predict relapse and response to therapy, 2) looking at matched primary melanomas and their metastases to elucidate the nature of evolution and spread and 3) determining how ‘biomarkers’ (distinct measurable characteristics of a tumour) may be used to predict treatment response.
We are always incredibly grateful for the generosity of our patients and their families who contribute to these studies.
Stay tuned for more Shomelanoma adventures soon.