When Robert Harsh learned that his cancer treatments weren't working, he stocked up on birthday cards and Valentines so he could still tell his wife and three children how much he loved them even after he was gone.
Two years later, the 43-year-old Maryland state trooper is still celebrating his kids' birthdays in person, thanks to a new drug that has erased all evidence of his melanoma. The disease had spread from a small skin mole to multiple sites around his lungs.
The drug that has kept Harsh alive, called Yervoy, is the first approved therapy to clearly prolong life for patients with metastatic melanoma, says the Food and Drug Administration, which approved the therapy in March.
Yervoy is one of a dozen or so new melanoma therapies that, for the first time, give doctors and patients reason to hope, says Timothy Turnham of the Melanoma Research Foundation.
Melanoma is difficult to treat, rarely responds to traditional chemotherapy and often kills within six to nine months. Until recently, the best therapy available helped only about 15% of patients.
More than 68,000 Americans were diagnosed with melanoma last year, and about 8,700 died, the National Cancer Institute says.
None of the new drugs has been proven to cure melanoma, despite the occasional, spectacular success for patients such as Harsh.
But these therapies are helping people live longer and are setting a new standard of care, says Allen Lichter, CEO of the American Society of Clinical Oncology. The group highlighted melanoma research at its annual meeting over the weekend in Chicago.
Researchers are learning about the basic biology of melanoma, finding genetic mutations that drive the disease and potentially could be "turned off" with drugs, says Lynn Schuchter, a professor at the the University of Pennsylvania School of Medicine.
Doctors there are so hopeful that at a recent patients' conference, the hospital celebrated with a Champagne toast, she says.
"It's like a Lazarus effect," Lichter says. "Now, you could argue that melanoma is one of the most active areas of research."
Yervoy, which is now available, revs up the body's immune system and turns off the brakes on key disease fighters called T-cells.
In a study of 502 patients presented Sunday, combining Yervoy with chemotherapy helped patients live a median of 11.2 months two months longer than those given only chemo. But supercharging the immune system also can cause serious side effects. More than half of those treated with Yervoy developed serious complications, twice the rate of patients given chemo alone, the study says.
Doctors are even more excited about an experimental "targeted therapy" called vemurafenib, which helps slow tumor growth in the half of melanoma patients whose tumors have a mutation in a gene called BRAF, Lichter says.
In a study of 675 patients with BRAF mutations, vemurafenib reduced the risk of death during the study by 63%, says study author Paul Chapman of New York's Memorial Sloan-Kettering Cancer Center.
After six months, 84% of patients taking vemurafenib were alive, compared with 64% of patients on chemo, Chapman says.
Vemurafenib also shrank the tumors in nearly half of patients, while chemo shrank tumors for only 6% of patients, Chapman says.
Although the trial is still going on, those kinds of results are "unprecedented," Chapman says.
The new drugs aren't perfect, however. Vemurafenib caused a number of side effects, including diarrhea, hair loss, rash, joint pain and squamous cell skin cancers, the study says.
About 38% of vemurafenib patients had to reduce their dose because of these side effects, Chapman says.
Researchers already are planning ways to combine some of the new drugs, Turnham says. He says he hopes such combinations will keep tumors in check, much as combination therapy helps control HIV and AIDS, and transform melanoma from a death sentence into a chronic illness.
These life-extending drugs can have enormous ripple effects, Turnham says.
Harsh, who is also a flight paramedic with the Maryland State Police, has been back to work full-time since February, flying accident victims, cancer patients and others to the hospital. He says he misses only a couple of days' work every three months, when he gets treatments.
"Think of all the people who will be saved," Turnham says, "because he is able to get back on the job."
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