Dermatology World

Targeted therapies take aim at skin cancer

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New technologies drive advances in treatment

By Jan Bowers, contributing writer, March 1, 2012

Dermatologists who specialize in treating skin cancer are heralding events of the past year as real breakthroughs in battling deadly and disfiguring forms of the disease. In 2011 the U.S. Food and Drug Administration (FDA) approved two new drugs for the treatment of advanced metastatic melanoma, as well as a device that helps dermatologists select which lesions to biopsy for melanoma. In addition, the FDA approved a promising new treatment of advanced basal cell carcinoma (BCC), vismodegib, on Jan. 30. In the meantime, for the growing population of frail elderly patients with BCC and squamous cell carcinoma (SCC), technological advances are prompting a new look at superficial radiation therapy, a once-common modality that experienced a gradual decline after the 1970s (see sidebar, "A new look at radiation therapy").

One goal, two approaches

With melanoma incidence and mortality both on the rise, the emergence of two drugs that effectively combat the disease at its most advanced stage sparked excitement and enthusiasm. “With these new treatments, even some patients with brain metastases, where most treatments are completely ineffective, are responding, which is quite miraculous,” said Allan C. Halpern, MD, chief of the dermatology service at Memorial Sloan-Kettering Cancer Center. “They have completely different mechanisms of action, which in some ways makes it even more exciting, because it means we’ve opened up two fronts against the disease.”

Ipilimumab, approved last March, is a monoclonal antibody that blocks the molecule cytotoxic T-lymphocyte antigen (CTLA-4), which is thought to act as a brake on the immune system. “Ipilimumab basically counteracts the inhibition of the immune attack against the melanoma cells and allows that attack to proceed more effectively,” said Martin A. Weinstock, MD, PhD, chief of dermatology at Providence VA Medical Center and professor of dermatology and community health at Brown University’s Warren Alpert Medical School.