Tuesday, 11 August 2015

Melanoma- a great overview!

A MUST- READ 2015 primer for anyone with interest in Melanoma!

A very well-written, complete and up-to-date overview about Melanoma from April 2015 published in the Journal Nature by a group of international Melanoma experts: http://www.nature.com/articles/nrdp20153

A few comments-

Figure 1 shows the incidence of Melanoma, so how many patients are diagnosed with Melanoma in a given country. The numbers come from Globocan 2012- please check it out, it is a very good data source from the World Health Organisation! 

The authors give a numbers of reasons for the differences in incidence between countries but remembering Ana-Maria talks you might want to add the differences in the qualities of the registries: 

If you don't register your Melanoma cases, you don't have a Melanoma problem!

Table 2 gives compares the results of the latest drugs in Melanoma- very useful! 
IMPORTANT-Please note that foot notes 'results confounded by cross-over'- so Dacarbazine has NOT gotten any more efficient over time, it is just that patients who (not very surprisingly) did not respond to Dacarbazine crossed over to the other treatment arm and therefore lived longer than on Dacarbazine alone. 
Even without cross-over, patients who progress on a clinical trial can leave the trial and move on to other treatments- as patient interest is obviously to survive as long as possible- but this can make the trial treatments better than they actually are!

And we are obviously keen on the Ipi plus Nivo results in comparison!

Table 3 for BRAF mutated Melanoma: there should be no doubt left that the combination of a BRAF and a MEK inhibitor is better than a BRAF inhibitor alone!

Should your oncologist STILL disagree, this would be a paper- including the supporting studies, references at the end of the paper- to take to him or her to scientifically argue your case.

On the primer in pdf- a really beautiful summary of the article in a practical format. Just one point- why the 'subjective' perception in the Quality of Life section?! 

We should get out of this 'objective' versus 'subjective' (suggesting lower quality of the latter) and rather focus on how to solidly capture and analyze this type of data in a way that fits its nature. 
Quality of Life IS subjective by definition- just like e.g. pain is- which does not mean that one can not objectively measure and analyze the impact of a treatment on the quality of life in groups of patients. 
It is not that 'objective' measures in clinical trials are not open for debate- as just discussed above, even the 'very hard' factor of overall survival is influenced by outside circumstances, so blindly trusting this 'objective' data could be down-right dangerous.

Because in the end, patients need life in quality- anything else would be extended suffering. 

Bettina Ryll

11th August 2015