Lions and Tigers and Bears, Oh My!

A layperson’s explanation of biomarkers and targeted immunotherapy
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Although people share many biological similarities, each person is a unique biological environment of its own. The melanoma animal grows and defends itself based on the environment in which it has taken residence. This is one of the reasons it has been so difficult to find a standard treatment for this disease. Treatments create similar side effects in all individuals but may not have the same effect on the melanoma.

One of the most promising breakthroughs in melanoma treatment in recent years is the area of immunotherapy. There is presently a small but growing assortment of immunotherapy drugs available for melanoma treatment. These have two modes of operation. Interleukin, IL2, which has been available for decades, places the body’s immune system into high gear to attack the cancer. A more recent class of drugs, the “–umab” family (ipilumimab, nivolumab, etc.), removes one of the checkpoint systems the body uses to limit the immune system’s activity in order to protect itself from damage. These are the present weapons in the arsenal and the key is to determine which will be the best for each individual. This is where biomarkers come into play.

According to the National Cancer Institute a biomarker is "a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition."  Look at it as hunters seeking to kill some prey and using evidence from biomarkers to determine what the prey is. First determine the environment, say the Serengeti. Then examine the tracks and scat of the prey to determine the exact animal, in this case a lion. Next bring together what you know; this will give you the safest and best chance of success. You choose your people and weapons and set out to eliminate the threat as quickly as possible. Your approach will depend on whether you find you are facing a tiger in the jungle or a bear in a forest. To further complicate the issue, melanoma can be an infinite number of hybrids of these environments and animals, which will mean the therapies must also be used in the correct combination with each other and with targeted therapies such as BRAF and MEK inhibitors that attack specific genetic mutations in some melanoma tumors.

All this is even more important because melanoma is adaptable. That is, if not eliminated on the first run it can adapt and protect itself, much like how infections will lose vulnerability to antibiotics but on an accelerated timeline. This underscores the importance of coming up with the correct therapy and dosage for the individual patient so that a maximum dose of the most effective treatment can be delivered the first time. As always, early diagnosis and speed of therapy is key because the less time the melanoma has to grow and prepare its defense, the better chance there is of success. 

--Robin Zimmerman
   Sol Survivors Oregon

SolSurvivors Oregon is a local network of patients, supporters, and advocates who educate our community, advocate for sun safety, and are working to improve outcomes with early detection.
www.wearesolsurvivors.org

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