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The large gray areas on the left hand image show the spread of melanoma tumors to the lung. On the right hand side, the tumors have shrunk after treatment.
Pembrolizumab hailed as 'miraculous' in skin cancer trial
A pioneering new drug appears to have cured a British man with advanced skin cancer who had been given just months to live. The drug, pembrolizumab, is the latest in a new generation of treatments that prevent cancers shielding themselves from the immune system. It was tested on melanoma - the most dangerous form of skin cancer - because the prospects for patients with advanced forms of this disease are so bleak.
Pembrolizumab is a synthetic antibody that blocks a biological pathway called programmed cell death 1 (PD-1) which cancers activate to suppress the immune system. In healthy individuals, PD-1 is part of the process that applies a "brake" to the immune system and prevents it running out of control. Without the brake, there is a risk of a harmful inflammatory reaction - a potential serious side-effect of the new drugs.
In a trial of 411 patients evaluating pembrolizumab - 69% of patients survived at least a year. This means a boost survival rates of melanoma from one in ten to nearly three in four. The result is considered remarkable because all had highly advanced melanoma and a very poor prognosis.
Currently one-year survival rates for untreated patients diagnosed with advanced stage four melanoma are just 10% for men and 35% for women.
Warwick Steele, a 64 year old television engineer from Ruislip, west London, had undergone six months of treatment with pembrolizumab, which is injected into the bloodstream. Doctors were astonished when after just three months his tumours had almost disappeared. Since then they have shown no sign of returning - and in fact have shrunk even further.
Before the treatment started he could barely walk because the melanoma had spread to one of his lungs and he found it hard to breathe. "I got tired simply standing up and was literally too exhausted to shave. But now I feel back to normal and can do gardening and go shopping", Steele remarks. Scans of his lungs - shown above - reveal that after just three infusions, the drug appears to have completely cleared the cancer from his lung.
More Trials Necessary
Doctors are urging caution. The results which have been published are of Phase I, early stage trials. Much larger Phase III trials are underway involving many UK hospitals. Only when they report, in about a year's time, can clinicians be sure what the likely benefits will be.
Like all drugs, the experimental treatments have side effects. Warwick Steele said he experienced night sweats and even had two brief blackouts when on the new drug. But he said it was well worth it, and doctors were now treating these symptoms.
Clinicians do not yet know the true extent of how pembrolizumab might affect survival. After 18 months, 62% of patients were still alive and undergoing treatment. In addition, around 80% of patients responded to the drug - an unusually high proportion. A total of 72% experienced tumour shrinkage, including 39% whose tumours were more than halved in size, according to one kind of assessment.
Additional data showed that the drug also reduced the size of advanced non-small cell lung cancers by up to 47%. Pembrolizumab's manufacturer, the pharmaceutical company Merck Sharp & Dohme, is expected to apply for a European licence to market the drug within months.
Source: The Independent, BBC News
Photo credit: BBC News
Are you thinking about downloading that $5 smartphone app that claims to have the most advanced algorithm for analyzing skin lesions from a photo? Well, think again. A new study suggests that these apps are not very good at determining which ones are cancerous.
Marketed As Educational Only
The apps are marketed as educational only and so aren't covered as medical devices under the Food and Drug Administration's regulations. But that may not stop some people from relying on the inexpensive tools instead of going to see a dermatologist, researchers said - which could mean slower diagnosis of potentially dangerous lesions.
"There's no substitute, at this point, for a complete skin exam performed by an expert dermatologist for picking up melanoma as well as other skin cancers," said Dr. Karen Edison, a dermatologist from University of Missouri in Columbia who wasn't involved in the new study. “For example, even if an app makes a correct diagnosis of melanoma, that doesn't necessarily help if the patient doesn't know where to get a biopsy or doesn't have insurance to pay for it”, Edison said. "We're all for technology, but we need to keep it in perspective, and make it a tool."
Three of those apps, which cost under $5 to own, use algorithms to determine whether a lesion is likely to be cancerous or not. The fourth sends images to a certified dermatologist for evaluation, at a price of $5 per lesion.
Of the three algorithm-based apps, the most accurate still missed 18 of the 60 melanomas, mistakenly classifying them as lower-risk, Dr. Laura Ferris from the University of Pittsburgh Medical Center in Pennsylvania and her colleagues reported Wednesday in JAMA Dermatology. The dermatologist consultation app did better than the others, misdiagnosing just one out of 53 evaluable images of cancerous lesions.
All but one of the apps classified more than half of the benign, non-cancerous lesions as problematic. The researchers said they chose not to release the commercial names of the apps evaluated because their purpose was to determine the accuracy of this type of tool, in general.
In conclusion, don't waste your money on these apps. No technology can beat in-person exams to check for skin cancer. Early detection is the key.
Source: JAMA Dermatology
The School of Medical Science and Technology at IIT, Kharagpur has developed a smartphone application, called ‘ClipOCam-Derma', to help physicians speed up skin cancer diagnosis. Lead by research scholar Debdoot Sheet, this innovation has recently won the ‘GE Edison Challenge 2013’ in Bangalore.
"Being a portable and affordable solution, it can be used by trained health care workers to reach out to elderly and patients in mobility restricted areas for health care delivery," Sheet said.
How It Works
Along with the mobile app, a clip-on device is illuminates the patient’s skin using a colorful flash while the smartphone’s camera captures a sequence of images. The images are then uploaded to the ‘DRICTION’ cloud computational imaging service.
The images are then processed to provide consolidated diagnostic information to skilled physicians to assess potential risks. The mobile application will assist in fast and high-precision screening of skin lesions and abnormalities such as cancers, melanoma, ulcers, psoriasis, and lypoma.
"This in effect will facilitate high-throughput screening of patients at resource constrained or remotely located healthcare centers lacking even minimal access to expert physicians, but witnessing an exponential rise in deaths related to complex skin abnormalities," Sheet said.
Accuracy and Availability
‘ClipOCam-Derma' will be launched after regulatory approvals and Sheet said tests have found it to be 99% accurate.
Note that this mobile app is only available to hospitals and trained physicians. Although there are ‘so-called’ skin cancer diagnosis mobile apps available for iPhone and Android for under $5, the accuracy of those apps is questionable.