Opinion: Fighting the Resistance
25 August 2016
Jane Cadzow’s Good Weekend feature quite rightly celebrates the advent of immunotherapies in cancer treatment and the results these are delivering for patients especially, but not only, in melanoma.
However, like a palimpsest there is another story underneath which must be revealed. This feature just touches on it: resistance. If immunotherapies have emerged as the promised land for cancer patients, then resistance is its border crossing. Currently, we have no way of knowing who will successfully make it across the border and why. These ‘wonder drugs’ only work for 70% of patients. The other 30% do not respond at all. Similarly, targeted therapies, which block the action of a particular mutated gene, work initially in 95% of patients but 70% will develop resistance over time.
Nowhere have immunotherapies demonstrated greater success than in treatment of advanced melanoma. Previously, melanoma was the cancer no one wanted to have because the only treatment was surgery and that only worked if diagnosed early. Today through our clinical trials program at Melanoma Institute Australia, we are achieving remarkable results with patients with advanced melanoma which has spread to other organs. Their one-year survival rate in 2011 was 25%. It is now 75%. Their two-year survival rate is over 50%. It used to be less than 15%.
The next frontier in cancer research is unlocking the mystery of resistance and how to overcome it, as well as developing the ability to accurately predict an individual’s response to therapies. The vast array of samples held in our BioSpecimen Bank, the largest in melanoma in the world, are enabling this research. Liquid biopsies are being developed with bloods as early predictors of therapeutic outcome. Tissue donated whilst on therapy is being used to examine both the tumour genome and its micro-environment to discover the drivers of resistance.
Resistance is the story in cancer today, and an even more significant narrative in other tumours than in melanoma. As drugs developed for melanoma are now leading the way, it is our aspiration that in short order it will be melanoma research which surmounts the obstacle of resistance to truly enable precision medicine for cancers: the right therapy for the right person, at the right time and in the right dose, so we really can claim cure.
Chief Executive Officer
Melanoma Institute Australia
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