Melanoma Success Story: David (age 66)
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Patient Presentation: Stage IV Metastatic Melanoma
David is a 66-year-old male with superficial spreading melanoma (SSM). Based on a recent biopsy, his cancer was graded as pT3a stage of progression. David’s oncologist had prescribed him the standard treatment for this diagnosis: surgical excision of sentinel (closest to the tumour) lymph nodes; and if biopsies of the removed lymph nodes indicated cancer, then adjuvant IFNα/IL-2 therapy would be introduced.
However, David wanted to know for certain that this was the best treatment plan for him. So he reached out to CTOAM for a second opinion.
Melanoma Success Story
How CTOAM Helped David
1. Records Review and Personalized Research
CTOAM’s cancer experts reviewed David’s medical records and life history. Our research revealed that the treatment plan recommended by David’s oncologist was not ideal for David’s unique case.
- Tumour removal: First, it might not be necessary to remove four of David’s lymph nodes for his unique case. This is because accurate diagnosis requires the use of multiple medical imaging and diagnostic modalities. Therefore, an assumption of the degree of metastasis should not be determined from biopsy results alone.
- Adjuvant treatment: Second, adjuvant treatment with the toxic IFNα/IL-2 combination produces many negative side effects, and metastatic patients typically progress within a few months to a year. Additionally, this type of treatment would be mostly ineffective for David.
2. Introduced Advanced Diagnostics
To create a new treatment plan for David, we first needed to determine whether or not his sentinel lymph nodes contained cancer. (Versus David’s oncologist’s recommendation to remove the lymph nodes before knowing if this was actually necessary.)
So we ordered a PET/CT to confirm whether David’s disease was metastatic.
How to Detect Melanoma
What is a PET/CT Scan?
PET/CT, unlike other forms of medical imaging, is able to identify active tumours at a very small size, based on the biological activity of the tumour.
While most forms of imaging look at the density of the tumour and compare it to the surrounding tissues, PET/CT uses a harmless radioactive isotope that is bound to a sugar molecule.
Since tumour cells are constantly growing and therefore highly metabolic, they drink up more of the sugar-isotope solution than the surrounding tissues, and any tumour will glow like a Christmas tree light.
Since only live tumours will drink the sugar-isotope solution, PET/CT can tell if a tumour is alive or if it has been affected (killed) by a specific treatment. No other form of imaging can reveal this essential information!
Furthermore, since the amount of the sugar-isotope solution a specific tumour drinks depends on how fast it is growing, a PET/CT can determine how aggressive a specific tumour is compared with other tumours in the body. This can allow doctors to focus on the tumours that are most likely to metastasize.
Possible Genetic Testing
If David did have metastatic disease, we would then test his tumour DNA for the BRAF V and E600 mutations. These mutations are commonly found in his specific form of melanoma, and effective targeted therapies exist for them.
- Benefit of targeted drugs: Targeted cancer therapies only kill cancerous cells with the mutation and leave healthy cells alone to flourish. Therefore, they have fewer and less severe side effects than standard treatment and standard chemotherapy.
- Read more about tumour DNA sequencing
If David was found to have BRAF mutated metastatic melanoma, we suggested that he try Dual BRAF and MEK inhibition.
Recent data indicate that combined Dabrafenib (BRAF inhibitor) and Trametinib (MEK inhibitor) therapy is superior to monotherapy. Response rates with this combination therapy were 76% compared with only 54% for Dabrafenib monotherapy (P = 0.03). This combination reduces the cutaneous squamous-cell carcinoma that can accompany treatment with BRAF inhibitors to 7% versus 19% receiving monotherapy (P = 0.09) (Flaherty et al., 2012).
CTOAM’s cancer specialists also created a gene-targeted nutraceutical diet to help slow the rate of David’s cancer. This diet includes foods and supplements that have been proven to inhibit the genes and molecular processes that caused the type of melanoma David had.
5. Patient Outcome
Luckily, David’s PET/CT indicated that he did not have metastatic disease. Therefore, the painful surgical removal of his sentinel lymph nodes was completely unnecessary!
If David had accepted his oncologist’s original treatment plan, he would have been subjected to serious surgery for absolutely no reason. Because he sought a second opinion from CTOAM, David was able to avoid unnecessary surgery and ineffective standard treatment. He’s also now benefitting from a personalized diet that is proven to prevent his form of cancer from recurring.
This is the power of precision oncology.
At this point, David requires no further treatment. However, we suggest that he be monitored using PET/CT to ensure that he remains healthy.
- Misdiagnosis in standard treatment: David’s case is not unique. CTOAM has seen many cases where patients were being treated with harsh chemotherapy for cancers they did not actually have. Usually, it is only after the patient gets a PET/CT scan that their doctors realize the misdiagnosis and mistreatment. And often, the only way to get a PET/CT scan is by seeking a private clinic.
- Get a PET/CT scan: If you’ve received a cancer diagnosis without a PET/CT, contact CTOAM so we can arrange a private scan for you. The sooner you get a PET/CT scan, the sooner you will know whether your original diagnosis (and current treatment) is correct. We cannot recommend this enough.
As you can see, CTOAM’s advanced diagnostics, records review, and consultations can result in significant benefits to a patient’s outcome. Having access to a team of precision oncology specialists, doctors, and patient advocates can make all the difference in the outcome of your disease.
If you or a loved one has cancer, contact us today so we can do a brief review of your medical records. CTOAM’s cancer experts will ensure that you have access to the most advanced tests and treatments available for your unique form of cancer – as close to home as possible.
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