Treating Advanced Melanoma

By Kathryn E. Vinson, MS, CCRC

When we were kids, we learned the old song about how the head bone is connected to the neck bone, and the neck bone is connected to the shoulder bone, and so on. As time has marched on, we’ve learned that our bodies are connecting in so many ways that its mind boggling. We touched on that when we discussed Smoking and Bladder Cancer. But rather than looking at causes of cancer like we did when we talked about bladder cancer, researchers are seeing hope for treating advanced melanoma with fecal transplants! With that, let’s take some time today to look at late-stage melanoma, its standard treatment, and how fecal transplants may help treating this dreaded affliction.

Late-Stage Melanoma by the Numbers

In 2021, there are predicted to be over 106,000 new cases of melanoma diagnosed in the United States, with more than 7,000 expected to succumb to this disease. People of Caucasian heritage are much more likely to be diagnosed with melanoma than are other ethnic groups. In the under 50 age group, women are the most likely to be diagnosed with melanoma, although after age 65, men are twice as likely to be diagnosed with the disease. Sadly, this is a disease that also affects young people, with upwards of 2,500 diagnoses a year in the 15-29 age group.

The staging of melanoma is much like other cancers, with more advanced melanomas having spread further. The illustration below is sourced from the AT Melanoma Foundation with many thanks.

Again, like with other cancers, melanoma is cured most easily when caught early – like 99% five-year survival rates when it is localized disease. As the disease progresses, those numbers drop to only about 27% for distant spread of the disease.

Treatments for Late-Stage Melanoma

Treating late-stage melanoma can be tricky. It likes to travel to distant places like the brain, where surgical removals can be difficult at best, and drugs are not often successful at reaching. (Think Izzy on Grey’s Anatomy). While the removal of the primary tumor (where it originally began) is often recommended, it should be noted that surgeons will often take a large portion of the skin to ensure what are called “clean margins,” meaning that there are no cancer cells detected at the edges of what was removed. Also, it is common for regional lymph nodes to be removed, as well as other tumors that have developed on a case-by-case basis. I say this is a “case-by-case” issue as sometimes the spread is too great, or the tumors are located in places where removal is not safe. In most cases, surgery is followed by a combination of radiation, chemotherapy, immunotherapy, and targeted therapies. The decision on the proper course often comes down to the exact type of melanoma found by genetic typing.

New Research into Treating Advanced Melanoma

Earlier this month, researchers with the National Cancer Institute released findings that offer great hope for people with late-stage melanoma. In this work, the scientists looked at how the biology of our intestines affects how melanoma patients respond to immunotherapy. A big part of our immune systems are located in our intestines and is regulated by the types of bacteria found in them. What they found was quite interesting. They found that in patients that had failed treatment with immunotherapy, a fecal transplant from a patient that was successful, had a good chance of increasing the response to treatment. Before you get too grossed out, fecal transplants are performed via colonoscopy, with samples that have been cleared of potential disease-causing germs. Although a lot more research needs to be done on this topic, this initial study provides evidence for larger scale clinical trials.

Speaking of clinical trials, most physicians believe that the key to understanding why certain melanomas respond to treatment, while others do not, lies in clinical trials. We encourage you to take a look at our page dedicated to clinical trials, and to discuss these possibilities with your cancer treatment team if you are so inclined.

As always, much love, many prayers, and abundant blessings to all of the warriors out there!!