JILL MARGO

The aftermath of surgery for melanoma.Photo: Dean Osland

Sometimes, when hope is low, cancer treatment can turn up an unexpectedly good result. This happened recently in New York at the renowned Memorial Sloan-Kettering Cancer Centre.

It involved a woman of 41 with advanced melanoma who had three children and had run out of curative options.

In 2004 she had been treated for a melanoma on her back, but the cancer had already escaped and seven years later, despite further treatment, had spread into her lymph nodes, her spleen and into an area close to her spine.

Although she received the newly approved melanoma drug, ipilumumab, her condition worsened. She was in pain and her outlook was grim.

To relieve the pain of the lesion pressing on her spine, doctors gave her local radiation only to this area.

What followed was unexpected. Not only did the spinal lesion shrink back dramatically, but so did the lesions in the rest of her body that had not been targeted by the radiation.

The radiation had triggered something that made the tumours in her back and lymph shrink and those in her spleen, that had appeared as distinct dark patches on the scan, vanish completely.

It is now 15 months since that occurred and she continues to do well. CT scans two weeks ago found the only site of disease was on her back, which remained stable in size.

Her unique case, published in The New England Journal of Medicine last month, described the event as a rare phenomenon.

It occurs when local radiation delivered to a single tumour in a person with advanced disease results in tumour disappearance outside the irradiated area.

It has been described in cancer before including in melanoma, lymphoma and kidney cancer.

While no one is sure how it eliminates cancer, researchers from MSKCC suggest this case may have resulted from a combination of the new drug and the radiation. They believe the immune system’s cancer-fighting response may have been turned up a notch with the addition of focused radiation.

Ipilimumab was developed at MSKKC and is the first drug ever to show an improvement in overall survival in advanced melanoma.

It is a form of immunotherapy that exploits the body’s own immune system to attack cancer. Last year it was approved for use in advanced melanoma in the United States and in Australia.

For this case study, changes in the woman’s immune system were constantly measured and changes in tumour-directed antibody levels and immune cell populations were noted at the time of the abscopal effect.

This suggests radiation may help activate the immune system to fight cancer. Trials are now under way in the US to confirm the approach of combining radiation therapy with ipilimumab for the treatment of melanoma and, interestingly, prostate cancer.

Michael Postow, oncologist and the lead author of the case study, says the woman still complains of right-sided rib pain which he believes may be due to nerve damage from the cancerous mass that was in her back.

Despite this, she now has “remarkably durable, stable, low volume disease and is clinically well”.

The Australian Financial Review