Immunotherapy & Dermatology
Although the incidence of melanoma is increasing, most cases are diagnosed at an early stage.
When early, surgical excision is curative in most cases, but some patients at high risk of developing metastatic disease or advanced cases may benefit from adjuvant (additional therapy on top of first therapy) IMMUNOTHERAPY.
IMMUNOTHERAPY is FASCINATING
First you have to understand, that we as healthy humans have an amazing immune system that naturally and ideally can tell between what's foreign (what it should attack), and what's healthy and normal (what it should back down and leave alone).
To do this, it uses “checkpoints.” Immune checkpoints are molecules on certain immune cells that need to be activated (or inactivated) to start an immune response.
Cancer cells sometimes find ways to use checkpoints to evade the immune system and grow.
Medicines that target these checkpoints hold a lot of promise as cancer treatments. These drugs are called checkpoint inhibitors.
PD-1 is a checkpoint protein on immune cells called T cells. It normally acts as a type of “off switch” that helps keep the T cells from attacking other cells in the body. It does this when it attaches to PD-L1, a protein on some normal (and cancer) cells. When PD-1 binds to PD-L1, it basically tells the T cell to leave the other cell alone. Some cancer cells have large amounts of PD-L1, which helps them hide from an immune attack.
Meds that target either PD-1 or PD-L1 can block this binding and boost the immune response against cancer cells. These drugs have shown a great deal of promise in treating certain cancers like melanoma.
These therapies are not perfect but I am grateful they exist!
Since we uncheck the checkpoints to calm your immune system down to go beat down your cancer...certain side effects can occur, ESPECIALLY in the skin.
Where do I come in?
Well, first I diagnose the cancer clinically with a biopsy and with the help of a dermatopathologist. If advanced, I coordinate care with my brainy and amazing heme/onc colleagues and oncology surgeons, and monitor for skin side effects during adjuvant immunotherapy...which are plentiful!