Boy, have we come a long way since the ‘80s.
I had been a teenage sun worshiper, diagnosed with a Clark’s level III melanoma on my shoulder in 1982. As the panic ensued, all I could think of was a line from my nursing school textbook: “usually fatal within a few months.”
I underwent a wide excision with skin grafting and the standard CT scans as follow-up. The brain scan suggested metastasis and an experimental protocol using Peg Interferon alpha 2 injections was discussed, but their results were not impressive and I declined. I had a five-year-old old daughter and husband at home and felt I needed to prepare for the inevitable. I stocked up on shoes for my daughter’s EEE wide feet, all sorts of clothes for her next few years, and yes, a horse for Christmas. My credit cards were nearly exhausted.
Then came the waiting. Although the scans didn’t change over the next few years, I was looking at life differently. Eventually, after about five years, I realized that okay, I didn’t die, and I really didn’t have to think about this every day anymore.
So I just moved on (and continued to pay off credit cards). I am glad to say I am still doing fine, and am diligent about annual exams and body checks.
That was the early ‘80s – a time when we offered little hope for advanced diseases. Recent treatment has taken great strides, especially since around 2011, and can include surgery, radiation, targeted therapy, immunotherapy, and chemotherapy, offering hope for possible cure and extending survival.
There are some incredible survival stories with promising new therapies, but not without a cost.
2015 Melanoma — A One-Year Case Study
Paid claims: $1,240,658
A 30-year-old mother of two young children presented to the emergency room with a headache. Diagnostic imaging found a frontal mass requiring craniotomy with tumor resection and confirming pathology of stage IV metastatic melanoma, primary site unknown. She was treated with stereotactic radiation and four courses of Yervoy, and next underwent whole brain radiation and treatment with Opdivo. After a full year of treatment, the claimant was responding to treatment and reportedly the tumors had decreased in size by 50%. We did not renew this account – this claimant was at very high risk for ongoing treatment that would again be over $1 million. As of late July 2016, she was still beating the odds after nearly two years of treatment.
Then Versus Now
Today’s treatments offer new hope for a cure for even advanced stage disease, with combination therapy extending survival for almost a year without disease progression.
— Targeted therapies take aim at the genetic mutations and work to destroy the abnormal aspects of the tumor cells without harming the normal ones. These FDA targeted therapies are Vemurafenib/Zelboraf, Dabrafenib/Tafinlar, Trametinib/Mekinist and Cobimetinib/Cotellic.
— Immunotherapies trigger the immune system to fight against the cancer. FDA-approved immunotherapies are Ipilimumab/Yervoy, Pembrolizumab/Keytruda, Nivolumab/Opdivo, Talimogene laherparepvec/Imlygic/T-VEC, Interleukin-2/IL-2 and Peg Interferon alfa-2b/Sylatron.
— Chemotherapy with DTIC/Dacarbazine is FDA approved for stage IV melanoma.
All of these drugs are expensive. The average Medicare patient will pay from $60,000 to $300,000 yearly for combination treatment. For others you can predict annual costs up to $1 million or more.
There are several types of melanomas but melanomas typically occur in the skin and can be due to exposure to natural and/or UV light. They can also be found in the mouth, intestine, and even the eye, where sunlight doesn’t reach. It is the deadliest form of skin cancer with incidence on the rise in the U.S. and has best outcomes when found and treated early.
… and One More Sign of Hope
Look at Jimmy Carter! Our former president was diagnosed in August of 2015, treated with surgery, radiation and immunotherapy, (Keytruda) for melanoma that had metastasized to his liver and brain. Scans in December 2015 showed he was cancer-free and he was able to stop therapy March 2016.