Saturday, April 2, 2011

Imagining a Cure..Melanoma ..Jim Breitfeller

Imagining a Cure
By Nicholas P. Restifo and Megan Bachinski
For cancer patients, close is not good enough.

Andrzej KrauzeImagine a land where every year a deadly plague afflicts 53,000 people—enough to fill a small stadium. Most are fortunate enough to discover their illness early, when it is completely curable. But 8,000 are not so lucky and their disease spreads to other parts of the body, with lethal consequences. Imagine this happening each year, with little reduction in the numbers who die, and you will understand the toll melanoma takes on patients and their families in the United States alone.

An electrical switch for cancer?

Currently, there are only two FDA-approved treatments for patients with metastatic melanoma: dacarbazine and interleukin-2. These treatments have complete response rates of 2.7 percent and 6.3 percent respectively. A durable complete response—the disappearance of all cancer—is the holy grail of cancer treatment. While patients can sometimes benefit enormously from partial responses, every patient aspires to become cancer free. Studies have shown that in the case of metastatic cancer, any residual tumor cells not killed by therapeutic intervention will ultimately grow back.

Two new treatments, ipilimumab and PLX4032, will probably soon receive FDA approval. While both improve the survival of late-stage metastatic melanoma patients, their reported rates of durable complete response are 0.6 percent and about 2.0 percent, respectively. The difficult reality for melanoma patients is that partial response with any of the available treatment offers only a temporary respite in disease progression. Of course, living with cancer is better than dying from it, but oncologists have not yet been able to achieve a “stasis” of disease like that seen in patients with HIV. Although there are exceptions, delays in the progression of metastatic melanoma after an incomplete response to treatment are usually measured in months, not years, and most of these patients will die from their disease.

A durable complete response—the disappearance of all cancer—is the holy grail of cancer treatment.Adoptive cell transfer (ACT) might offer more than simply hope to people who have failed on these and other treatments. ACT employs methods that involve extracting a patient’s antigen-specific immune cells, usually found in tumor tissue, and expanding the number of these antitumor T lymphocytes ex vivo. When the cells are reinfused intravenously together with the T-cell growth factor (interleukin-2), they are demonstrably capable of trafficking to the tumor and mediating its destruction. The addition of “preparative lymphodepletion”—the temporary ablation of a cancer patient’s immune system—can be accomplished using chemotherapy alone or in combination with total-body irradiation, and is associated with enhanced persistence of the transferred T cells.

ACT can lead to prolonged tumor eradication even for patients with stage IV metastatic melanoma who have exhausted other treatment options. While oncologists are always hesitant to use the word “cure,” mature clinical trials of ACT have demonstrated the disappearance of all tumor in 20/93 patients treated (21.5%). Most importantly, for 19 of these 20 patients (95%), the complete responses have been durable and long-lasting, with some patients remaining disease free for more than 7 years (J Clin Oncol, 26:5233-39, 2008; updated 2010). For these patients, ACT-based immunotherapy may well represent a cure.

It is not easy to own the “drug” used in adoptive cell transfer— the patient’s own T cells.It is important to distinguish ACT-based treatments from other immunotherapies, such as therapeutic cancer vaccines, which have seen a surge of support from pharmaceutical companies since the approval of sipuleucel-T (Provenge). Costing approximately $93,000, sipuleucel-T is not associated with long-term response or even tumor regression. Cancer vaccine clinical trials have resulted in an overall response rate of less than 4 percent (Immunol Rev, 239:27-44, 2011). Some therapeutic cancer vaccines might provide modest but valuable prolongation of survival, but those currently in use do not come close to the aspirational goal of a “cure.”

If ACT-based immunotherapies have the potential to cure one in five patients with metastatic melanoma, why is the procedure only available in a handful of locations worldwide? Why is there so little commercial interest in developing this therapy? What can be done to facilitate the more widespread administration of ACT-based immunotherapies?

The first explanation for the scarcity of these treatments is financial. ACT-based immunotherapies are still considered experimental, are not FDA-approved, and are not paid for by patients’ insurance. Thus, only a handful of locations are able to bear the fiscal burden of administering ACT. But how heavy is that burden? Assuming the host institution has a cell production facility and the specialized staff to run it, the cost for producing a single dose of adoptively transferred T cells is approximately $20,000 plus all costs associated with hospitalization for the treatment. However, even though the costs of ACT can be high, most patients only require a single dose. Estimated costs seem comparable to or less expensive than many of the recently FDA-approved cancer medications—such as bevacizumab (Avastin) or cetuximab (Erbitux)—where the price tag for the medicine alone can exceed $80,000, and no patients are cured. Although ACT-based immunotherapies are neither quick nor cheap, an immune-based approach this effective for a subset of patients is likely to represent a reasonable cost-benefit profile.

It might seem perplexing that the private sector has not pushed for an FDA-approved licensing trial. However a clear path to profitability is still missing in the development of ACT-based immunotherapy for use in the medical marketplace. Not a simple injection or a pill, ACT-based treatments are uniquely tailored for each patient. The cost of entry into the field with a licensing trial includes construction of a specialized facility and the acquisition of highly trained medical and laboratory staff. There may also be a perception that ACT-based approaches lack a clearly defined claim to intellectual property (IP), which entices companies and their shareholders to invest in the development of new treatments. After all, it is not easy to own the “drug” used in ACT—the patient’s own T cells. However, recent financial success realized by Dendreon, the manufacturers of Provenge, which also uses autologous cells, may go a long way toward changing the attitudes of investors. Many aspects of antitumor T cell production might be patentable, and the use of patentable genetically engineered T cells could provide the type of clearly defined IP that investors seek.

Some may argue that a more appropriate sponsor for ACT-based immunotherapy is the cash-strapped public sector. It seems more likely that a network of cancer centers, institutes, and hospitals could form a consortium to refine ACT technology and sponsor an FDA-approved licensing trial. A successful trial and FDA approval for ACT-based immunotherapy could result in a financial windfall for participating institutions. It also seems plausible that leaders from the not-for-profit sector could step forward. A social entrepreneur or “dot-org” research foundation could potentially catalyze the widespread application of ACT technology.

Adding to the list of cancers treatable with ACT could provide a new group of stakeholders with the impetus to push the concept forward. Although most of the work done thus far has been focused on melanoma, current efforts have enlarged the list of cancers treatable with ACT to include synovial-cell sarcomas and B-cell lymphomas. These new examples will hopefully encourage corporate and nonprofit entities to envision the possibility of treating more-common cancers, such as those of the lung, breast, colon and prostate, which offer bigger targets for cure, as well as larger financial incentives. Although the use of ACT-based treatments remains confined to a handful of centers worldwide, the employment of a patient’s own immune system to eradicate cancer is a strategy that can no longer be ignored.

Nicholas P. Restifo is a principal investigator at the National Cancer Institute’s Center for Cancer Research, where he works on designing new immunotherapies for patients with advanced cancer. Megan Bachinski is a writer and editor living in Silver Spring, Maryland.

Read more: Imagining a Cure - The Scientist - Magazine of the Life Sciences

Instead of using ACT therapy (Growing the cells outside body in flasks), What if you did it in vivo. (Inside the Body) This can be done with Combinatorial Therapy with the help of the newly approved Yervoy (Ipilimumab) and Interluekin-2.

Melanoma and the Magic Bullet (Monoclonal Antibodies)

Click on for a copy of Melanoma and the Magic Bullet

“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”
~Charles Darwin~
Take Care,
Jimmy B

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Greetings to One and All

This Blog is dedicated My Brother Kenny B. who passed away in the late 1970's with Cancer before the Internet.

It was he, who showed me How to live and give back. He was wise beyond his years.

Kenny B

Jimmy and Dee

Carepage: Jimmybreitfeller
Jimmy Breitfeller

My Profile as of 2009

My photo
Last July (2005)I was riding my bicycle to work at the Eastman Kodak Research Labs about 3 miles from home. I was wearing a knapsack to carry my things to and from the labs. I started noticing an ache on my back. So I decide to go to the dermatologist. To make the long story short, it was cancer. I knew from my research that I would be needing adjuvant therapy. So I started communicating with Sloan Kettering, University of Pittsburgh Cancer Center, and a couple of others including the Wilmot Cancer Center at Strong. I realized that by telling my story, I might help someone else out there in a similar situation. So to all who are linked by diagnosis or by relation to someone with melanoma, I wish you well. Stay positive, read as much as you can (information helps to eliminate the fear associated with the unknown), and live for today, as no one can predict what tomorrow may bring. Jimmy B. posted 12/15/08


The information contained within this Blog is not meant to replace the examination or advice of your Oncologist or Medical Team. The educational material that is covered here or Linked to, does not cover every detail of each disorder discussed.

Only your physician/Oncologist can make medical decisions and treatment plans that are appropriate for you. But, An Educated Consumer is a Smart consumer.

As Dr. Casey Culberson Said:

"The BEST melanoma patient is an ACTIVE PARTICIPANT in his or her treatment

Melanoma and the “Magic Bullet” (Monoclonal Antibodies)

Just to let you know I posted the first draft of the Melanoma and the “Magic Bullet” (Monoclonal Antibodies). on Melanoma Missionary In the Shared File Section. you can download it for 19.95 (Only kidding) it is Free for the taking.

It is 33 pages long and may help you in your quest for the Yellow Brick Broad. Just to let you know it is only the first draft. Revisions are sure to come. I wanted to get it to the people that need it the most, the Melanoma Patients.


So, where does Interluekin-2 (IL-2) come into play? According to Byung-Scok et al and recent reports, IL-2 is not needed for developmental CD4+ CD25+ Treg cells in the thymus but does play an important role in the maintenance and function in the peripheral.18 Peripheral is defines as secondary system outside the bone marrow and thymus. It entails the site of antigen, immune system interaction. IL-2 is required for the peripheral generation of Tregs based Abbas’s and colleagues research.19

IL-2 prevents the spontaneous apoptosis of the CD4+ CD25+ Treg cells. It has been reported that patients with multiple advance-stage tumors have elevated levels of Tregs within the tumor microenviroment.20 Interluekin-2 is the survival factor for CD4+ CD25+ Treg cells.21 If the addition of IL-2 is on or before the maximum propagation of the CD4+ T cells, the Tregs population can increase 5-fold in a 96 hour period based on certain growth mediums.

By controlling the addition of the endogenous IL-2, one has a knob to turn and can lead to the control of the expansion of the Tregs. When you combined this control with the anti-CTLA-4 blockage, you can shift the balance of the immune response.

Now here is the catch. The maintenance and function of the CD8+ T-cells require CD4+ cells which secrete IL-2. So we don’t want to deplete the CD4+ cells, we want to control the expansion of the Tregs which are a subset of the CD4+ cells. It has been postulated by some researchers that the Anti-CTLA-4 blockage also suppresses the Treg function in a different mechanism. By using IL-2 as the rate limiting factor, we can suppress the CD4+ CD25+ Treg cell expansion by controlling the concentration and timing of the Inerluekin-2 at the tumor microenvironment.

The Interluekin-2 plays another role in this Melanoma Maze. In a study by Janas et al, Il-2 increases the expressions of the perforin and granzyme A, B and C genes in the CD8+ T-cells. This increase expression causes the CD8+ T-cells to mature into Cytoxic T Lymphocytes (CTLs). The exogenous IL-2 is required for the granzyme proteins. As stated previously, CTLs have cytoplasmic granules that contain the proteins perforin and granzymes. A dozen or more perforin molecules insert themselves into the plasma membrane of target cells forming a pore that enables granzymes to enter the cell. Once in the tumor cell, these enzymes are able to breakup (lyse) the cell and destroy it. This is the beginning of the end for the cancer cells. The tumors begin to shrink and the rest is history,

On the other hand, prolong therapy with Il-2 can result in causing apoptotic death of the tumor- specific CD8+ T-cells.23

Clearly in a clinical setting, timing, dose, and exposure to these drugs play a major roll in the immunotherapy, and can have dramatic effects on the outcome.

All it takes is that one magic bullet to start the immune reaction..

Melanoma And The Magic Bullet (Monoclonal Antibodies)

Public Service Announcement

A call for Melanoma Patients by Dr. Steven A Rosenberg

"We continue to see a high rate of clinical responses in our cell transfer immunotherapy treatments for patients with metastatic melanoma", Dr. Rosenberg said.

"We are actively seeking patients for these trials and any note of that on a patient-directed web site would be appreciated."

If you would like to apply for his trials, here is the website and information.

Dr. Rosenberg's information

Dr. Rosenberg's Clinical Trials

For the Warriors

The Melanoma Research Alliance has partnered with Bruce Springsteen, the E Street Band, and the Federici family to alleviate suffering and death from melanoma. Please view Bruce Springsteen’s public service announcement inspired by Danny Federici. Danny was the E Street Band’s organist and keyboard player. He died on April 17, 2008 at Memorial Sloan-Kettering Cancer Center in New York City after a three year battle with melanoma.

Source Fastcures blog

Join the Relay for Life!!!


Dear Family and Friends,

I’ve decided to take a stand and fight back against cancer by participating in the American Cancer Society Relay For Life® event right here in my community! Please support me in this important cause by making a secure, tax-deductible donation online using the link below.

To donate on line now, click here to visit my personal page.
Jimmy B AKA Melanoma_Missionary

Relay For Life® is a life-changing event that brings together more than 3.5 million people worldwide to:

CELEBRATE the lives of those who have battled cancer. The strength of survivors inspires others to continue to fight.

REMEMBER loved ones lost to the disease. At Relay, people who have walked alongside people battling cancer can grieve and find healing.

FIGHT BACK. We Relay because we have been touched by cancer and desperately want to put an end to the disease.

Whatever you can give will help - it all adds up! I greatly appreciate your support and will keep you posted on my progress.

Keep the Fire Burning!!!



Jimmy Breitfeller
Turn off Music before you "Click to Play"
Signs of Melanoma Carcinoma Skin Cancer

How Skin Cancer Develops by " : Dermatology"

Call for Patients with Unresectable Liver Metastases Due to Melanoma

Delcath Systems Granted Orphan-Drug Designations for Cutaneous and Ocular Melanoma

Delcath is actively enrolling patients in a Phase III clinical trial testing its proprietary drug delivery system, known as Percutaneous Hepatic Perfusion (“PHP”), with melphalan for the treatment of ocular and cutaneous melanoma metastatic to the liver.

This NCI-led trial is enrolling patients at leading cancer centers throughout the United States. Commenting on these orphan-drug designations, Richard L. Taney, President and CEO of Delcath, stated, “These favorable designations are important steps in our efforts to secure Delcath’s commercial position upon conclusion of our pivotal Phase III trial for metastatic melanoma. We remain steadfast in our commitment to become the leader in the regional treatment of liver cancers and we continue to enroll patients in this study, and advance our technology and the promise that it offers to patients with these deadly forms of melanoma and other cancers of the liver, all with limited treatment options.”

Orphan drug designation, when granted by the FDA’s Office of Orphan Products Development, allows for up to seven years of market exclusivity upon FDA approval, as well as clinical study incentives, study design assistance, waivers of certain FDA user fees, and potential tax credits.

Current Trial Centers

Phase I Study of Hepatic Arterial Melphalan Infusion and Hepatic Venous Hemofiltration Using
Percutaneously Placed Catheters in Patients With Unresectable Hepatic Malignancies

James F. Pingpank, Jr., MD, FACS
Associate Professor of Surgery
Division of Surgical Oncology
Suite 406, UPMC Cancer Pavillion
5150 Centre Avenue
Pittsburgh, PA 15232
412-692-2852 (Office)
412-692-2520 (Fax)

Blog Archive

Call For Melanoma Patients!!!!

Call For Melanoma Patients!!!!

Dr. Rosenberg Has a New Clinical Trial.

Our latest treatment has a 72% objective response rate with 36% complete responses.

We are currently recruiting patients for our latest trial.

Is there some way to post this “Call for Patients” on the web site?

Steve Rosenberg

Dr. Rosenberg's Clinical Trials

(For a copy of the research paper.. see My Shared files)

The news headlines shown above for Melanoma / Skin Cancer are provided courtesy of Medical News Today.