Once the tumor had spread, the diagnosis of “black skin cancer” was still a death sentence a few years ago. Immunotherapy has changed that. It actively supports the immune system.
Many patients with melanoma have high hopes for immunotherapy. It is now an established form of treatment for this aggressive type of cancer, alongside other targeted therapies. “At the moment it is assumed that about a quarter to a third of the patients actually responds to the immunotherapy,” explains Susanne Weg-Remers from the Cancer Information Service of the DKFZ, the German Cancer Research Center in Heidelberg.
“There are patients who, thanks to immunotherapy, have been living with their advanced tumor disease for years, while before it was quite clear that patients with such a disease only had a very limited prognosis of maybe a few months.”
The evil tricks of cancer cells
Actually, the immune system should recognize cancer cells. The stronger the changes are compared to healthy tissue, the easier it is for the immune system to manage and fight the dangerous cells. As soon as the defense cells of our immune system detect dangerous tumor cells somewhere in the body, they could attack them directly.
But cancer cells often work with nasty tricks. They are constantly changing, hiding, and thus escaping the usual mechanisms. The immune system remains inactive if it does not recognize the cancer cells. These continue to grow unhindered and spread.
The so-called checkpoint signals, which are sent out by the cancer cells, are responsible for this. They modulate the immune reaction and can dampen it, i.e. slow it down. To change this, immune checkpoint inhibitors are used in immunotherapy. With the help of antibodies, they block the insidious signals of the cancer cells and can thus neutralize the braking effect of the cancer cells.
The defense cells have a clear path and can take action. The inhibitors prevent the immune response from being suppressed, can reactivate the immune system, and make it functional again.
Immunotherapy in advanced cancer
Above all, patients with advanced black skin cancer or lung cancer, but also with some rarer tumor diseases, are suitable for immunotherapy. This can lead to significant side effects.
These include, among other things, excessive immune reactions. These can show up on the skin, for example. They can cause skin rashes and liver changes, as well as diarrhea or changes in the endocrine system.
Nevertheless, immunotherapy is considered to be a very successful form of therapy. The possibility of immunotherapy gives hope to most patients. There are also a number of new, targeted drugs that can be used in certain disease situations in the case of advanced melanoma or lung cancer.
“The new drugs,” says Weg-Remers, “give these patients an additional treatment and success option. If the drugs prove effective in clinical trials and have reasonably acceptable side effects, they will initially be approved for advanced diseases. Further studies are needed to use them in people with localized cancer.”
No patient reacts like the other
For example, the scientists want to study exactly why some patients respond to immunotherapy while others don’t, and what could be done to make it work in as many patients as possible.
In the early stages, black skin cancer often seems quite harmless
Not every cancer can be treated with immunotherapy. “Immune checkpoint inhibitors have already been used in clinical studies on prostate cancer, colon cancer, and breast cancer, for example. However, there have only been successes in a few disease situations,” says Weg-Remers. Black skin cancer and lung cancer in particular are still diseases for which therapy is successful in many cases.
Immunotherapy offers many approaches
The immune checkpoint inhibitors are just one form of immunotherapy. Vaccinations are another option. These are not designed to prevent cancer, but to treat it. “For example, research is being carried out into so-called therapeutic vaccinations. They are used when the cancer is already there. Vaccinations have already been investigated in basic research and there are also initial clinical studies,” says Weg-Remers. In some cases, the first results are promising.
Overall, however, there is still a lack of data to be able to assess whether and to what extent such vaccinations help patients in the long term. That is the subject of further, intensive research, says Weg-Remers.
During skin cancer screening, the doctor can already detect small changes
Chances of surviving melanoma high
Black skin cancer is a particularly sneaky and aggressive cancer. The disease often begins without being noticed, for example with a small black spot. The affected person may not recognize this at first, for example when it appears on their back, or they are not particularly concerned about this small skin change.
In the worst case, the diagnosis of ‘black skin cancer’ will come at some point. By then, however, aggressive cancer can spread further and metastases can form.
If skin cancer is detected early, an operation often helps to keep cancer in check. In addition to surgery, radiation, and chemotherapy, immunotherapy, together with other targeted drugs, is now considered the fourth pillar in cancer treatment. Doctors usually carry them out when other therapies have not worked. But the best thing is to catch cancer as early as possible – or to prevent it. Regular check-ups should be high on your to-do list. And instead of exposing yourself to the sun too often and for too long, the following applies: Always go into the shade.