Recently presented at ESMO 2016 Congress Copenhagen, Denmark, a survey by Dr Lidija Kandolf Sekulović, Head of the Department and Deputy Head of the Skin and Venereal Diseases Clinic of the Military Medical Academy, has warned that over 5,000 patients with metastatic melanoma in Europe are being denied access to life saving drugs which is escalating death rates.
The survey study, based on data from 46 European countries on the availability of cancer drugs, was published in European Society for Medical Oncology (ESMO).
Melanoma is the deadliest of all skin cancers that affects every 1 in 100 Europeans. The incidence is rising all across Europe and the world. However, with effective and advanced treatment, the survival rate can be increased.
Of all the European countries, the incidence of melanoma is highest in Switzerland, Netherlands and the Scandinavian countries — Norway, Sweden, Denmark — where about 20 out of 100,000 people are diagnosed every year. The incidence in Germany has also risen to about 78% increase from 1999 to 2012. Globally, the risk and rate of melanoma is rising too. More and more cases are emerging in the US and Australia as we speak.
Treatments for metastatic melanoma cancer have improved significantly in the last five years. There are medicines which can prolong the survival rate in patients from 18 months to 10 years. However, Dr Lidija and team have noted that the patients have limited access to these medicines, especially in Eastern and South Eastern Europe. Physicians are also facing difficulties obtaining these new medicines as pain relieving chemotherapy does not improve the survival of the patients.
According to their survey, every year an estimated 19,250 European patients are treated for metastatic melanoma, out of which 7,450 of the patients come from Eastern and South-Eastern Europe where proper medical treatment is not available. From these patients, 5,128 unfortunately do not have access to the latest treatment according to European guidelines.
Overall in Europe, one-third of the patients do not have access to new medicines.
Kandolf-Sekulovic says, “It is not new that disparities in healthcare can lead to disparities in overall survival of patients, but these disparities are becoming even sharper for patients with chemotherapy resistant metastatic melanoma in whom durable responses lasting for years can be seen in up to 20% of patients if treated with innovative medicines.”
She also provides a solution for the problem, “This everyday situation, which is a source of a large frustration for metastatic melanoma patients, their families and physicians, needs to be addressed urgently by all stakeholders. We need harmonization of reimbursement procedures throughout Europe.”
Standard treatment for metastatic melanoma is a combination of immunotherapy and BRAFi+MEKi combination which are used regularly in Western Europe. BRAF is a human gene that makes the protein B-Raf and any mutation in it increases the risk of cancers.
BRAF and MEK inhibitors are targeted drugs that work differently from standard chemotherapy drugs as they are specific in their action. These drugs slow the growth of tumors in people with a change in the BRAF gene or MEK gene. BRAF inhibiting drugs like Vemurafenib (Zelboraf) and dabrafenib (Tafinlar) attack BRAF proteins while MEK inhibiting drugs like trametinib (Mekinist) and cobimetinib (Cotellic) attack MEK proteins.
BRAF inhibitors are taken twice a day while MEK inhibitors are taken once a day and both are taken in a combination as MEK inhibitors don’t shrink as many melanomas as BRAF inhibitors when used singly. In addition, some people treated with BRAF inhibitors develop new cell skin cancers which are usually less serious than melanoma and can be properly treated.
The BRAFi+MEKi combination is available in 75% of Western European countries and can be fully reimbursed in 58% countries while in Eastern Europe the treatment is available only in 42% of countries and reimbursed in 18% only.
In Western Europe about 70% of the patients have access to medical treatment while in Eastern Europe only 10% of the patients have access to proper medical treatment and life-saving drugs.
In addition to the BARF inhibitors, immunotherapy that utilize antibodies include CTLA-4 blocking agents like ipilimumab and PD-1 antibodies such as nivolumab and pembrolizumab.
But from all these medications, BRAFi/MEKi inhibitor increases over 70% chance of the tumor being cleansed.
Furthermore, tumors of metastatic characteristics should be screened for mutations of BRAF V600. If the results are negative, further testing should be carried out for NRAS, c-Kit, GNA11 or GNAQ.
The patients are advised to avoid sunburn or unprotected UV radiation exposure and to have regular self-examinations throughout their life.
A Persistent Rush Towards Metastatic Melanoma
According to experts, an obsession of people with tanning is putting them at risks of various types of cancers, including melanoma. When UV rays interact with the epidermis, they damage the skin cells. In response the immune system increases blood flow to the skin to repair it and this inflammation gives the sunburnt skin a reddish color.
In addition, white blood cells attack the damaged skin and remove dead cells, can causing the sunburnt skin to itch and peel.
Dermatologists have repeatedly claimed that people, especially women and those with lighter skin, hair and eye color, who have a long-term, unprotected sun exposure are at higher risk of developing skin cancers like basal cell carcinoma and squamous cell carcinoma because they have less melanin in their skin to protect them.
However, melanoma is slightly different as it is the result of intense exposure of the skin to UV radiation for a short time. Other risk factors of melanoma include family history.
Still, The Week reports that according to a YouGov poll, fewer people are going to beaches for a tan due to changing trends, health concerns and a lack of confidence on the beach and therefore 18 percent of sunbed purchasers plan to use them more often.
But even though sunbeds are marketed as a ‘safe’ way to get a tan, experts say that people who use them are at an equal danger as those who get tans from sun exposure and the amount of UV radiation people receive vary a lot.
International Agency for Research on Cancer (IARC) says that there is profound evidence which shows that using sunbeds damages the skin and causes melanoma skin cancer.
In addition, tanning ages the skin faster causing wrinkles, uneven skin tone, age spots and freckles which all look unnatural and unhealthy and is another reason why experts discourage tanning.