Question:
I was diagnosed with a level 2 malignant melanoma in July of 1996
(1.5mm thick 0n0m) I had a reexcision (ankle) and sentinal lymph node
disection (groin) which both came back clear
However, I found a lump a few weeks ago (July 1997) in what I
suspected was a lymph node (groin) and had it and two others biopsied.
Unfortunately the enlarged node came back with melanoma, while the
other two were clear.
I'm having a CT and MRI tomorrow, and barring any tumors, the most
recent surgeon suggested removing the remaining lymph nodes from the
July 1996 site. The information I'm getting is that the leg drains to
2 potential locations of nodes in the groin area; one which through a
tracer was identified and 2-3 nodes biopsied (July 1996), and the
second where I found the lump and all nodes were removed.
I have a couple of questions about what to do next:
I've not had any problem thusfar with drainage / swelling, but will i
when the remaining nodes are biopsied?
Is there any chance of the lymphatics rerouting to the deeper set of
nodes which traditionally drains the pelvic area?
What is the risk / benefit of doing this next surgery?
An oncologist suggested two possible treatments: interferon or a
vaccine program GM2 (still in clinical study) Apparently the sucess
rates from each of these are similar. Interferon has been around
longer, but GM2 virtually no side effects. Also the only way to get
the vaccine is to join the study, then flip a coin to see which
treatment I get, since interferon is the control arm.
Does anyone think that there is greater merit to either of these
treatments?
Is there one I should lean toward considering the progression of the
melanoma?
Is there any clear forefront in melanoma research? I've heard that
UAB is miles ahead and is conveniently close for me as well...any
opinions?
Answer:
Some difficult questions. The proper surgery and complications of it are
best addressed by your surgeon.
There is little chemotherapy that is effective against melanoma, but it
appears that stimulating the immune system to reject the melanoma is of
value. However, no one knows the best way to do this. The logic behind a
randomized study is since no one knows if the interferon or the vaccine
is better, flip a coin. Key question -- if one fails, can you get the
other??
First, if you have more tumor remove, CRYOPRESERVE IT!! This allow you
and your oncologist to access vaccines and T-cells. This way you can be
tx'ed w/ IFN(interferon) see how it does and still have other tx's
available to you.
In regards to melanoma vaccines, there are many around. The gm2 is a PH I
trials(I think). There are a few other vaccine in which PH II(Dr. Berds -
DNP/BCG & Cancer Therapeutics'- DNP/BCG/GM-CFS) and PHIII(Ribi -
Melacine-may be difficult to get in) and further along and should be
considered.
We also isolate T-cell(lymphocytes) from tumor biopsies in order to grow
the T-cell in to larger numbers and reinfuse them back into the patient.
In combination w/ IL-2, the T-cell show increased complete
remission/partial remission as well as a higher % in 3 yr survival time.
The MOST IMPORTANT thing is to cryopreserve any more tumor. If you would
like to talk about any of our Cryopreserving, DNP/BCG/GM-CSF and/or
IL-2/T-cell, please call me at (800)279-2796 or beeper (615)407-9539 then
key in your #.
Dr. Robert Oldham would also be interested int talking w/ your oncologist
about tx'ing you with the above tx'ments.
