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In his 45 years as a physician, Arthur Frankel has witnessed a striking evolution in available cancer treatments, and in patient outcomes. Not so long ago, for instance, “metastatic melanoma was truly a horrible disease,” says the University of South Alabama physician-researcher. In the US, more than 10,000 people each year were diagnosed with the cancer, which starts in the skin and has typically carried little chance of survival once it spreads to the lymph nodes and internal organs. With the recent approvals of several checkpoint inhibitors and another class of drugs known as BRAF inhibitors, however, Frankel says he saw “dramatic responses” in some of his patients: their tumors would disappear, and the patients would go into years-long remissions—but not all of them. The response rate of melanoma patients to one common combination immunotherapy, Nivolumab plus Ipilimumab, is less than 60 percent.
Melanoma is but ...