Annual Report 2007 3-24-08.pdf - Moffitt Cancer Center

Momentum Against Melanoma Is Building
Cancer can change your life. Just ask Ph.D. student Jacqueline Smith, 29, of Orlando who was
diagnosed with melanoma after she had started the first semester of her doctoral program at
Syracuse University.
“I had a lump in my groin and all the doctors who looked at it said it was nothing to worry about,”
she recalls.
But, with the persistence of the graduate student she was, she sought more information and finally
had a biopsy. The diagnosis –– melanoma. Worse, Ms. Smith was told that it would be a miracle if she lived
beyond five years. Not only did her Ph.D. work come to a screeching halt, but for a time so did her life.
“I went home to Orlando,” she says. “My doctor there told me I needed to go to Moffitt Cancer
Center. I’d never heard of Moffitt.” So, she contacted Moffitt and, although she didn’t know it then,
started the wheels of her life back into motion.
“I remember as they were taking my information over the phone,
someone asked, ‘and you are a white female?’ Wrong, I said. I’m African-
American.”
“It is a common misperception that people with darker skin don’t get
skin cancer, but that simply is not true,” says Vernon Sondak, M.D., who
performed Ms. Smith’s surgery. Dr. Sondak leads Moffitt’s Cutaneous
Oncology Program.
Ms. Smith’s life now is back on track. At the beginning of 2008 she
returned to New York where she is channeling her energy back into her
educational goals as she pursues her Ph.D. in Sociology.
Jackie Smith’s life is back on track after
surgery and treatment for melanoma.
What is melanoma and how is it different from other cancers?
Melanoma is a skin cancer that
begins in the cells that produce skin pigment,
“the melanocytes.” These cells produce
melanin to protect skin from the
harmful ultraviolet rays of the sun.
However, UV rays can damage the DNA,
or genetic material in skin cells. The
genetic damage can cause uncontrolled
cell growth and cell division that can
develop into melanoma. Unlike many
other skin cancers, melanoma cells can
spread quickly to vital organs.
Still, if caught early, melanoma is
almost always curable, notes Dr. Sondak.
“But if it gets just a little bit thicker or
if a few cells break free and get into the
lymph nodes, it can turn into being one
of the most deadly and refractory (treatment-resistant)
diseases that we treat.”
Risk factors for melanoma include
a family history of melanoma, abnormal
or numerous moles on the skin, fair
complexion, frequent high intensity sun
exposure, and a history of blistering sunburns.
Using tanning booths has also
recently been clearly linked to melanoma
development. And although light-skinned
people are more prone to burning and sun
damage that could lead to skin cancer
such as melanoma, people with darker
skin also can be affected.
Melanoma, now the fifth most common
malignancy in the U.S., is difficult
to treat in part because of the inherent
biology of melanocytes, the cells that
lead to melanoma. Cancer treatments
such as chemotherapy and radiation
therapy cause DNA damage, and the
hope is that cancer cells will be more sensitive
to this type of damage than normal
cells. But melanocytes are designed to
protect our bodies from DNA damage
caused by ultraviolet radiation. So it is
not surprising that the treatments that
cause DNA damage and that work in
other forms of cancer are of little value
in treating melanoma.
On the other hand, melanoma is
unique in that the body’s immune system
tends to recognize this cancer better
than it does other human tumors. That
is why physician-scientists believe that
immunotherapy may be more effective
in treating melanoma. Yet even though
the immune system “sees” melanoma, in
most cases the tumor continues to grow.
Gene Therapy Boosts
Immune System
Pumping the interleukin-12 gene
directly into melanoma tumors is the aim
of a novel gene therapy technique called
“electroporation” used by Adil Daud, M.D.,
director of the Moffitt Clinical Research
Network, and Richard Heller, Ph.D., of the
University of South Florida College of
Medicine.
“In this technique, a small electric
shock opens a tumor’s pores long enough
to insert a gene,” explains Dr. Daud.
A hand-held device delivers six short
electric pulses after the gene is injected
into the tumor. This treatment renders
the tumor more permeable to the interleukin-12
gene, allowing the tumor to be
clearly “visualized” by the immune system.
Twenty-four patients were treated
in the first-ever trial with electroporation
gene therapy at Moffitt. Three of the
24 patients had a complete remission
of all melanoma tumors, even those distant
from the treatment site, indicating
that the immune system was activated.
A larger trial to confirm these exciting
results is planned.
6 MOFFITT CANCER CENTER