Combination therapy offers hope for melanoma patients facing recurrence

A melanoma diagnosis can be scary, but when it’s caught and treated early, the estimated five-year survival rate in the U.S. is about 99%. But what if your melanoma is one of the rare melanomas to recur after treatment? That’s what happened to HonorHealth patient Leticia Rascon, who was first diagnosed with stage II melanoma in 2017. Thanks to a comprehensive treatment available in the Valley, and the collaborative care between the Virginia G. Piper Cancer Care Network and HonorHealth Research Institute, Leticia was given a second chance at life.

After successful treatment outside the country following her initial diagnosis, Leticia came to HonorHealth in 2019 when her symptoms returned. She was referred to Abhishek Patel, MD, an oncologist at the Virginia G. Piper Cancer Care Network, who determined that not only had her melanoma returned – it was now in her lymph nodes.

She was scheduled for surgery with Rick Low, MD, a general surgeon and independent member of the HonorHealth Medical Staff, to remove the melanoma and was treated with an adjuvant therapy, which is a standard of care that reduces the risk of the melanoma coming back. Unfortunately, her melanoma was very aggressive, and new melanomas began developing on her leg even during treatment.

Because of a genetic mutation in her melanoma, she was treated with a medication to specifically target the genetic mutation. Although her lesions began to shrink while she was on this new therapy, her body just couldn’t tolerate the side effects. By this point, the melanoma had progressed along her legs and feet, causing significant swelling so she could no longer walk comfortably.

Facing an uncertain future, Leticia was referred to Justin Moser, MD, a hematologist and medical oncologist at the HonorHealth Research Institute Melanoma Clinic. Based on published trials, Dr. Moser and Dr. Patel recommended a combined therapy of two medications – talimogene laherparepvec, which is an FDA-approved virus-based therapy for melanoma that is injected directly into the tumors, and ipilimumab, a medication that is often used when cancer has come back after prior treatment. Leticia agreed to try the combined therapy.

“Intratumoral injections, like talimogene laherparepvec, can be very effective therapies for patients with melanoma. Unfortunately, they are highly under-utilized for the treatment of patients with melanoma, and HonorHealth Research Institute is one of the few places in the Phoenix area to offer this FDA-approved, effective therapy,” said Dr. Moser. “Most of her lesions were injectable, and we know that if we can inject most of the lesions, the chance of the tumor responding to treatment is very high.”

Side effects are also typically mild, which was the case for Leticia, and a welcome change after her previous therapies. After just five weeks of treatment, the melanomas on her leg began to shrink and eventually went away completely. After six months of treatment, only two mildly enlarged lymph nodes remained. Based on the recommendation from her care team, Leticia decided to have both surgically removed so they could find out if there was any melanoma remaining. Pathology from the surgery found the lymph nodes to be free from melanoma – indicating a complete response to the combined therapy. Leticia was now cancer-free.

“Our primary focus at the HonorHealth Research Institute Melanoma clinic is our patients. Given Leticia didn’t live close to our clinic, we closely coordinated her care with other members of her healthcare team so that she could more conveniently get surgery and ipilimumab closer to home with Drs. Low and Patel, although she did have to come to our clinic for her intratumoral injections,” said Dr. Moser. “We want all patients in the Phoenix area to have access to the most comprehensive treatment options available for their cancer, including intratumoral injections, clinical trials and other options that we offer at HonorHealth Research Institute.”

Leticia credits her recovery to this collaborative approach at HonorHealth. She continues to follow-up with Dr. Patel every three months and is still free from cancer. Her foot, which had gotten quite swollen from the melanomas, is back to its normal size, and she’s thankful she can wear her shoes and walk comfortably once again.

Melanoma research at HonorHealth

For more information on treatment options for melanoma and oncology clinical trials at HonorHealth Research Institute, please contact the Oncology Research Nurse Navigation Team at 480-323-1364 or send an email.

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