Monday, January 2, 2012

Skin cancer patients get new treatment option in Chicago Northwestern, Illinois Masonic offer isolated limb infusion By Steven Ross Johnson, Special to the Tribune

January 4, 2012

After two surgeries and several rounds of chemotherapy failed to eradicate or even slow down the highly aggressive skin cancer on his right arm, Larry Black felt as though he was left with very few options.

"The melanoma was spreading very rapidly in my arm, to the point that it had popped out on my arm like little blisters all over and was spreading," said Black, 73, of Kankakee. "They (the doctors) said: 'We're not sure we can do any more surgery because if we did, it would take a large portion of the arm.' To save my life, the amputation would have to come next."

Black was diagnosed in December 2010 with metastatic melanoma, a deadly form of skin cancer in which a malignant tumor forms within the cells that produce melanin, which is the material responsible for skin color. Faced with either death or amputation, Black decided he would have his arm removed, an obvious choice but by no means an easy one to accept.

"The fact that it was in my right arm and that I'm right-handed, it was really devastating news," Black said. "But when my wife and I talked about it, we decided it was simply better to go through life with that than not be able to have more years on my life."

But it turned out Black was not out of options. In June, Black began visiting Northwestern Memorial Hospital, where he was presented with an alternative procedure that could possibly save both his arm and his life.

The procedure, called isolated limb infusion, uses a tourniquet to stop the flow of blood to the affected limb, which is then treated with high-dose injections of chemotherapy medication. The process allows large doses of highly toxic anti-cancer drugs to be used on a specific area without adversely affecting the rest of the body.

It was recently announced that Northwestern, as well as Advocate Illinois Masonic Medical Center, would offer isolated limb infusion, making them among only a few centers throughout the U.S. where the procedure is available.

Northwestern Memorial surgical oncologist Karl Bilimoria said isolated limb infusion can be a good option for those with advanced melanoma in which the cancer has not spread to other parts of the body. Bilimoria estimated that two-thirds of patients who underwent the procedure experienced either partial or complete elimination of their tumors.

"It's a great option for any age, and really can improve their quality of life overall both in terms of reducing the amount of melanoma and resolving their pain symptoms," Bilimoria added.

Black said he noticed positive results not long after undergoing surgery.

"We could very quickly see that some of those little melanoma blister cells that had popped up on the skin of my arm had started to pop open and looked like they were beginning to dry up," Black said. "The fact that we started seeing some of them disappear really had given me more hope because if they were disappearing that meant there were no new ones developing."

Despite only recently being available to patients in the Chicago area, isolated limb infusion has been around for nearly 20 years when it was first developed in Sydney in the early 1990s.

Only a few medical institutions in the United States offer isolated limb infusion because of the procedure requires a great deal of resources and personnel, Bilimoria said.

"It's resource-intensive, and it's intellectually intensive, and it's hard to pick the right patients," Bilimoria said. "So I think there are a lot of barriers to getting it in place."

Another challenge lies with the disease itself, in that melanoma is a particularly difficult cancer to treat, said Timothy Turnham, executive director of the national Melanoma Research Foundation. Melanoma affects up to 70,000 Americans and causes 9,000 deaths annually, he said.

"The problem with melanoma in general is that there are a lot of things that might work, but no one thing that will work. Your odds on most of the things out there are pretty low," Turnham said. "People have been trying to find other options, and this (isolated limb infusion) is certainly one of them. But it's just a nasty disease that has a high recurrence rate, and I'm not sure anybody has really found a good answer for it yet."

Turnham said he remains optimistic, however, that great strides toward the treatment of melanoma would someday lead to a cure.

"Things are changing, and we can see a time when for most patients, melanoma will become a curable or manageable disease," he said.

According to Bilimoria, procedures such as isolated limb infusion will probably become more widespread as treatment for melanoma improves.

"Because we have slightly better systemic therapies for melanoma now, we think about a patient with advanced disease somewhat differently," he said. "Before, we had sort of a nihilistic approach because our systemic therapies didn't work very well.

"But now that they work a little better, we are more inclined to spend time thinking about their arm or their leg, whereas before, I guess people were a little pessimistic about dealing with that part when the chances of the disease spreading elsewhere were so high."

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