People with chronic lymphocytic leukemia (CLL) have a 600 percent higher risk of melanoma, the most dangerous form of skin cancer, a new study reports.
The higher melanoma risk isn’t news, but no one has reported a full analysis of detection rates and treatments among CLL patients, says Clive Zent, professor of hematology/oncology and medicine at the University of Rochester Medical Cancer and Wilmot Cancer Center.
“…in CLL patients, failure of this control system increases the rate at which cancer cells can grow into tumors…”
As a result of the new data, Zent recommends that all clinical teams who care for CLL patients should actively monitor for melanoma as a part of routine care. The goal is to catch the skin cancer early and manage it with the targeted therapies.
“We do not for sure know why CLL patients are more susceptible to melanoma, but the most likely cause is a suppressed immune system,” says Zent, lead author of the paper in the journal Leukemia Research.
“Normally, in people with healthy immune systems, malignant skin cells might be detected and destroyed before they become a problem. But in CLL patients, failure of this control system increases the rate at which cancer cells can grow into tumors, and also the likelihood that they will become invasive or spread to distant sites.”
Study results show that, among 470 people in the cohort, 22 received melanoma diagnoses, a rate that’s more than 600 percent higher than what would be expected in a similar group of age- and gender-matched people from the general population.
Of the 22 diagnoses, monitoring in a dermatology clinic caught 15 (or 68 percent) cases, and CLL specialists detected the other two (9 percent). Eighty-eight percent of the cases involved earlier-stage disease with a better prognosis, the study says.
Researchers also note a silver lining: one CLL patient, a 75-year-old woman who developed advanced melanoma, received a targeted cancer-immunotherapy drug, pembrolizumab (Keytruda), and went into remission for more than two years. She had been taking another targeted therapy, ibrutinib, for the leukemia.
Zent says he believes this is the first published report to offer evidence that the ibrutinib/pembrolizumab combination is effective.
CLL is the most common type of leukemia in the United States with about 140,000 adults living with the disease. Immune dysfunction is a major complication. The new findings support the need for larger studies to seek solutions for the CLL/skin cancer risk.
The Cadregari Endowment Fund at the Wilmot Cancer Institute supported the study. Zent is editor-in-chief of the journal that published the paper, but he was blinded to the peer-review process, which another editor at the journal oversaw.
Source: University of Rochester