Key topics in melanoma presented at EADO 2018

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Published: 22 Nov 2018
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Dr Josep Malvehy - Hospital Clínic de Barcelona, Barcelona, Spain

Dr Josep Malvehy speaks with ecancer as the co-organiser of the EADO 2018 congress in Barcelona about the success of this year's meeting and about some of the key topics.

Dr Malvehy explains that there were important breakout sessions on managing databases along with skin cancer centres and also the connection of different departments.

He discusses the importance of challenging the disparity of patient access to treatments in order to provide patients across a wide range of countries with the best treatments in a shorter time frame.

He also explains that while we are able to improve early diagnosis, a key issue raised is that there is still a disparity in the delay of the early detection of the cancer, something to be improved by education and access to medical care.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

About this meeting, this is a joint meeting, the EADO meeting, and a melanoma and skin cancer centred meeting. I have to say that we are really happy with the attendance in Barcelona, it’s probably the best meeting of the year in terms of skin cancer being, of course, very focussed on skin cancer issues and covering from issues about early prevention, early detection, prevention, of course, management of the patients’ treatment, prognosis, and including in the programme the participation of patient advocacy and associations of patients that is very essential and also nurses. This is something that we want to promote in the future as well because patients are many times treated by nurses and they are very close to patients and nurses are not participating in so many of these meetings. So we consider that it’s very essential to keep the education of nurses in meetings like this one.

We had 1,100 people attending in the end with more than 100 speakers involved in the meeting, that is a huge number; a huge number of symposiums, parallel sessions, about 200 abstracts presented with very good research in skin cancer. And something that is very unique, I have to say, is what we call breakout sessions, that is a forum for discussion of particular problems that are not present in most of the medical meetings like access acquittance to treatment or how to manage a skin cancer centre, multidisciplinary board meetings, how to run databases that are very essential, biobanking, many issues that are in the problem with the intention to export models that have been successful to other centres in the world.

What has been reported at this conference?

From this conference, these breakout sessions, we have formal discussions in smaller groups and then we have the reporting of these breakout sessions in the plenary during the morning with all the auditorium full. That’s what was very, very interesting. Today we had breakout sessions about how to manage big databases, how to organise the information in skin cancer centres, how to connect different departments and issues about accessibility of this data that are, in the end, very essential for the management of patients and for the translational research with challenges about biobanking and other issues. We had also reporting the conclusions about how to facilitate the access and equity for patients in Europe and worldwide to innovative medications. That is really a challenge that we have today very evident. So there is a disparity of access to medications in Europe depending on the country where the patients are living because the medications are not approved in that country or they are not reimbursed or because there are some delays in the time when the medication is approved in Europe by EMA and with indication and the time that the government decides to cover the cost of this medication. So access is not possible during a long time for these patients. In some of the countries many of the issues are very evident so medications that are very useful for the treatment of high risk patients or patients with metastasis are not available actually in Europe.

What are some of the most exciting topics coming out of this conference?

There are many exciting things to consider. From prevention what seems very clear is that we are able to improve early diagnosis of skin cancer with the knowledge we have in medicine but still we have a delay in the early detection of cancer. So patients having melanoma are having their diagnosis too late and this is very evident today in many situations. So the disparity I was telling you about, it’s very evident also in early detection because of many reasons. One is education, so we need to improve education of the population, and access to medical care from the beginning. It’s very clear that what we were doing in prevention for skin cancer, that means primary prevention, basically avoid UV radiation as far as possible because this is the main reason for having this epidemic of skin cancer, was not very successful. We could explain to the population and educate the population about these risk factors, they know about sun damage, they know about sunburns, they know about skin cancer but they are not changing their habits. And this is something that is really very clear. Mortality, even with this knowledge and the new therapies we have, is still flat, we are not changing in most of the cases mortality rates in melanoma; it’s what is really a challenge. The reason for that is because we have still delayed diagnosis of skin cancer that’s very essential.

Then in terms of diagnosis we have very good news because we are implementing new tools for early diagnosis that probably will be exported in real life for the clinical practice from the user-based apps for early detection of suspicious lesions in the future. It’s fascinating how artificial intelligence is evolving in general but particularly in medicine, and today it’s very clear that we don’t have tools to replace doctors doing diagnosis but probably computer vision will help in many of these challenges in the future. We were discussing about this. We have today different tools that are supposed to be replacing doctors very soon and it’s evident that this won’t be the case but they will help us in many situations where we need fast tools for detecting suspicious lesions. We have today diagnoses that can be done in very early lesions that were impossible to be detected in the past using microscopes and other technologies that are really useful. We can detect populations at risk for skin cancer and melanoma because we know much better the genetic background for these risk factors and we can identify high risk populations that benefit from a strict follow-up. This is now well based in genetic counselling and some of this genetic testing that we can do today in skin cancer.

We have, of course, very good news for the treatment of patients when they need that treatment with innovative therapies that have been proven to benefit these patients even in the adjuvant setting in melanoma or in a more advanced stage in melanoma and other cancers. This includes many things like immunotherapy or targeted therapies or the combination of different new innovative drugs. Of course, this is very good news and we are able to improve survival in metastatic patients that was considered impossible just a few years ago. However, we need to think in skin cancer globally and understand what are the gaps that we need to cover in the future.

Is this something that you would like to see in the next few years?

Yes, always we have the intention to say, no, no, in 2025 we will have no melanoma mortality. Unfortunately this is very difficult and challenging because cancer is a very complex disease. Even if we understand better every single tumour, not just melanoma, other cancers, but particularly the tumours in every patient, we understand that this is a very complex disease. It means that we need to fight, probably in the next years we will be able to improve the number of patients surviving with advanced disease, we hope so, but it will be very difficult to cure all the patients having metastasis. For that reason we need to fight from the beginning in early detection, of course prevention, early detection and, of course, again the treatment of advanced patients.

Is there anything else that you would like to add?

Just I want to say that it’s really fantastic to have so many people engaged in this battle against cancer from different perspectives. This should be the way to beat the cancer in the future and skin cancer in particular.