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Melanoma study offers cautious hope

Rating

3 Star

Melanoma study offers cautious hope

Our Review Summary

This concise report (524 words) relates in simple terms the apparent success of a complex immunotherapy in treating a single patient with metastatic melanoma. The story shows how a single case study such as this can illuminate advances in therapy for often-incurable diseases, and is careful to point out that the research is very preliminary.  The story seems to have tried to be sure the reader did NOT go away with the impression that this experimental approach was ready for prime time.  It is very difficult to communicate this science as this story tried to do.

 

But we criticize the use of the term "cure" in the opening sentence.  And the story did let Dr. Rosenberg discuss unpublished data, which may glorify positive results when we don’t know the whole picture yet. Another major oversight is that the story does not mention any of the potential harms of treatment, which can include devastating infections and a flu-like syndrome. Readers would probably also benefit from a brief note about the limitations of case series, explaining why they can’t account for all of the factors that might explain a “positive” outcome in a handful of individuals.  Finally, the story did not include any independent perspective, since both experts interviewed are involved in this line of research. 

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story says the cost is roughly $30,000 to $50,000.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story relates the benefits of immunotherapy reported in a published, New England Journal of Medicine study in simple, absolute terms—complete remission from a late-stage cancer that “has stayed away for more than two years.” It also uses a loaded term–"cured"—to describe this remission. However, it is not yet known if this man is "cured." And if the man has been lost to follow-up, as another news report suggests, we may never know. The story’s reporting of unpublished data by Dr. Rosenberg is also incomplete, stating only that "52 of 93 patients experienced a positive result." What does "positive result" mean?

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story does not mention potential harms of the immunotherapy it describes. Immunotherapy frequently causes a flu-like syndrome. Among the potential complication are devastating infections. The published case study hints at these, observing that the patient’s initial reaction to the therapy was “transient lymphopenia, low-grade fever, and myalgia.” Other adverse events commonly reported after immunotherapy include diarrhea, rash, adrenal insufficiency, and liver test abnormalities.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The news report is careful to point out that this is a case study of a single individual with metastatic melanoma, and as such the results are suggestive and hopeful but very preliminary. However, it could have provided more information about the drawbacks of case reports in general and of this case report in particular–pointing out, for example, that they can’t account for all of the factors that might explain a “positive” outcome in a handful of individuals.  In the Seattle research, why did the other 8 fail treatment? Perhaps there were other factors, not the immunotherapy, involved in the positive outcome experienced by this one patient. Where is this patient now? In another news story, Dr. Yee reports that the patient has been lost to follow-up at 2-years. But the story’s first line said he was "cured."  This is a loaded term, and it is not yet known if this man is "cured" and may never be known if he is lost to follow-up.

Does the story commit disease-mongering?

Satisfactory

The story shows how a single case study such as this can illuminate advances in therapy for often-incurable diseases, but it does not overstate the importance of late-stage melanoma or prey on fears.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The article quotes two scientists—the lead researcher on the published paper and the chief surgeon at the National Cancer Institute, an investigator involved in another study that the news story mentioned. Neither is an independent source.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story notes that the person undergoing the new immunotherapy failed to improve with chemotherapy, though it does not mention tumor excision or radiation as other potential therapies. And one wonders whether the prior chemotherapy played a role in the one Seattle patient’s remission. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The news story explains that the therapy it describes is not widely available, and probably won’t be mainstream for another 5-10 years. However, the story does not say whether the therapy is FDA-approved. Numerous immunotherapies have been approved for various cancers, but this treatment for melanoma does not appear to be among them.

Does the story establish the true novelty of the approach?

Satisfactory

The story does a nice job of placing this story in its historical context, explaining that the new therapy comes out of the field of "adoptive immunotherapy," which has evolved over the course of some 30 years.

Does the story appear to rely solely or largely on a news release?

Satisfactory

It does not appear that the story relied solely or largely on a news release.

Total Score: 5 of 10 Satisfactory

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