Talk of the Towne episode 07: Melanoma Research Alliance

Talk of the Towne is Antidote’s podcast that bridges the gap between clinical discussion and patient centricity, hosted by Dr. Richard Towne, PharmD, Antidote’s Senior Clinical Informatics Manager. Each episode, Talk of the Towne features a new guest from an Antidote partner organization, and takes an in-depth look at particular therapeutic areas, zeroing in on the story that our data is telling about how best to connect patients and research. 

Our seventh episode, recorded during Melanoma Awareness Month, features Dr. Marc Hurlbert, the Chief Executive Officer of the Melanoma Research Alliance.MRA is the world’s largest private nonprofit funder of melanoma research, and through investing in research, they are advancing their mission to cure melanoma and prevent new diagnoses from taking place.

In this episode, we chat with Marc about all things melanoma, highlighting recent breakthroughs, research developments, and the landscape of melanoma clinical trials. Listen to the episode below, or scroll down to read the transcription.

Welcome to Talk of The Towne, the podcast from Antidote that bridges the gap between clinical research and conversation. I'm Rich Towne, a trained pharmacist, and the Senior Clinical Informatics Manager at Antidote.

Today I'm thrilled to welcome Dr. Marc Hurlbert of Melanoma Research Alliance, one of the members of Antidote's partner network. Dr. Marc Hurlbert, a pharmacologist by training, was appointed Chief Executive Officer for the Melanoma Research Alliance in May of 2022 after serving as a Chief Science Officer for three years.

He has more than 20 years of nonprofit and grant-making experience focused on advancing medical research, and his past work has included treatment and prevention strategies for melanoma, breast cancer, lymphoma, multiple myeloma, and juvenile diabetes. Mark has also led expanding public health programs to enable low-income, uninsured, and minority patient populations to access cancer treatments and care throughout the U.S. and the world. Welcome to Talk of the Towne, Marc.

Marc Hurlbert:
Thanks, Richard. It's always great to talk to another pharmacist, pharmacologist Pharm D. So great to talk to someone with some shared medical interests.

Rich Towne:
Absolutely. So just a brief overview before we start: Melanoma is not just one of the most common cancers in the United States. Rates of melanoma continue to be on the rise despite the fact that rates of other common cancers have been on the decline. In the United States, nearly 100,000 people are living with a melanoma diagnosis, and it's estimated that one in 50 Americans will be diagnosed with melanoma in their lifetime. Experts believe that 90% of all melanomas are caused by sun exposure, which is why prevention is such an important part of the conversation surrounding this condition. Every May is designated a Skin Cancer Awareness month, an event dedicated to discussing prevention strategies, research breakthroughs, and support resources for those that are diagnosed.

MRA is the world's largest private non-profit funder of melanoma research and has created a new paradigm for how cancer is treated. By directly investing in research and providing support to patients and their families, they're advancing their mission to cure melanoma and prevent new diagnoses from taking place. Today, we're so excited to chat with Marc about all things melanoma highlighting recent breakthroughs, research developments, and the landscape of melanoma clinical trials.

So to really start off; melanoma, as we mentioned, it's very unique among cancers for its ability to spread to other parts of the body, making it the deadliest of all the skin cancers. How important would you say early detection is for individuals?

Marc Hurlbert:
That's a great question. So it is important to find melanoma early. We like to step back a little bit so the audience knows skin cancer is critical. There's more than 2 million skin cancer cases a year. The most two common are basal cell and squamous cell carcinoma, and most of those can be cut out by simple surgery, sometimes more complicated surgeries. Melanoma is the third-largest type of skin cancer, a hundred thousand new cases. A hundred thousand people will be diagnosed this year in the United States and several hundred thousand around the globe. And it is unique. You can't only do surgery necessarily, and if melanoma has spread deeper into the skin and potentially reached a blood vessel or your lymph nodes, melanoma can spread and metastasize. So it can be quite deadly if it's metastatic disease. So we do think of early detection for melanoma to be very important.

The MRA likes to tell people to know your bodies, know your moles, your lesions, what spots and things you have, and then especially monitor for changes over time. For self checks, it's good to know the ABCDE rule. So look for asymmetry in a mole or a freckle or a spot. Look if the borders are irregular. So most of your freckles are pretty circular, but if the borders are irregular, if the color is irregular, meaning part of a mole or a freckle is lighter toned, and another portion of it's darker toned, if it's quite a big diameter, greater than six millimeters across. And then the last one, E, evolving. If it's changing over time, if it's evolving and causing any symptoms, these are the things that then you would want to go to your primary care doctor to have it examined.

So early detection is critical for melanoma, but we want to balance it. We don't want everyone to feel anxious and worried about every spot or blemish, right? We don't want them running to their doctors to have things cut out and biopsied all the time. So it's good to just know your body today, know what freckles and spots and moles and lesions you have, and then especially if anything's changing, then to report those to your doctor.

Rich Towne:
One of the things I'm really interested in is for certain people, if their family has a history of melanoma or can you think of any real risk factors that even before moles pop up, or maybe after they do, that people should get a relationship with a dermatologist?

Marc Hurlbert:
Yeah, so it's a great question. So there is a real shortage, unfortunately, of dermatologists around the country. Specifically all over the country, but even in rural areas in particular. And so it's good to have a good relationship with a primary care home, a primary care doctor, and then if needed, a dermatologist and dermatology clinic. There is a certain number of melanomas, it does run in families so there is a family component to it. So direct relatives; parents, grandparents, siblings have melanoma, then you might be considered at higher risk and should absolutely discuss that with your primary care doctor and maybe find a dermatology home. But experts estimate that more than 90% of cases of melanoma are caused by sun exposure, and a lot of that is sun exposure in your adolescent years, teens and twenties. And most melanomas, the average age of diagnosis is when someone's in their sixties. But it's those exposures you had as a juvenile, as a teenager.

And so if you had some severe sunburns when you were in your teens and twenties, then you could be more at risk. Even one severe sunburn is enough to cause enough damage that you should be monitoring. So we suggest, again, following the ABCDE self-check rules, check your body, and then if you know you're at elevated risk, if there's melanoma or even other skin cancers in your family, your immediate family, bring this to your doctor's attention and your primary care doctor might recommend you find a dermatology home that you can go to for more in-depth skin checks.

Rich Towne:
And another thing, and I think you alluded to it briefly, there are different subtypes of melanoma, and some are obviously a lot more rare than others. Could you go into that a little bit?

Marc Hurlbert:
Yeah. So when people think of melanoma, we think of the moles that show up on your sun exposed areas of your skin. Your head and neck, your shoulders, your back and arms, and maybe your belly, your chest. And these are the most common types. It's called cutaneous melanoma or skin melanoma. That makes up about more than 90% of cases every year, but they're about 10% are rare subtypes. And so there's one that occurs in the eye called ocular melanoma or uveal melanoma. That's a few thousand cases a year. There's one that's called acral melanoma that occurs on the soles of the feet or the palms of the hand or underneath your fingernails and toenails. And this acral melanoma similarly is a few thousand cases a year.

And then an even more rare subtype is called mucosal melanoma, which is the mucus membranes of your body. So it's easiest for the audience listening to think of the moist tissues of your body when you think of your mucus membranes. So in your nasal canal, in your mouth and oral cavity, all the interior moist tissues are your mucus membranes and there are melanocytes, and you can get melanoma on the mucus tissue. So mucosal melanoma is the rarest of the four types I've described about a thousand or 2000 cases in the U.S. each year.

Rich Towne:
As they're more rare and as people might not really know to look for them, MRA has created the RARE Registry that's designed for patients and family members that have been impacted by these rare subtypes of melanoma. Can you talk a little bit more about the rare registry and how that's making an impact?

Marc Hurlbert:
Yeah, that's a great question. So the RARE Melanoma Registry was brought to MRA by patients and family members of patients with acral and mucosal melanoma. And specifically they realize that there's a a lack of research into these rare subtypes. And they asked MRA if we would help them advance research in this area. And the melanoma research alliance has invested about $10 million into rare melanoma research over the last decade, and we've begun to understand some differences of genomically, how are these tumors different than cutaneous melanoma? There's some different mutations in genes and different drivers in acral and mucosal and uveal compared to cutaneous melanoma. But even with our 10 million investments, the largest studies at a single university often only included 20 or 30 patients. Not very large studies. And so to really make a difference in understanding rare melanomas, we've launched this RARE Melanoma Registry. You can go to raremelanoma.org if you want to learn more.

And the idea is we hope to enroll hundreds to thousands of patients with these rare types of melanoma. And the RARE Melanoma Registry, by having hundreds of patients with acral or hundreds of patients with mucosal, will really help us understand on a bigger scale, what are the risk factors? Who getting this disease? What's the age of onset? Are there risk factors we can identify that are unique and different from cutaneous melanoma? How are they diagnosed? The mucosal melanoma, acral melanoma on the sole of your foot, probably not diagnosed by a dermatologist. So who's diagnosing these people? Is it the primary care doctors? The podiatrist? And then what's their treatment journey? Do they get surgery? What treatments are they offered and what are their outcomes from treatments? And so we've launched this registry, as well as a few other programs, to really understand the whole journey for patients with acral and mucosal melanoma.

Rich Towne:
One of the chief focuses of Antidote is we talk about advancing these research studies, and obviously Melanoma Research Alliance has that goal as well with the RARE Registry. What sort of challenges do you see in the recruitment and enrollment of melanoma trials? You've already mentioned that the sample size is very, very low, even for some of the biggest trials. Is there any insight as to why that is?

Marc Hurlbert:
Yeah, so clinical trials for melanoma, it's the blessing and the challenge that we have of all the progress in the last decade. So since 2011, there have been 15 new drugs approved by the Food and Drug Administration for treating melanoma. And that's great news. There's tangible, measurable progress. About half of patients with metastatic melanoma now are surviving five years or longer. Hopefully many of them might be cured with some of these new immunotherapies as well as BRAF and MEK targeted therapies. But all these advances, exactly to your point here, Richard, makes it more complicated. So if you're developing a drug today in 2023 and beyond, it's much more complicated landscape. Patients often will have had one, two, three prior lines of therapy. You have to stick to the current standards of care, which are checkpoint immunotherapies or BRAF and MEK targeted therapies depending on the type of melanoma and the genes driving that melanoma.

So drug development and clinical trials right now are more complicated, and that's why the Melanoma Research Alliance is really proud to partner with Antidote. The clinical trial finder that we provide to patients and to the public in partnership with Antidote is critical for people to find trials. It's very simple to use the clinical trial finder. You enter a couple of search terms, your zip code and where you live, and you can find active trials nearby you, and you set the parameters. Willing to drive 25 miles per clinical trial, 200 miles, you can really set the parameters. So the trial finder is great because it is getting more complicated to recruit and enroll patients.

And then specifically, as clinical trials relate to these rare melanomas, we've seen some success with some of the trials underway. There's been some signals in patients with mucosal melanoma, some responses in patients with acral melanoma. And just earlier in 2022, the first ever drug approved for patients with metastatic uveal melanoma, Kimmtrak or tebentafusp. And so it is possible to develop drugs for these rare subtypes. Our hope with the RARE Registry is that if there are drugs that show signals for acral melanoma, for mucosa melanoma, that we could help suggest these trials to patients that are in the registry if they need a trial.

Rich Towne:
And with that, we mentioned that there are ways for patients to find trials, there's ways to get engaged and there's challenges. But from a patient perspective, are there any common misconceptions about clinical trials specifically for melanoma patients?

Marc Hurlbert:
Yeah, one of the biggest misconceptions that patients say to us is their fear or worry about being put on a placebo, essentially a sugar pill and not getting an actual treatment. And that really is not a worry today in melanoma. Like I said, there's been 15 new drugs approved in the last decade. The standard of care is pretty clearly defined in the ASCO and NCCN guidelines for how you would treat patients with a advanced diagnosis. Some of these drugs are now approved for earlier stages of melanoma, stage two, stage three, as well as metastatic stage four melanoma. And so most trials today are randomized to standard of care, which the standard of care is quite amazing with checkpoint immunotherapies, with BRAF and MEK inhibitors. And so the misconception that you could get a placebo or a sugar pill really doesn't apply to melanoma. You'd be randomized to standard of care or standard of care plus whatever the new agent is that we're hoping is even better potentially in combination.

So that's one of the biggest misconceptions. The other thing is when I talk to patients individually, I talk to several every week that are newly diagnosed, maybe they've advanced through one or two lines of therapy and they're reaching out to us for advice on clinical trials. One, we point them in the direction of the clinical trial finder, but two, I always talk to them, even if I was newly diagnosed with stage four melanoma, stage three melanoma, if I was diagnosed, just hypothetically, I would ask my doctor about what clinical trials are there.

I always tell patients when I'm talking to them, "You don't go down to the Apple Store and say, 'Hey, I'd like an iPhone 1.0 or 2.0. We all want the iPhone 14 or whatever the current version is.'" So why when you go to your doctor do you say you want the drug that was FDA approved in 2014? Which is a great drug, great slate of drugs, but I would ask them, "Hey, what's going on in clinical trials? Are there any that I might be eligible for?" And think of it as you're getting the latest generation, the newest generation of treatments.

Rich Towne:
So speaking about providers, do you think that providers have a complete knowledge of clinical trials or do you think there's a little bit more work they could do to familiarize themselves with the treatment landscape?

Marc Hurlbert:
I think it's a great question. So I think it's really hard for doctors and providers today to be aware of every clinical trial. I think that's where there's an important role for groups like the Melanoma Research Alliance and Antidote and our partnership to be a trusted third party of, "Here's the list of all currently active trials." And that list is changing every day, right? Phase one and phase two clinical trials start and stop every single day. So it's really impossible for any one person, including myself or any one doctor, to know about all the possible trials.

If I'm at one of the top cancer centers like Memorial Sloan Kettering or MD Anderson, I might not know about that clinical trial that's launching at Northwestern or UCSF. So it's impossible to be aware of all trials. And so I think yes, to educate doctors is important, but I think key is to put also the power in the hands of patients to be able to find trials, and then they can bring a list of potential trials relevant to melanoma to their provider and walk through that. I think what's key is to have a discussion with your oncologist.

Rich Towne:
And another big player in all this is obviously the people designing the trials. Do you have any thoughts on how the inclusion/exclusion criteria are structured? Obviously there's a little bit more discussion these days about inclusion/exclusion criteria being too strict and potentially failing eligible patients for the sake of data clarity.

Marc Hurlbert:
Yeah, so it's a great question. So the Melanoma Research Alliance has been proud to partner with the Food and Drug Administration for many, many years, but specifically starting in 2018, working with groups from breast cancer and lung cancer, the Melanoma Research Alliance, in partnership with the FDA, pulled together a committee to look at these inclusion and exclusion criteria, specifically as it relates to patients with brain metastasis or leptomeningeal disease. And what was discussed at that workshop and what's been found is that there have been some carryovers of, potentially not necessary exclusion criteria or really rigid inclusion criteria, and the FDA has specific guidance around brain metastasis and central nervous system metastasis. So not necessarily loosening the criteria, but just clarifying and loosening where it makes the sense. The FDA's willing to talk to industry and spot trial sponsors to help in their design.

An industry provider designing a new trial today might have a specific population they want to test the drug in, but they shouldn't arbitrarily exclude, for example, patients with leptomeningeal disease or brain metastasis. And maybe there's a way they could design the trial where they have the co-cohort, which is one they're following, and then a separate sub-arm where they're looking at these higher risk populations such as with brain metastasis. So there are some flexibilities, the FDA's willing to work with sponsors, and I think it's critical for all people that are designing clinical trials to really think about being more inclusive and less exclusive where possible and design trials in ways that could be more open to more patients.

Rich Towne:
I think that's a perfect segue when we talk about inclusion to talk about, broadly across all clinical trials including melanoma, there's a significant lack of diversity in who's enrolled versus the actual population of people with the disease. So for example, Black patients are far less likely to develop melanoma than non-Hispanic white patients, Black patients development at rate about one per 100,000 compared to 30 per 100,000 in white patients due to the protection that melanin provides from UV rays. However, Black people who do develop skin cancer have a much lower five year survival rate. Can you talk about some historical challenges with the recruitment of Black patients and what can be done to address this?

Marc Hurlbert:
Yeah, so I think I'll separate it into two answers. First, all people, all races and ethnicities get melanoma. So people that are Black or African American, Asian, Hispanic, all people can get melanoma no matter how dark your skin tone. So everyone needs to practice sun safety. Again, know the ABCDE rules and know the spots and lesions on your body and report those to your doctors. So knowing that everyone can get melanoma is critical. The people that are in darker skin of color populations, Black, darker-skinned Hispanic, Asian populations around the world, do get more of these rare subtypes. So in addition to knowing the spots and moles on your body, your back, your shoulders, your arms, they should specifically also be aware of any changes on the bottom of their feet, the palms of their hand, streaks under their fingernail bed, discolorations under their nails.

And then mucosal membrane melanoma often people might see a spot on the roof of their mouth or the palate of their mouth. And so again, anything that's changing you should absolutely talk to your doctor about. So one of the challenges with survival in Black populations, but in all populations, is a later stage diagnosis. So if they don't know the signs to look out for or things to bring to the attention of their healthcare providers, that's the problem. The second part of your question around clinical trials is a key to raising diversity in trials, and historically Black and African American populations have been a little bit untrustworthy of the medical establishment in the U.S. and for very good reasons. And I think what's critical is medicine today is very different than it was historically.

And I was really impressed with some of the data that came out of the COVID vaccine trials and how diverse the populations that were enrolled in those studies. Many of the industry sponsors of clinical trials, especially in the COVID vaccines and COVID treatment space, really learned new tips and tools of how to enroll diverse populations around the U.S. and around the globe. And we're hopeful in melanoma and in the entire field of oncology that we can learn from what they did during the COVID vaccine treatment development and come up with how do we enroll more diverse populations in melanoma trials, in all of cancer trials.

Rich Towne:
Another key concern that's not necessarily as capturable as inclusion/exclusion criteria is access to the clinical trial sites. The ability to get to the research site, be able to have enough time to actually receive the study drug as required. So I was curious about any thoughts on that? And then as a follow-up to that, if you see a role for decentralized clinical trial sites in melanoma?

Marc Hurlbert:
Yeah, absolutely. So access to trials, whether it's a geography access or the ability to take time off of work, it's a critical issue. And so more and more trial sponsors are trying to help accommodate the transportation to and from trials, if there's overnight hotel stays. So don't rule out a trial on your own without talking to your doctor about it and seeing what assistance might be available. That's one point. And then the second point is absolutely about decentralized trials. Again, this is another great lesson we got from COVID. For a period of time, you could get a second opinion virtually all over the United States, and you didn't have to fly across the country to a center.

And that worked really well during COVID, especially when it wasn't safe to gather in groups and go en masse into buildings and things. But again, so what can we learn from that and is there a way to decentralize trials? There's a lot of efforts underway in this by trial sponsors, by melanoma researchers, by the Food and Drug Administration, and I think it's critical to try to solve this make trials more decentralized, more available in people's local communities so they don't have to travel only to the top cancer center, which could be hundreds of miles away. So absolutely, there's a role for decentralized trials in melanoma, but still a lot of work to be done in that space.

Rich Towne:
And also with talking about changing the treatment landscape, changing access to care, in 2022, as you mentioned before, both Kimmtrak and Opdualag were approved by the FDA, both of which were the first their kind to do so. How do you see these new developments changing the treatment landscape? And on top of that, is there any other treatment and development that you see significantly changing the landscape as well?

Marc Hurlbert:
It's amazing the amount of progress in melanoma just in the last decade or so. Again, with 15 new drugs approved since 2011, no other type of cancer or field of oncology has had that much progress. And then when you look at 2022, it was two new approvals, Kimmtrak, which is tebentafusp or Opdualag, which is relatlimab and nivolumab. And so both of these are very exciting. So Opdualag is the first of its kind what's called a LAG-3 inhibitor. It's a new immune checkpoint in our armamentarium. So now we have drugs that target PD-1, an immune checkpoint, CTLA-4 and LAG-3. So it's very exciting that this is entirely new class of drugs with Opdualag coming to approval last year. And it's very exciting opportunity for patients that maybe didn't respond to some of the existing immune therapies. So very excited to see how Opdualag helps more patients than what was previously treated.

Similarly, Kimmtrak is a first of its kind. It's the first T-cell receptor therapeutic, as I mentioned earlier, was previously approved for uveal melanoma in 2022. And this is great. It's the first drug specifically for uveal melanoma as well as the first TCR drug. What's exciting about that it's another approach to immunotherapy and the approach that's used, the backbone of tebentafusp, so Kimmtrak, this T-cell receptor targeting is being used now for other targets beyond the one used in Kimmtrak. So the TCR technology is being now applied to PRAME and other protein targets, and it's exciting. There are trials for PRAME in cutaneous melanoma and other melanoma. So we think these are both very exciting advances. Great to have two new approaches to stimulate the immune system to attack cancer and look forward to more trials in this space and more benefit to patients.

Rich Towne:
So with other developments in route, is there anything that you particularly have your eye on, whether it's a treatment like Kimmtrak or Opdualag, or even a diagnostic trial where they're looking at hopefully catching melanoma cases earlier?

Marc Hurlbert:
Yeah, we're very excited about both. So on the diagnostic front, there's new technologies and new advances coming, new tools to help primary care doctors, new tools to potentially help dermatologists decide what's a melanoma, what's not a melanoma. Some of these diagnostics are imaging based, so using artificial intelligence and machine learning to help in the diagnostic process, whether it's a dermatoscope or other imaging technique. There are other technologies such as bioelectric impedance, which measures the impedance of your skin and can assess an abnormal mole and whether there's differences in that versus normal skin. And then there's some of these things, we call them tape test or strip test, it looks like a bandaid for any of your listeners. It looks like a bandaid, you put it over a mole. There's already one on the market by DermTech and it measures two genes.

You put the bandaid over the lesion or the mole, it can measure two specific genes, in this case, the one that's on the market. And if both of them are elevated, then you might want to have that looked at and biopsied. So tools to help primary care doctors and dermatologists diagnose melanoma are very exciting and lots of research underway in that area. And then on the treatment front, like I said, some of these new agents just approved last year are very exciting. We're also watching what's happening in the vaccine space, so those mRNA vaccines that all the listeners heard about during the COVID vaccine development, there's a couple of the mRNA vaccines in clinical trials now against melanoma. So some that are customized to your tumor where they looks at some specific markers in your tumor and then make an mRNA vaccine specific to you. And then others that are maybe more broadly available, we call off-the-shelf and they're made against the 20 most common melanoma antigens. And so the vaccines are very exciting. We're keeping our eye on that. We're investing in those areas as well.

Looking at other immune checkpoints beyond PD-1, CTLA-4 and LAG-3, there's a whole host of other immune checkpoints that are being targeted and are in clinical trials. And then as well the cell-based therapies. So there's a whole field called tumor infiltrating lymphocytes, TIL therapies. The progress reported from phase two trials look very, very promising. The first one of those is now with the FDA for review and assessment and might be hopefully approved later this year. And then other cell-based therapies, MRA's investing not only in these T-cell based therapies called TIL therapies, but there's other groups that we're investing in still at the research stages and just beginning to enter clinical trials. So really early days, but looking at could you infuse natural killer cells or NK cells? Could we explore CAR T-cell based therapies for melanoma? So very excited about vaccine approaches to treating melanoma, very excited about new immunotherapy approaches, new immune checkpoints, and then very excited about these cell-based approaches; TIL, NK and CAR T. So really a bright future still of how do we help the patients that aren't responding to the whole armamentarium of treatments that we have today.

Rich Towne:
And with that, one of the three questions, that I like to ask at the end of the podcast are single pieces of advice that you'd give to different parties in regards to clinical trials. So the first is, if you had had to give one piece of advice to melanoma patients, and let's say regardless of stage relating to clinical trials, what would that be?

Marc Hurlbert:
To patients I like to say consider a trial first. Talk to your doctor. From your time of diagnosis ask, "What are the treatments approved today that are on the market?" But also, "What's in development? And should I be thinking about any of those based on my case?"

Rich Towne:
The second that I think is interesting to talk about is physicians, whether oncologists, primary care, potentially dermatologists, and if there's not one overarching for all of them, is there one that specifically stands out for even each kind of provider?

Marc Hurlbert:
I think one overarching for all of them. So to all doctors; be aware of the exciting clinical trials going on in melanoma. There's a lot of exciting trials in the detection and diagnosis space. I think I forgot to mention earlier, ctDNA and other approaches to diagnose and prognose melanoma and help guide treatment selection. So it's an exciting time in the field of melanoma. So I think for doctors to take continuing education and brush up on what trials are available, both on the diagnostic and the treatment front for melanoma, because it's a rapidly changing landscape.

Rich Towne:
And lastly, and you mentioned that MRA already has really strong relationships with various sponsors, but if a sponsor is interested in conducting a trial in melanoma, is there any advice you'd give to them or maybe even how they could work with MRA?

Marc Hurlbert:
Yeah, so would tell all trial sponsors, all industry partners, to reach out to the Melanoma Research Alliance. We're very interested in understanding your technology, your drug, your treatment approach, and seeing how we might be able to partner with you. One thing I would say to all industry partners is melanoma is not yet cured. Still half of patients with advanced disease do not respond to all the wonderful drugs we've talked about during this podcast. So more innovation is needed, more treatments are needed, and so we encourage trial sponsors to really consider melanoma. The second thing I like to tell trial sponsors is look how rapidly some treatments have been brought to bear in the melanoma space. And many of these can be proven first in melanoma and then many often then translated out to larger other cancers; breast cancers, lung cancers. And so we are eager to partner with and hear from all industry partners.

Rich Towne:
So advice aside, if someone is looking for resources on melanoma, whether it's as a patient, a physician, or as a sponsor, is there any website or specific link within the melanoma Research alliance that you could point them to?

Marc Hurlbert:
Yeah, I would encourage everyone to visit the Melanoma Research Alliance website. It's curemelanoma.org. There we have really great information for patients, for newly diagnosed understanding their diagnosis, what are the treatment options? We also have the clinical trial finder at curemelanoma.org for patients to plan trials. Similarly, for researchers and pharmaceutical partners, there's ways to how to get involved with us. If you're a university researcher, how to apply to us for research funding if you have a great idea. The unique feature of Melanoma Research Alliance is we see ourselves as the neutral convener of bringing all parties together, whether that's government, academia, industry, or patients and family members. And we're all under this one big tent of advancing melanoma and trying to end this disease.

Rich Towne:
And that's awesome. So we had a very in-depth conversation today. Is there anything that we didn't cover that you might want to into?

Marc Hurlbert:
I think we've done great. It's an exciting time to be in the melanoma field. As a scientist myself, I'm so thrilled every day at some of the advances I get to read about, both in progress reports as well as published in the literature. The one thing I would touch on is the importance of making this international. So some of these rare melanomas that we're trying to tackle now, melanoma is a problem all over the world, and we think it's critical for trial sponsors to think about global trials, especially as we look at acral, mucosal, uveal and rare melanomas. It's going to take a global approach to solve some of these rare melanoma subtypes.

Rich Towne:
Well, that was a very in-depth conversation. I personally learned a lot. There's a probably hours more questions that I could ask you, but I'd like to thank you a lot for being on the show, Marc, and for everything you've done for melanoma patients and industry sponsor partners worldwide. And yeah, that was great.

Marc Hurlbert:
Yeah, thank you so much for having us today.