Melanoma Clinical Oncology Research: Interview with Dr. Joshua Arbesman
By Pooja H. Rambhia, MD Candidate, Case Western Reserve University | 6 June 2017 | Science, Treatment
As a third year medical student, MD Candidate Pooja Rambhia had the privilege of conducting an elective research year under Dr. Joshua Arbesman’s mentorship at University Hospitals Cleveland Medical Center. Arbesman’s unique role in translational basic science research within the realm of familial melanoma has provided Pooja, an aspiring dermatologist, with an invaluable and enriching learning opportunity.
Joshua Arbesman, MD joined the Dermatology Faculty of Case Western Reserve University School of Medicine in 2015. He is currently a Case Comprehensive Cancer K12 Paul Calabresi Scholar, and was recently awarded a Dermatology Foundation Medical Dermatology Career Development Award. Arbesman conducts basic science and clinical research in the areas of melanoma genetics and melanoma drug development.
How has melanoma treatment changed since you began training as a dermatologist?
During my residency, the new melanoma therapies, both targeted and immunotherapies, were beginning to be approved. Throughout my training, I have witnessed the increase in efficacy of these treatments from when they were first reported to more recently becoming the standard of care for metastatic melanoma patients. For example, pembrolizumab was approved during my residency, off of a phase I trial. Patients using this treatment are among those who would not have survived 5 -10 years ago, but are now living multiple years past their initial diagnosis of metastatic melanoma. Seeing the success of these treatments emboldens us to believe that what we do in the basic science and translational world can be brought to clinics and impact patient care in remarkable ways. Each success story personally encourages and motivates me.
Describe your research interest in melanoma, and describe influencers.
As a dermatologist, I see the greatest impact on melanoma and skin cancer patients in two realms: 1. Better preventative efforts, and 2. Helping prevent recurrence in early and intermediate stage melanoma patients. As such, my research focus centers on understanding genetic risk factors in high-risk melanoma patients, as a vehicle to understand melanoma development generally. In addition to genetic melanoma work, I also work on novel neoadjuvant and adjuvant therapies for intermediate stage melanoma patients.
Patients I see in my practice are the major motivator for my work, and have largely shaped my research interest. I see a high percentage of fairly healthy melanoma patients who are keen on understanding how to prevent both a recurrence of their existing melanoma, and the development of a new melanoma. My patients need the prevention or adjuvant therapy effort, which is where I feel I can help the most from a research perspective.
How do you see your research impacting patients?
One of my major goals is to understand what puts patients at risk for familial melanoma. This can be extremely helpful for patients, particularly from an emotional perspective, as they want to understand their own risk as well as their children’s risk of getting melanoma. The vehicles we’re using to understand this are high-risk melanoma families. We try to understand whether there is a specific mutation in this family that may also be mutated in other melanomas. I believe that a greater understanding of the genetic backdrop for melanomas can aid in the development of novel preventative therapies.
Can you speak to some of the emerging immunotherapy approaches that you’ve utilized with your patients?
While I don’t actively treat with immunotherapies, I do care for a number of patients being treated and monitor their responses, to help manage skin side effects.
What do you hope to see more of in the future of melanoma research?
I think better screening technology will be crucial for detecting skin cancers, and is already beginning to emerge. Various detection techniques, beyond dermoscopy, are being developed. With better non-invasive technologies, which I hope to see more of in the future, we can hopefully reduce patient anxiety and costs.
Regarding treatment, I believe given the negative side effect profile of immunotherapies, we need to anticipate which patients will most benefit from immunotherapy, to prevent those who will not from needlessly experiencing side effects. Understanding how each patient may require different therapies will be important as we personalize melanoma treatment. As we further develop and advance these treatments, I hope to see improvement in this area.
Can you speak to the dynamic of working together with medical oncologists and surgical oncologists treating patients with aggressive melanomas?
Here at University Hospitals Cleveland Medical Center, we have a multidisciplinary melanoma clinic where patients can see medical oncology, surgical oncology, and dermatology, all in the same day. The different medical disciplines that participate in this clinic work closely together, and are able to see this directly benefiting the patient. We also have a weekly, multidisciplinary melanoma conference to discuss both challenging and more typical melanoma cases in order to ensure all patients are receiving the best standard of care. This close working relationship is advantageous on both a clinical and research level, and helps foster close collaborations in the clinical and basic science research realms.
For more information on Dr. Arbesman’s work, please visit: http://casemed.case.edu/dept/dermatology/Faculty/JoshuaArbesman/index.html
Immunotherapies Immunotherapy medical oncology surgical oncology dermatology metastatic melanoma pembrolizumab high-risk melanoma