Menacing Melanoma: Marc Hulbert, PhD on How You Can Fight Back

Mark (00:04)
It's almost summertime, and that means the risk of melanoma are increasing. Melanoma is the deadliest form of
skin cancer. What's the latest research telling us about identifying and treating it?

Marc Hurlbert (00:16)
I think we're at this, you know, moment in time with change. With the role of philanthropy, the role of
nonprofits, like the Melanoma Research Alliance is gonna be even more critical. Y ou know, nonprofits can
move a little bit more nimbly than the governme nt.

Margaret (00:30)
Our guest is Ma rc Hurlbert , who earned a PhD in pharmacology from the University of Colorado. He served as
the Melanoma Research Alliance's Chief Science Officer, and now is its CEO.

Dr. Hurlbert (00:42)
We've invested in some imagin g techniques, some other techniques that, you know, aren't ready for primetime
today, but I think in the near future, maybe. But we need tools for the individual at home, the primary care
doctor and the dermatologist.

Margaret (00:56)
This is Conversation s on Healthcare.

Mark (01:09)
Well welcome Dr. Hurlbert to Conversations on Healthcare.

Dr. Hurlbert (01:13)
Thank you. Thank you so much, for having me on .

Mark (01:15)
We're talking to you now. As, as you mentioned, also, may is Melanoma and Skin Canc er Awareness Month.
And Melanoma Research Alliance is the world's largest private nonprofit funder of melanoma research. And
you directly invested, and this is pretty impressive, 175 million towards scientific discoveries. I guess our
audience would love t o know, are we making progress?

Dr. Hurlbert (01:40)
Absolutely. So, making progress on the war on melanoma, since we were founded in 2007, as you noted, we've
invested 175 million to 500 projects at the top cancer centers all over the world, top medical universities. And,
the progress we've made, really in the last, a little over the last decade, there's been 17 new treatments approved
for melanoma. I f, if you have an early - stage melanoma on your skin, you know, that can be cut out by surgery
and your, yo ur monitor for a few years, and usually you're all good if it has spread throughout the body, which is
quite common. If it gets a little too deep into the skin, that's when you need systemic treatments. And like I said,
there's been 17 approved and, you kn ow, and you, if you had a metastatic melanoma diagnosis, you know, 15
years ago it was quite deadly and, and, and urgent. And, today with these new treatments, we're able to cure
about half of patients with metastatic melanoma. So a lot of good progress, b ut more work to be done.

Margaret (02:42)
Well, we're really glad to bring, that optimism, to the show as well as of course, focusing on prevention. But
we're also, so interested in the research, that is underway. So we know you recently announced funding to
support 30 high impact research projects, around the country. I understand, I don't know if they were
international, at various academic and medical institutions. Tell us about these investments. What's the range of
the kind of research that's going on now through these high impact investments?

Dr. Hurlbert (03:12)
Absolutely. We, we just launched, just announced another $9 million investment to 30 projects. It's across the
US a few countries in Europe and in Australia. So it is a global research portfolio. W e are investing in some new
ways to tackle melanoma detecti on, investments in some of these rare melanomas. There's a few rare melanoma
subtypes I hope your viewers, have, learned about or have heard about uveal melanoma that starts in the eye. A
rare subtype that starts on your hands and your feet called acro mel anoma, and then one that starts on the
internal mucus membranes. Essentially your, in your nasal cavity, oral cavity, and all the moist internal tissues.
And so an investment on the rare melanomas. And then lastly, investing quite heavily in, in tackling b rain
metastasis. So when melanoma spreads from the skin or other, other sites to your brain or to your central

nervous system and spine, which is what we call leptomeningeal disease, it becomes very difficult to treat. And
so much more research is needed t here. So rare melanomas, brain metastasis and CNS disease and
understanding treatment resistance. So really excited about this new group of projects.

Mark (04:24)
You know, I'd like to really explore a little more one area of funding, which is your super charging anti - tumor
immune responses and enhancing the body's ability to recognize and destroy cancer cells. What, how, how
realistic is this looking, at this, at this time?

Dr. Hurlbert (04:42)
Well, it's, it's, it's a, it's a proven treatment now. So in 2011, we had the first immune therapy approved called
ipilimumab. And then in 2014, two new joined the class pembrolizumab and nivolumab and these immune
therapies, those first three that I mentioned, they essentially take the breaks off the immune system and let the,
let the immune system march forward into the tumor and have an effect. And like I said, this is curing about half
of patients with metastatic melanoma. I think importantly for me, for these new immune therapies, they were
approved first in me lanoma, but now they're used in 24 different types of cancer. And so I think it's a, I consider
immune therapy the fourth pillar of cancer treatment, right? So we have surgery, radiation, chemotherapy, and
now the fourth pillar since these new treatments e volved is immune therapy. Our new investments are, trying to
tackle that question, why doesn't every patient respond to immune therapy? These amazing drugs that have
really saved lives and changed lives. And so we're looking at some of the cell - based thera pies. You may have
heard of CAR T and TIL therapies before. We're looking at some novel ways to stimulate the immune system.
The, first group of immune therapy drugs sort of take the breaks off the immune system. They're, we're looking
at a few research pr ojects of how do we stimulate the immune system to go in and attack the cancer just like it
would attack a virus or a bacterial infection.

Margaret (06:05)
Well, you are, rightly so, very proud that MRA funded researchers have been part of every major mel anoma
breakthrough, that we've had. And certainly the patient community is deeply grateful to you, but we are always,
I think, worried that the rates of melanoma are continuing to rise. A nd especially in younger people, I
understand cases of melanoma, I th ink, have tripled in the last 30 years when we're fortunately seeing some
diminishment, of other common cancers. I mean, I, when we ask ourselves, why is this happening? I don't know
if we could all say too much sun exposure, but is something more than tha t going on? What, what is your answer
to that question, which I'm sure you're asked all the time.

Dr. Hurlbert (06:50)
Yeah, we don't know all the reasons. I mean, so melanoma cases did triple over the last 30 or so years. T hey
have flattened out over the last five to seven years. So the incidents, the, the growth of incidents has slowed a
little bit except for in those younger populations. And, you know, I don't know. I'm, I'm a child of the seventies
and eighties, and we didn't practice sun safety as muc h when I was growing up. I think in the, the nineties and
two thousands, hopefully we learned better, but I'm wondering if, if the next group of teens, if we need to do a,
continuing the effort of education and practice on safety, and then there could be o ther factors around that we
just don't know around climate change or other UV exposures. But, definitely need to continually practice sun
safety. I like to tell, everyone, start your teens, your, your toddlers and teens, young practicing sun safety. And I
also say it's never too late to get started if you're someone of an older generation and, and haven't practiced sun
safety in the past. So wear sunscreen every day, year - round SPF 30 or higher on any sun exposed skin. And
then, practice wearing long sleeve s. There's amazing sun safety apparel. Now, if you do wanna spend a day out
on the water, out at the beach, out at the pool, lots of sun safe ways you can do that, but still, we mean sun safe.

Mark (08:04)
Well, that's great. That's a great public service announcement, right, right. F or everybody, and hopefully they
take key, the MRA, points out. Its funding and announcement is occurring at the same time. Unfortunately, the
Federal cancer research funding is being reduced. I'm wondering what you can tell o ur listeners about the
overall funding situation for melanoma research.

Dr. Hurlbert (08:25)
Yeah, so melanoma research, at large is funded by the National Institutes of Health. NIH. T he Department of
Defense a few years ago launched a specific program ca lled the Congressionally Directed Medical Research
Program. And, you know, we're, we're still monitoring the situation and see what happens. T oday the DOD
funding is, appears secure, and we're monitoring what's happening with NIH. I think we're at this, yo u know,
moment in time with change where the role of philanthropy, the role of nonprofits, like the Melanoma Research

Alliance is gonna be even more critical. Y ou know, nonprofits can move a little bit more nimbly than the
government, and we're able to fun d innovation and maybe things that are a little bit more high risk, but might be
high reward. And so I think, it's a changing environment. We're just monitoring to see what's happening and
how best we can keep the momentum going. There's so much unmet need , but I think the role of philanthropy is
gonna be critical. These next, you know, two to five years .

Margaret (09:25)
You know, I, I look at these figures, such as over a hundred thousand people in the US will be diagnosed with
melanoma, sad they're diag nosed, good that they're diagnosed so they can get to treatment. One person every
hour of every day, will die from melanoma. And there's, access to approved treatments. But I, I have to think
about, and certainly from the, you know, the, the space that we' re primarily engaged in around primary care
Yeah. That all assumed they got to the point of diagnosis, which meant they either recognized a lesion and had
somebody who could look at it and give them expert advice. They had access to care, you know, actuall y had,
somebody doing a screening and that when they got screened, they could get to a dermatologist. Not such an
easy thing. What's the role of your organization in, in tackling some of those issues? B ecause I gotta tell you,
you know, people are not so a ccurate. Even people with some training are not so accurate at looking at a lesion
and saying, yes, this is worrisome. It's not really takes somebody who knows what they're looking at.

Dr. Hurlbert (10:29)
No, absolutely. So detecting melanoma still is an area with where, with an unmet need for research, more
research, more technology, and we've invested a fair amount in the past, but it's also one of our urgent,
investment prior areas over the next five years. So, improving detection and, and you got it e xactly right. Are
there tools that we could empower people at home where they could, you know, on an app on their phone, look
at, look at their moles and see if there's something, that that could help make it, make you aware if it's
suspicious? Are there t ools that we could help nurses and primary care doctors to really help cut down on what,
which people are referred to dermatology, where there's something really of concern or not? And so we've
invested in some imaging techniques, some other techniques tha t, you know, aren't ready for primetime today,
but I think in the near future, maybe. But we need tools for the individual at home, the primary care doctor and
the dermatologist. And we're investing in those areas and really believe that AI and imaging and imaging over
time, will really help, you know, to, to help in this detection space. And so we're, we've invested a little bit in the
past and, we'll be investing more over the next few years, but definitely dermatologists and primary physicians
need more tools to help them.

Mark (11:44)
Well, Margaret, we've been very engaged in that, line of work as well. Our, con ConferM ed, which, does
eConsults with primary care providers. W e've been working with a group out of Denmark, MELITEK, on a
dermoscope that makes it much easier, for the primary care, practitioner to get a good image, which is
oftentimes that, and there's a lack of dermatology. W e, we cherish our dermatologists. They do such a good job
and so important, but we also know g etting to the frontline, and one would hope soon, as you suggested, maybe
there's an opportunity for some home - based, access to this specialty care, right now. But I think there's a lot of
interesting work, going on in this particular area. D o you have any of those types of, intervention models that
you are looking at are best practices around the country?

Dr. Hurlbert (12:39)
Absolutely. The, the group you work with is fantastic. Y ou know, one, one of the pilot projects, just as one
example of about a doz en projects we recently funded was at New York University in New York City. And
what they piloted was, the idea that at a CVS or a Walgreens or a Duane Reed, could you, have a place there
where you could get, you know, three or four suspicious looking mole s, examined with a dermatoscope, and
then have it sent to a central dermatology lab where would be reviewed by expert dermatologists, and they
would refer, you either get in quickly or nothing to con be concerned about, you know, keep monitoring for the
ne xt six months. And it proved to work out. And so they have piloted that at NYU and, you know, look, look at
Covid, you know, when, when covid happened, you, you know, before that time you didn't always get
immunizations at Walgreens and Walmart and CVS. An d then we rapidly were able to do that, and could we do
something similar for skin health? And that's, the, the dream and the vision, but I still think a little bit more
research to be done.

Margaret (13:42)
Well, we have, a lot of questions we'd like to ask. We may run outta time before we get them. I'll ask, but it does
seem that, MRA is engaged at the, prevention, screening, early detection, and then treatment entire continuum.

And we probably have questions about all of them, but I wanna go to the, th e genetics on this one. I understand
there's a new gene - based blood test that has been shown to be, accurate in predicting whether some stage three
melanoma patients are going to experience recurrences of the tumors or not. We're always interested in what is
going on in the genetic, world around these things. Tell us about that.

Dr. Hurlbert (14:21)
Yeah, no, absolutely. So it, it is really an exciting time in monitoring cancer through a blood draw, right? You
know, essentially what we call liquid biopsy o r blood - based biopsy. And yes, so now there's some new tools and
new tests that can measure, whether you, have melanoma or not. If you have more advanced disease, stage three
and stage four, you know, when you have thinner tumors like a stage one, it's har der to detect. And they, they
might not even make it to the bloodstream. But, for more advanced melanomas, we can measure that just even
the presence of that at the time of your diagnosis tells us something about your melanoma. The, we can actually
measure in blood whether your melanoma has A - B - R - A - F mutation, which is the most common, mutation cause
in skin melanoma. And then importantly, these blood - based tests can be used to monitor whether you're
responding as you get treatment. And then, also help augm ent when you're doing imaging, CAT scans, PET
scans, augmenting the imaging test to see if you're having a recurrence. And so I think it's really an exciting time
I've been, involved in, in other organizations, before I joined melanoma funding, liquid biop sy, blood - based
biopsy research for cancers since about 2008. And, for many, many years I was saying it's not ready for prime
time. But today, I would say the message has changed. There are tests available, anyone diagnosed with
melanoma or any type of can cer, you should ask your doctor if there's any blood - based monitoring tests that
could help augment helping your, treatment decision making and monitoring for recurrence.

Mark (15:53)
You know, Margaret, one of the things that we keep a close eye on at th e Weitzman Institute are clinical trials
and the importance of clinical trials. And, you believe that a lack of enrollment in clinical trials is really a, a, a
large obstacle to bringing new therapies to market. Right now, I believe there are around 400 me lanoma faced
focused clinical trials, testing new treatment areas that are currently recruiting patients. I'm wondering if you
can, give us a high - level overview of the, of the, these trials, and also just a reminder of how important, for the
general popul ation, to consider enrolling, into these trials.

Dr. Hurlbert (16:34)
Absolutely. Well, clinical trials in melanoma today, you know, we have so many new drugs that are the standard
of care. And so the new trials are having to compare the new drug, the new agent, the new approach to an
amazing standard of care. So, this idea that you might be a Guinea pig is no longer, you know, that's not valid.
So that's a misconception. There are 400 trials. A lot of them are looking at novel immune therapies, novel
targ eted therapies. I'd say over the last five years, cancer researchers have found a lot of new targets within the
cancer cell and also within the microenvironment around the cancer cell, how the cancer cell interacts with
fibroblasts and other parts of, you know, the, the healthy tissues where it's growing. And, so how can they target
the environment as well as the cancer cells. So these 400 trials are new immune therapies, new targeted
therapies, combinations of agents. We're also looking at, questions, what we call neoadjuvant therapy. Do you
give the, IV systemic therapy before surgery, before you cut out the melanoma? It's done in other cancers. So
giving systemic therapy before you remove the tumor. And it's still, in the area of research, it's not, not y et FDA
approved to do neoadjuvant treatment, but there's some suggestion from early clinical trials and from lab studies
that giving these immune therapies I've been talking about before, the surgery might be more effective. There's,
the, the hypothesis by scientists is that there's more tumor antigens around because you haven't cut it out, and
that the immune system might be stimulated more to recognize it, then you could do the surgery and then
continue these systemic therapies. So that's, that's what thi s, you know, current bunch of ongoing trials is doing.
I will say, my, my message for everyone when I talk about clinical trials, you don't walk down to the Apple
store today and say, Hey, I'd like an iPhone one or an iPhone two, right? You all want the, t he 14, the 15,
whatever generation we're on. So why would you go to your oncologist and say, give me, you know, medicine
1.0. You know, we want the most modern medicine. And that's what clinical trials are providing you today in
melanoma.

Margaret (18:42)
Well, I'm, I'm gonna keep bouncing around. You'll all have to forgive me from this prevention, early detection
and, and treatment, continu um because I, I think melanoma may represent one of the best meta examples of how
it all has to work, right? If we're gonna do a good job, we have to think about prevention, early detection,
screening. Mm - hmm. A nd treatment. But, you know, I'm, I'm gonna start on the, the treatment end of this. Now,
patient needs to get to a surgery site where they can have a MOS procedu re or some, treatment if they're at a, an
appropriate stage. But across the United States, we have huge sort shortages, right? Of the experts, the primary

care, the, the dermatologist, the specially trained dermatologist for melanoma. What's, what's your a dvocacy
role as an organization, in that? Are you working with, schools and training programs, trying to develop new
generations of, I'm sure physician assistants and nurse practitioners are also a big piece of that workforce. What
are you doing to make su re that everybody can get access when they're diagnosed and that they have c overage to
be treated as well? The insurance coverage?

Dr. Hurlbert (19:52)
Yeah, that's a great question. And yeah, it's definitely an unmet need. W e need more dermatologists, mo re
surgeons, more oncologists and, and the staff, the nurse practitioners and physician's assistants that support
them. We have a few programs, you know, for example, training new dermatologists interested in melanoma
called our dermatology fellowship prog ram. We have another program called the Young Investigator Award,
which strips simulates new faculty within the first five years of their career. But absolutely more work needs to
be done on training. Those we do encourage anyone diagnosed with, melanoma, especially if you have a more
advanced stage, you know, stage 2, 3 4, that you really should do your best to get to an NCI designated Cancer
Center, the National Cancer Institute, there's about 75 of them around the country. They're usually affiliated
with top universities and medical schools in your cities and towns. And we do encourage people, at least to get a
second opinion at one of the NCI designated Cancer centers. If it's a few hours drive away, go there for a second
opinion, and then, you maybe cou ld still get treatment locally back home once you sort of know what is the right
treatment path for you. And so that's, that's where we encourage people. B ut absolutely there's a need for more
physicians.

Mark (21:06)
You know, Margaret, we talk so much o n the show about machine learning, AI , MNRA technology, and
CRISPR, wondering how all of those are playing a role in the work that you're doing as you look out on the
horizon of new opportunities and new interventions that we may wanna keep an eye on?

Dr. Hurlbert (21:25)
This is a great question. I think there absolutely will be a role for artificial intelligence machine learning,
especially in melanoma detection and diagnosis. So if we have these imaging tools like a dermatoscope that the
dermatologist u ses or a primary care physician uses, there are other imaging tests I don't think we have time to
get into today. But there are other imaging tools being developed, but any sort of imaging tests, anything that
measures a change in your, mole or a change in your tumor over time is, perfectly ripe for being part of AI and
machine learning. And so we've invested about $10 million into this space so far, but more needs to be done.
But absolutely, I think they will have a role in helping detect, changes in moles over time, helping detect when
they, when a mole is melanoma and needs treatment. And then there will be a role, I think, in ai machine
learning and monitoring patients with known cancer and as they, are treated over time. So I think it's an exciting
area . AI machine learning can detect changes, potentially, you know, that someone with the human eyes can't
detect, you know, if you can look at images, you know, microscopic changes over time. And so it's an exciting
area that is worthy of more investments.

Margaret (22:42)
All right. I'm gonna bounce back to prevention, prevention and research. We'll tie both of those, together. So, I
had dinner with a friend not long ago who had been visiting her grandchildren in Australia, and she, showed me
a photograph o f the two, beautiful school age boys. And they were both where they had just come out from
school and they were both wearing large kind of floppy hats. And I thought it was amusing 'cause little boys
generally are not too keen on that kind of thing. And sh e said, it's not even a question in Australia. It's the
number one, highest incidence of melanoma in the world. I don't know if that's accurate, but that was, her
understanding, and that it is, it is the norm to see children wearing protective headgear and really everybody
wearing it. So I wonder what your thoughts are, relative to research and human behavior, also in area that we're
very interested in. Mm - hmm. And the Weitzman Institute, I don't see that happening around me in the United
States. I don't se e it happening at the beach, although maybe with the very, the babies, a little more attention to,
covering. But what are you doing in terms of, research into how you really change behavior to move away from
those numbers that we talked about earlier about the significant increase in younger people of melanoma that's
gotta require behavioral change. What are you studying? What's effective? Does it have to come from the
healthcare provider? Is it social norms? Tell us your thoughts on that.

Dr. Hurlbert (2 4:10)
Yeah, no, absolutely. We definitely need to do more to educate the public on it. And like I suggested earlier on,
maybe we've made some progress in the nineties and early two thousands, and maybe we need to double down
on efforts, right? On sun safe behaviors. A bsolutely. We've funded a few projects that were piloting ideas,

piloting ideas on social media locally to see if they could, get, the public and people, you know, to improve their
knowledge about sun safety, not just sunscreen, which is critic al every day, year round, reapply if you're gonna
be outdoors for more than two hours, but also some of these long sleeves, these hats, sunglasses, other things to
prevent, directly exposing your skin to the sun. And we need absolutely to do more of that b ecause it is a
behavioral change across society and absolutely Australia, leads the way in some safe behavior because
melanoma is so critical down there.

Mark (25:05)
Dr. H url bert, I think our listeners would be interested if you could share how you got i nvolved in melanoma
research and advocacy and leading this effort.

Dr. Hurlbert (25:15)
Absolutely. Well, thank you for that question. I'm a scientist by training my background's in pharmacology or
drug development for the lay listener. A nd I've worked in neuroscience for a decade and then diabetes for about
five years. And then I moved into cancer research, just over 20 years ago. I spent most of that time in the breast
cancer field, and I moved over to Melanoma Research Alliance seven years ago, quite honestly, because I was
very excited by these new immune therapies. I think stimulating the immune system to attack cancer just like it
goes after a virus or bacteria, has been a game changer in melanoma, and now more than two dozen other types
of cancer. And I think balancing that immune therapy with abnormal cancer cells will be the way that we cure
many, many types of cancer going forward.

Margaret (26:04)
And, and perhaps one more que question on my end. Y ou're a big advocate, obviously, to try and, find this early
and treat people effectively. B ut also the message that melanoma does not discriminate anybody, no matter your
age, no matter your ethnicity, no matter your racial background, can get this and that you in fact are seeing rare
melanomas more oft en in patients with black, Hispanic or Asian, ancestry. What's the message that you wanna
get out there to all people about screening?

Dr. Hurlbert (26:34)
Yeah, so everyone should practice sun safety. All races, all ethnicities, anyone, any race, any eth nicity, can get
skin. Melanoma can get melanoma and particular people with darker skin tones, black, Asian, Hispanic, they
should be, cognizant of changes, moles or abnormal naive blisters on their hands and feet. They can get these
rare melanomas, acral, melanoma on their hands and feet. A nd they just need to be aware that melanoma isn't
always just a brown spot on your shoulder. You know, it could, could be on your hands or your feet or under
your fingernail beds. And, but I think the key message is any r ace, any ethnicity is, susceptible to melanoma.
And everyone needs to be aware about their own skin and changes in their body over time.

Mark (27:17)
You know, I'm sure Margaret, a lot of people who are listening this wanna know more about M RA's work. Tel l
us how people will get in touch, of the work that you're doing. Is there a place that they can go on the web, to
find out the latest research?

Dr. Hurlbert (27:32)
Absolutely. I would encourage the listeners to, join us at curemelanoma.org, our website. You could subscribe
to our e - newsletter. It goes out every month with usually four to five new features, new research, highlights,
new breakthroughs. We're very excited, this springtime, springtime of year. There's a lot of cancer conferences.
I'm sure ma ny of you, you, both of the, both of you follow it and many of your listeners do. And so we'll be
reporting, in a few weeks from now from the ASCO conference, but really, would welcome any of your listeners
to join [email protected] .

Margaret (28:003)
Perfect. And thank you Mar c , so much for joining us. And thank you to our audience for being here. J ust a
reminder, be sure to subscribe to our videos on YouTube, find us on Facebook, and also, please share your
th oughts and your comments about this program. Take care, and be well.

(28:22)
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