The Duke Cancer Institute melanoma and advanced skin cancer disease group includes a multi-disciplinary team of surgical, radiation, and medical oncologists, as well as dermatologists. Our team specializes in the treatment of melanoma as well as advanced cutaneous squamous cell, basal cell, and Merkel cell carcinomas. We seek to individualize treatment based on a patient’s needs and offer a wide array of clinical trials to provide access to the latest therapies.
Our physicians strive to improve patient outcomes through projects that span the spectrum between basic, translational, and clinical research. Our doctors work closely with scientists, with the hope of using our basic and translational research findings to improve the treatments and the clinical outcomes of patients with advanced skin cancers.
Treatment options for patients with melanoma have rapidly expanded in recent years, with some of the biggest advances coming in the development of new immunotherapies. Despite this promise, many patients with advanced melanoma do not respond to the medications that are currently available. As a result, one of our primary translational research goals is to better understand how melanomas develop resistance to these types of agents. We believe that a fundamental understanding of these mechanisms will lead to the identification of novel immunotherapy strategies as well as the discovery of biomarkers capable of improving the management of patients with advanced melanoma.
With this goal in mind, we use pre-clinical models as well as clinical tissue specimens to investigate these questions and to develop novel immunotherapy approaches for patients with melanomas that have been refractory (resistant) to standard treatment. This work includes projects to identify pharmacological targets capable of enhancing the activity of and overcoming resistance to checkpoint inhibitor immunotherapy. This initiative also extends to the identification of useful markers capable of predicting which patients are more likely to respond to current immunotherapy options as well as those patients more likely to develop immunotherapy-associated side effects.
DCI scientists are also working in the lab to develop therapies that stimulate immune responses that target and kill melanoma cells by releasing tumor antigens and activating immune cells that infiltrate the tumor. To achieve these goals, basic research scientists and clinical investigators within the program collaborate closely to generate a clinically meaningful impact on patients with advanced skin cancer.
For more information on Tumor Immunology and Immunotherapy, visit:
The Hanks Lab investigates mechanisms of immunotherapy resistance and toxicity while striving to translate these findings into the clinic.
The Nair Lab designs and tests novel vaccines against cancer and viral infections using murine and human assay systems.
Less chemo, more targeted immunotherapy for all types of cancer: that’s the dream of cancer researchers today. Brent Hanks, MD, PhD, and April Salama, MD, associate professors in the division of Medical Oncology, are on the leading edge of helping to make that dream a reality for stage four melanoma patients.
While new immunotherapies have revolutionized treatment options for patients with advanced melanoma over the last 10 years, they only work about 50% of the time. With a deeper understanding of the mechanics behind cancer immunotherapy resistance in these patients, a focus of Hanks’ ongoing research, the investigators hope to develop innovative strategies to augment the efficacy of immunotherapy, thereby expanding the patient population that can benefit.
Hanks and his lab team have uncovered one such mechanism: activation of the NLRP3 pathway, which leads to resistance to PD-1 based immunotherapy, a mainstay of therapy for patients with advanced melanoma. By inhibiting the NLRP3 pathway, Hanks and Salama hope to restore the therapeutic efficacy of checkpoint inhibitor drugs.
Continue reading on the Duke Department of Medicine website.
Co-leader of the Duke Cancer Institute Melanoma Disease Group Georgia Beasley, MD, MHSc, is among 40 recipients nationally of a Young Physician-Scientist Award from The American Society for Clinical Investigation.
The annual award, according to ASCI, "recognizes excellent physician-scientists who are early in their first faculty appointment and have made notable achievements in their research." As part of the award ASCI "seeks to encourage and inspire these physician-scientists" through their participation in the Joint Meeting of ASCI/The Association of American Physicians (AAP)/The American Physician-Scientists Association (APSA), which was held April 8-10 in Chicago this year
Over the course of the next two years, early-career awardees will also have the opportunity to participate in leadership development workshops, topical panel discussions with ASCI members, peer review groups, and virtual poster sessions
Beasley is an associate professor in the Department of Surgery, Division of Surgical Oncology, Duke University School of Medicine, and has a secondary appointment as an associate professor in the Department of Medicine. She is board certified in both general surgery and surgical oncology and has an active clinical practice treating patients with melanoma.
As a surgeon-scientist, Beasley is actively involved in clinical and translational research with a primary focus on utilizing the innate immune system to both predict and enhance response to immune checkpoint inhibitors in melanoma. The site PI for several national clinical trials, she also leads investigator-initiated homegrown trials at DCI, and has presided over independent laboratory projects in oncolytic viral therapy and application of immune therapy. She has authored more than 90 publications centered on melanoma and has received multiple internal and external funding awards including the Society of Surgical Oncology Young Investigator Award and an NIH K08 mentored physician-scientist award.
Beasley obtained her undergraduate degree from Duke University. While an undergraduate, she was a two-time conference player of the year for the Duke Women’s basketball team and was inducted into the Duke Athletics Hall of Fame in 2014. After playing three years in the WNBA, she returned to Duke for medical school; obtaining her MD in 2008 and a Masters of Health Science in Clinical Research in 2010 from Duke University School of Medicine. She completed General Surgery residency at Duke in 2015, during which time she was awarded an NCI postdoctoral trainee-ship grant (Surgical Oncology T32 grant). After completing her fellowship in Complex Surgical Oncology at The Ohio State University in 2017, she returned to Duke as a faculty member and was named co-director of the Duke Cancer Institute Melanoma Disease Group in 2019.
This article was written forMagnify, a Duke University School of Medicine online publication.
Fifty years since theNational Cancer Act of 1971 declared “War on Cancer”and a decade since the first drug, an immunotherapy, was approved to treat metastatic melanoma, a leading clinician researcher goes head to head with melanoma brain metastasis.
At age six,April Kelly Scott Salama, MD, already knew that she wanted to be a doctor when she grew up. Somewhere there’s photo evidence of her playing in a balloon hat that’s meant to be a scrub cap.
“No one knew why I wanted to be a doctor,” said Salama, now a medical oncologist. “No one in my family was a doctor.”
But two formative experiences that she had as a teenager further solidified the calling and led her to home in on the practice and science of oncology, specifically. First, her grandfather was diagnosed with lung cancer, got better, then declined and passed away—a heartbreaking experience for Salama. At the same time, her passion for molecular biology — critical to understanding how cancer works at the cellular level — was crystallizing in AP Biology at the public school she attended in Raleigh, NC, the city where she grew up.
Salama credits great mentorship — from her high school biology teacher, her undergraduate and medical school professors at UNC Chapel Hill, and her residency and fellowship mentors at the University of Chicago — for ultimately steering her toward a career at the intersection of cancer patient care and science. After completing her fellowship in the lab of Ravi Salgia, MD, PhD, an oncologist focused on translational lung cancer research, she made it her mission to return to her native North Carolina to care for patients and continue her research.
“I felt very, very, strongly about being able to serve patients in this area,” said Salama. “I really felt I owed a debt of gratitude to the state that had educated me and set me down this path.”
But, during her job search, Salama soon learned that there were no openings for a freshly-minted lung cancer clinician-researcher at any of the state’s research hospitals. Duke, however, was looking to fill a long-vacant faculty clinician position in the Melanoma Disease Group. Surgical oncologist Doug Tyler, MD, then director of the group, was ready to train her.
Tyler’s group was investigating immune checkpoint inhibitors, which work by helping the patient’s own immune system to recognize and destroy cancer cells. The first of these immunotherapy drugs (ipilimumab) was months away from FDA approval to treat metastatic melanoma. A second one (nivolumab) wasshowing signs of promise, and a third one (pembrolizumab) was about to start clinical trials.
Early-stage melanoma was being treated solely with surgery, but up until that point there had never been a drug trial that improved survival in patients whose melanoma had recurred and spread to other organs. It was an exciting time for metastatic melanoma researchers, and they wanted to bring Salama into the fold.
“As division chief of medical oncology, I had the great fortune to recruit Dr. Salama from the University of Chicago, where she had distinguished herself both clinically and academically during her fellowship. While her work had been in lung cancer, I was convinced she could transition into melanoma as a clinical investigator with mentorship from Dr. Tyler, our melanoma surgeon and leader of our melanoma program in the Duke Cancer Institute (DCI) and currently at the University of Texas Medical Branch at Galveston,” said Jeffrey Crawford, MD, George Barth Geller Distinguished Professor of Immunology.
Salama consulted her mentors in Chicago and together they agreed that pivoting from lung cancer to melanoma presented an undeniably exciting opportunity for her to be on the new front lines of cancer therapy research. Salama and her husband Joseph Salama, MD, whom she’d met while at the University of Chicago, packed their bags and headed south.
William Blake, 65, worked for the State of West Virginia for about 35 years in the toll division before taking early retirement in 2007 when he got sick with follicular lymphoma. He was treated at Charleston Area Medical Center (WV) and survived that cancer.
But when Blake was diagnosed four years later with a different type of cancer at the Beckley, WV, Veterans Hospital — metastatic melanoma to the brain — he was referred to Duke.
John Kirkpatrick, MD, PhD, the director of radiation oncology for The Duke Center for Brain and Spine Metastasis at Duke Cancer Institute and clinical director of radiation oncology at DCI, performed an image-guided stereotactic radiosurgery (SRS) procedure on Blake’s two brain lesions — a high-tech non-surgical therapy that delivers precisely-targeted high-dose radiation in one to five treatments, while preserving nearby healthy tissue.
Medical oncologist April Salama, MD, meanwhile, treated Blake with a course of ipilimumab, an immunotherapy that had just been approved that year for the treatment of advanced melanoma. When another lesion appeared in March 2012, Kirkpatrick “disappeared” that one as well.
“The prognosis was “We’ll do what we can, the mets are really small, and we caught it early,”” said Blake, who’s today making the most of his retirement.
While Blake has recently had some small localized melanomas and basal cell carcinomas removed in other areas of his body, there’s been no sign of cancer in his brain for seven years.