Dr. John Kirkwood (Text Version)

2023 MRP Vignette

Title: Addressing the Modern Epidemic Among Military Service Members

Investigator: Dr. John Kirkwood, Former Programmatic Panel member, University of Pittsburgh Medical Center

Melanoma is a modern epidemic. It's one which, often times, people don't recognize because they say skin cancer is not fatal. You know, there are a million cases a year of basal cell cancer and only a very small toll of mortality from that cancer. But for melanoma, we see an enormous toll in fatalities. And this is a cancer which is fourth or fifth in the 2023 window, but is projected by 2040 to be second. And so this is a modern epidemic.

The median age of development of melanoma is in the middle to late fifties. And the incidence of melanoma in the military is staggering. The development of melanoma in young UV- exposed service men in Afghanistan and in the Middle East and in several places where sun exposure is categorically higher than it is for us in the United States is a major problem.

The PRCRP, otherwise known as the Peer Reviewed Cancer Research Program, incorporated funding for melanoma, with a dozen or more other tumors that were underserved and underfunded in the estimation of the Congressional funding panel. Basically we worked in the PRCRP to equitably distribute funding amongst a dozen needing cancers or needy cancers. What we've seen with the advent of the Melanoma Research Program is an ability to focus upon melanoma, where my work for 50 years has been dedicated and where the gaps, in spite of the huge progress we've had over the last dozen years, are enormous and the opportunities for progress are equally enormous.

Now we're really trying to hit the gaps in the field of melanoma, the rare forms of melanoma, the acral and mucosal melanomas that really have still a long way to go in terms of developing treatments that are effective, understanding the biology, which differs considerably from the biology of skin melanoma, which is 95% of what we see in the U.S. With more than 20 new Food and Drug Administration-approved treatments for treatment of advanced melanoma, for prevention of relapse with what we were talking about as adjuvant therapy of melanoma.

One of the biggest gaps is that we have nothing - we have no understanding and we have no treatments that work - to prevent melanoma in the skin of people who we know have a higher risk of developing new primary melanoma. So that has become a major focus of the evolving program, and that addition of prevention and early understanding of the biology of what's going on in melanoma has become a major focus of the panel, but also of some of us who are parts of the panel in our own research.

The breadth of applications that we see coming to the Melanoma Research Program (MRP) has grown each year. The depth of the applications that we've seen each year for the last 14 years has increased enormously. And I think the expertise of the applicants, the qualifications of the applicants has become as high as they are for any funding agency that we have in the U.S.

For the past 4 years, it's been delightful to have a dedicated Melanoma Research Program, one which has progressively brought better and better science to the forum and to bring new initiatives in rare melanoma forms in prevention, in early disease that are very hard to fund. And that really allowed us to think in a focused, comprehensive way of the gaps that we confront in melanoma. And I think that's where the progress, the ability to fund applications that should significantly advance the field really, I think, hit its stride.