Stanford Cancer Institute

Advanced Melanoma Program: Honoring a Legacy

Allison Betof Warner

Allison Betof Warner

Melanoma is the deadliest form of skin cancer. Nationwide, nearly 100,000 cases of melanoma are diagnosed, with almost 8,000 lives lost to the disease annually. Early detection and timely treatment are crucial in improving melanoma outcomes. Unfortunately, many melanoma patients are diagnosed at more advanced stages, making treatment challenging and underscoring the need for novel research and treatment options.

Recognizing the urgent unmet need for treating patients battling advanced melanoma, the Stanford Cancer Institute (SCI) is establishing the Stanford Advanced Melanoma Program—a world-class advanced melanoma center of excellence on the West Coast. 

Ellie Guardino: Dedicated to advancing cancer research

The Stanford Advanced Melanoma Program was inspired by Ellie Guardino, MD, PhD. After completing an oncology fellowship at Stanford, Guardino worked in the lab of SCI leader Ronald Levy, MD. As a pioneer in cancer immunotherapy, she focused on developing a breast cancer vaccine program at Stanford. While at Stanford, she designed phase 1-2 clinical trials that utilized novel drug combinations to disrupt cancer pathways and inhibit cancer growth. 

Midway through her career at Stanford, she moved to the biotechnology company Genentech/Roche to help facilitate the FDA approval of several transformative drugs for cancer, including MabThera (rituximab), Herceptin, Kadcyla, and Perjeta—which led to remission for hundreds of thousands of breast cancer patients worldwide. Guardino was also a staunch cancer patient advocate. Her activism helped increase patient access to breast cancer therapies globally.

While most oncologists genuinely empathize with their patients’ struggles during diagnoses and treatment, Guardino walked in their shoes. In 2008, she was diagnosed with melanoma. Guardino profoundly understood her patients' physical and emotional challenges, fears, and uncertainties, providing unwavering care and compassion. Despite living with metastatic melanoma, she continued to relentlessly pursue her life goals, helping to advance breast cancer treatments. Up until her passing in 2021, Guardino remained dedicated to raising philanthropic funds for cancer research and actively met with her team to advance cancer research. 

Establishing an advanced melanoma center of excellence

The Stanford Advanced Melanoma Program aims to address the shortage of clinical trials and enhance melanoma expertise in California, which has the highest incidence of melanoma in the United States, as well as in neighboring states. Many patients looking for options need to travel across the country for care and access to novel clinical trials, all while trying to spend precious time with their families, recover and regain their strength, and maintain some normalcy in their lives already disrupted by cancer. 

Steven Artandi, MD, PhD, the Laurie Kraus Lacob Director of the Stanford Cancer Institute and a friend of Guardino, is actively working to make her final wish a reality. Artandi’s vision, along with the leadership of generous donors, is nothing less than to make Stanford a leading center for advanced melanoma care in Guardino’s honor.

“Ellie’s courageous battle and indelible mark on cancer research has ignited a spark within us all. We are determined to honor her legacy by making Stanford a beacon of hope and innovation in advanced melanoma care,” states Artandi.

Assembling a team of experts

The Stanford Cancer Institute has committed to assembling an expert team of leaders in melanoma care, translational research, and clinical trials. One crucial component of this endeavor is the recruitment of a preeminent scientific leader through an endowed professorship dedicated to honor Guardino’s legacy. The Dr. Ellie Guardino Professorship will be pivotal in advancing cutting-edge research, early-phase clinical trials, and innovative patient care.

Artandi states, “Thanks to the generous support of our donors, the new scientific leader will identify and reveal the disease’s biologic pathways for drug development and immunotherapy approaches. This professorship embodies our commitment to advancing the forefront of melanoma research and treatment."

For several years, SCI member Sunil Reddy, MD, was Stanford’s only dedicated medical oncologist for advanced melanoma and non-melanoma skin cancers. In March, SCI member Allison Betof Warner, MD, PhD, was recruited from Memorial Sloan Kettering Cancer Center to Stanford as the Mark and Mary Stevens Endowed Scholar in melanoma. Betof and SCI member Susan Swetter, MD, jointly lead the Stanford Pigmented Lesion and Melanoma Program (PLMP) and the SCI’s Cutaneous Oncology Program. Betof serves as the director of the Advanced Melanoma Program, which is a component of the PLMP.  Betof is focused on treating advanced melanoma and is internationally recognized for her expertise in brain/CNS metastasis and the use of novel cellular therapies, including tumor infiltrating lymphocyte (TIL) therapy for melanoma. She oversees the SCI’s melanoma and cutaneous oncology research portfolio, facilitates the translational clinical research of the Advanced Melanoma Program, and runs her own dedicated melanoma research lab. Betof also serves as the Melanoma & Cutaneous Oncology Clinical Research Group faculty director and director of Solid Tumor Cellular Therapy. 

Since her arrival, Betof has been focused on building a formidable team. In August, Pauline Funchain, MD, joined the Pigmented Lesion and Melanoma Program as the third medical oncology faculty member. Funchain is a preeminent oncologist specializing in the treatment of rare melanomas, such as ocular melanoma, and aggressive non-melanoma skin cancers, such as Merkel cell carcinoma. Her expertise also lies in cancer genetics, and she is a nationally recognized leader for her research related to predicting and managing side effects associated with immunotherapy. Additionally, she will co-direct the Immunotoxicity Working Group at Stanford. 

Swetter, who chairs the National Comprehensive Cancer Network (NCCN) Melanoma Panel and led the Stanford Pigmented Lesion and Melanoma Program for nearly three decades, states, “The addition of both Drs. Betof and Funchain provides us with a full complement of oncologic expertise to address the most challenging cases of melanoma and non-melanoma skin cancers. Their contributions to clinical and translational research will save lives and greatly enhance our renowned cutaneous oncology/dermatology program for the treatment of earlier stage disease.”

Betof states, “The first step was getting the right people on board to expand our ability to take care of patients quickly. With the addition of new faculty, we have tripled our ability to see oncologic patients, and with that comes a wealth of expertise in both clinical trials and clinical care. We can now schedule most patients within 48 hours of receiving a referral.” 

Establishing a comprehensive clinical trial portfolio

One of the Advanced Melanoma Program’s key objectives is establishing a comprehensive clinical trial portfolio across melanoma subtypes and stages–from newly diagnosed cases to those with advanced or refractory disease. The program is committed to seeing Guardino’s vision of a world-class advanced melanoma center at Stanford come to fruition, particularly for those patients who haven’t responded to standard therapy. The intent is to offer state-of-the-art treatments on par with those available at top cancer institutions worldwide, eliminating the need for Bay Area patients like Guardino to travel to receive the best possible care. 

"Having patients pick up, spend time away from their families, and travel all while critically ill never sat right for me. Being able to offer patients the highest level of care where they live–it just doesn’t get much better than that," said Betof. 

“By early 2024, we will have clinical trial options for the vast majority of patients with advanced melanoma. We are exceptionally grateful to Ellie’s vision and the generous donors who have made that possible.”

Unlocking the power of immunotherapy

Melanoma studies are often at the forefront of immunotherapy drug development. Because it is one of the most immune-responsive cancers, these drugs are often first developed for melanoma. If the treatment is successful, it is studied across a broader spectrum of cancers. For example, checkpoint inhibitors were developed and first approved for melanoma.

“This is a unique opportunity but also a huge responsibility,” states Betof. 

Stanford is a leader in cellular therapy. While cellular therapy, such as chimeric antigen receptor (CAR)T-cell therapy, has been approved for blood cancers, its success has yet to be fully realized for solid tumors. 

“Realistically, there are many more patients with solid tumors than patients with blood cancers. Finding a way to help use that technology to benefit solid tumor patients has been challenging both from a logistical and scientific standpoint,” explains Betof.

Betof is a pioneer in tumor-infiltrating lymphocyte (TIL) cell therapy.

“TIL cell therapy is a different type of cellular therapy, but it is guided by the same general principle of hyperactivating a patient’s own immune cells to recognize and kill tumor cells when medications to activate their immune system haven’t worked. It is a physically challenging therapy, but it can offer hope to patients who have exhausted all standard options.” 

Betof anticipates FDA approval of a TIL cell therapy medication early next year, which will be the first cellular therapy approved for any solid tumor. Stanford is poised to be among the first centers in the world to treat patients with this therapy once approved. The goal is to initially offer this therapy to melanoma patients safely. TIL cell therapy clinical trials are currently underway in lung cancer and other solid tumors under Betof’s leadership. 

Launching a dedicated advanced melanoma lab

The last piece of the puzzle is Betof’s new advanced melanoma lab–the first of its kind at Stanford. This significant initiative will create a robust system for collecting samples generously shared by melanoma patients and aid in advancing research, tailoring personalized treatments, and improving patient outcomes. 

“We are really excited about the ability to not only offer patients clinical trials but to have the opportunity to study samples in the lab in order to make the next generation of clinical trials even better,” remarked Betof.

Shaping the future of melanoma care

In honor of Guardino’s legacy and with the support of generous donors, the SCI is embarking on a transformative journey to establish a world-class advanced melanoma center of excellence on the West Coast. 

“We are poised to harness the SCI's unique expertise in cancer biology, genomics, and immunotherapy to reshape the future of melanoma care,” said Artandi

September 2023 by Sarah Pelta
Photo by Sarah Pelta