Melanoma research insights: impact, trends, opportunities Analytical Services Contents Executive summary 3 1 Global impact of melanoma 4 2 Melanoma research: progression and trends 7 3 Countries and institutions leading the charge 14 4 Research opportunities going forward 20 Melanoma research insights: impact, trends, opportunities Executive summary The incidence of melanoma has risen rapidly over the past Key findings 50 years, and analysis of the research landscape suggests that countries and institutions worldwide are responding. Disability Adjusted Life Years Resources are being invested not only in understanding (DALYs) per 1000 individuals in the epidemiology, but also in discovering and testing novel each country therapies and improving diagnostics to facilitate earlier detection. Today, melanoma represents four to five percent 21.65 global Disability Adjusted of all cancer research globally. Immunotherapy – both Life Years rate monotherapy and combinations – is a dominant theme in 20 years life lost per 1,000 people therapeutics studies. (p. 6) The United States is leading the charge in melanoma research overall, followed by China and Germany. That Top 10 countries based on said, a substantial portion of the scholarly output from the publication count top 10 countries includes collaborations with institutions • United States • France outside the country and between academic and corporate • China • Australia researchers. The same is true at the institutional level. For example, 41% of Harvard University’s melanoma research • Germany • Japan output involves international collaborations, as does 58% of • Italy • Spain the output from Université Paris-Saclay. • UK • Canada (p. 13) Although data on disparities is sparse, organizations such as the US National Cancer Institute, among others, have shown Top 10 institutions based on that melanoma disproportionately affects men compared publication count with women, and that there is low awareness among clinicians and the general population about melanoma risks • Harvard University for people of color. These areas may represent research • University of Texas MD Anderson opportunities going forward. Cancer Center • INSERM • Memorial Sloan-Kettering Cancer Center • University of Sydney • CNRS • US National Institutes of Health • Université, Paris-Saclay • University of Pennsylvania (p. 15) Melanoma research insights: impact, trends, opportunities 3 Chapter 1 Global impact of melanoma 1 Global impact of melanoma Melanoma is a type of cancer that occurs when the skin cells that produce melanin become malignant. While everyone is at some risk of developing melanoma, The preferred method of diagnosis is excisional biopsy, people at higher risk include those with: which involves removing the entire tumor. If that can’t be done, other methods may be used. Treatment options • Family history of melanoma for melanoma vary depending on the stage,3 and range 1 • Unusual-looking moles, also called atypical nevi from excision and lymph node management for resectable • Increased numbers of common nevi melanoma to novel immunotherapies and combination (i.e., moles that are benign) regimens for later-stage unresectable and recurrent • Fair skin types melanoma (see p. 11 of this report for the top 10 papers (i.e., light skin with little or no tanning ability) related to treatment). • Light eye color This research report explores the landscape of • Intermittent intense sun exposure and long-term melanoma-related research from global burden to chronic exposure research focus and country/institutional leaders, to research gaps and opportunities. Melanoma is more common in men than women, and there are more new cases among light-skinned individuals than darker-skinned individuals.2 (see p. 21) Sun protection behaviors aimed at preventing melanoma include: • Using sunscreen, especially in childhood • Wearing sun-protective clothing (e.g., broad-brimmed hat) • Avoiding midday sun • Avoiding sunburn • Avoiding tanning parlors Unless otherwise indicated, data on melanoma disease risks, prevention, and treatment comes from Elsevier’s ClinicalKey® 1. Batt M et al. (2016). Does an increased number of moles correlate to a higher risk of melanoma? Melanoma Management, Jun; 3 (2) 85-85. doi: 10.2217/mmt-2016-0001 2. Cancer Stat Facts: Melanoma of the Skin. Retrieved April 30, 2019 from https://seer.cancer.gov/statfacts/html/melan.html 3. Melanoma Treatment (PDQ) - Health Professional Version. Retrieved April 30, 2019 from https://www.cancer.gov/types/skin/ hp/melanoma-treatment-pdq#_885 Melanoma research insights: impact, trends, opportunities 5 Chapter 1 | Global Impact of Melanoma The global incidence of melanoma has risen rapidly over population, or the burden of disease, can be thought of as a the course of the last 50 years. Its incidence is greatest measurement of the gap between current health status and among fair-skinned populations, and in regions of higher an ideal health situation where the entire population lives to latitude. Incidence is greater among older populations, but an advanced age, free of disease and disability. melanoma is also among the most common cancers found For melanoma, the global DALY rate is 21.65, meaning that in adolescent and young adult populations.4 the disease is responsible for more than 20 years of life lost The World Health Organization (WHO) quantifies the and years lived with disability worldwide per 1,000 people. burden of disease from mortality and morbidity in Disability- In 2017 alone, melanoma killed one in 1,234 individuals. Adjusted Life Years (DALYs). One DALY can be thought of as Melanoma has the greatest impact in Australia, followed by one lost year of “healthy” life. nations in northern Europe (Norway, Sweden). DALYs are Specifically, DALYs are the sum of years of life lost and lowest for nations in South America, Africa, South Asia. years lived with disability. The sum of DALYs across the DALY . figure 1 Disability Adjusted Life Years (DALYs) per 1,000 individuals in each country. Source: Global Health Melanoma is responsible for Data Exchange (http://ghdx.healthdata.org/). more than 20 years of life lost and years lived with disability worldwide per 1,000 people. 4. Ward WH, Farma JM, editors. (2017) Cutaneous Melanoma: Etiology and Therapy (Internet). Chapter 1: Epidemiology of Melanoma. Retrieved April 30, 2019 from https://www.ncbi.nlm.nih.gov/books/NBK481862/ Melanoma research insights: impact, trends, opportunities 6 Chapter 2 Melanoma research: progression and trends 2 Melanoma research: progression and trends Since 1990, research on melanoma has risen to the point that today (through 2018), it represents about four to five percent of all cancer research performed globally, with a total of close to 50,000 publications from 2013­­-2018. To understand the landscape of melanoma research, we 10000 queried Scopus, a source-neutral abstract and citation 9000 database, curated by independent subject matter experts. 8000 7000 The Scopus database includes all publication types including 6000 articles, reviews, conference papers, book chapters, editorials, 5000 and abstract reports. 4000 3000 For this report, melanoma research was identified using Number of publications 2000 the term “melanoma” and querying against publication 1000 titles, abstracts and keywords. Since publications in 0 Scopus are indexed using Elsevier’s life science thesaurus, 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017 Year Emtree, using the search term “melanoma” retrieves a figure 2 broad set of melanoma-related publications. Since 1990, Number of publications on melanoma from 1960 to present. Source: Scopus research on melanoma has risen to the point that today (through 2018), it represents about four to five percent of all cancer research performed globally, with a total of close 6 to 50,000 publications from 2013-2018. 5 4 3 2 1 Percentage ofPercentage cancer research 0 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017 Year figure 3 Melanoma related publications shown as a percentage of all cancer related publications.5 Source: Scopus 5. Cancer research defined in Scopus using query: (TITLE-ABS-KEY (cancer) OR INDEXTERMS(“neoplasm”)) Melanoma research insights: impact, trends, opportunities 8 Chapter 2 | Melanoma research: progression and trends To gain perspective of the areas of focus within Melanoma research falls into three main categories melanoma research, we visualized the co-occurrence as shown below: of terms in melanoma-related publication titles and 1. Basic research (light blue), suggested by terms abstracts using VosViewer. like “cell” and “mouse.” 2. Epidemiology research (dark blue). 3. New therapeutics research (yellow), suggested by terms such as “immunotherapy” and “trial.” figure 4 Main concepts represented in melanoma research from 2013-2018. Terms appearing at least 100 times in the title or abstract of research publications were visualized based on co-occurrence of terms using VOSviewer. Source: Scopus Melanoma research insights: impact, trends, opportunities 9 Chapter 2 | Melanoma research: progression and trends In collaboration with research partners, Elsevier has analyzed year, and subject indexed in the Scopus database.7 FWCI is citation patterns of Scopus-indexed publications to define nearly considered one of the most sophisticated indicators in the 100,000 research topics.6 Whereas ASJC categories are broader modern bibliometric toolkit. and