Georgina Long: Immunotherapy Transforming Melanoma Outcomes

Overview

Georgina Long, 2024 Australian of the Year and Medical Director of Melanoma Institute Australia, discusses how immunotherapy has revolutionized melanoma treatment. She explains why Australia bears a high melanoma burden, how the cancer’s mutations interact with the immune system, and how new drugs are mobilizing the body’s own defenses to fight cancer.

Takeaways

Key themes include immune checkpoint inhibitors, biomarkers that predict response, and the shift from surgery-centric care to immune-based strategies. Long outlines the path from early intervention to stage 3 disease management and the potential to extend these advances to other cancers.

Introduction and context

Georgina Long, a pioneer in melanoma treatment and Medical Director at Melanoma Institute Australia, reflects on a field overhaul that began with understanding how a highly mutated cancer interacts with the immune system. She explains melanoma’s particular prevalence in Australia due to UV exposure and fair skin, and why this has driven a lab-to-clinic focus on leveraging the immune system to recognize and eradicate cancer cells.

Long describes how melanoma differs from other skin cancers, its tendency to metastasize, and how traditional surgical approaches were limited once the disease advanced. The shift toward immunotherapy emerged from the recognition that melanoma cells often carry numerous mutations, making them conspicuously foreign to the immune system and more detectable to T cells when the cancer’s immune-evasive tactics are blocked.

“The PD1 immunotherapy I spoke of that was developed in melanoma is now one of the most commonly used anti-cancer drugs.”

“I want to narrow that 50% who are dying of melanoma, I want to get that smaller and smaller.” - Georgina Long

Mechanisms of immunotherapy and patient selection

Long explains the central concept of immune checkpoint blockade: cancer cells often shield themselves from T cells with receptor-ligand interactions; blocking these interactions re-energizes T cells to attack tumors. This reactivation is not uniform, so patient selection matters. She highlights biomarkers such as higher tumour mutation burden and interferon gamma signatures as surrogates for activated, yet exhausted, T cells that can be revived by therapy.

She notes that in melanoma, immunotherapy has dramatically altered outcomes, with many patients achieving long-term remission, while others do not respond—driving work on better predictive tests and combination strategies. “Immunotherapy's completely different. We are not killing the cancer cells directly with our drug... the drug is not doing the work, the T cells are, your own immune system is.” - Georgina Long

Clinical application and early intervention

The discussion moves to how these therapies are integrated into practice, including pre-surgical or neoadjuvant approaches for stage 3 disease in Australia, where government-funded programs (PBS) now support these strategies. Long describes how early systemic therapy can shrink tumors before surgery and provide tissue for studying resistance mechanisms, informing future trials and broader cancer treatment approaches.

She emphasizes caution and individualized care, noting that immune therapies can cause diverse side effects and require careful monitoring and dosing tailored to each patient.

“The immune system can recognise it as very foreign and eradicate it.” - Georgina Long

Global impact and future directions

Finally, Long discusses how melanoma success informs other cancers. The same checkpoint inhibitors are now used in lung, kidney, and other cancers, albeit with varying efficacy. She stresses the “third space” challenge—the subset of patients who do not respond—and outlines the research agenda to extend cures to this group, with translational insights guiding trials across oncology. The ultimate goal is a universal, precise, and safer immunotherapy ecosystem that improves survival for melanoma and many other cancers while minimizing risks.

“We really are leading the way in pure immunotherapy use, but the goal is to cure the 3rd space where current therapies fail.” - Georgina Long