Friday, February 12, 2016

Come on, Bey! How come you be blonde?

Beyonce's new video and subsequent Super Bowl performance of "Formation" proves she was right.  "You know you dat bitch when you cause all that conversation!"   Indeed!! From NPR code switch to office lunch rooms to Facebook posts...everyone is talking!  The song, especially when paired with the powerful images in the video, has been variously described as ~ 'slay-worthy', 'powerful', 'hilarious', an 'insult', 'provocative', 'anti-cop', an 'anthem', 'insulting', a 'glorification of blackness'.  For me it is just as much the story of those left behind in the wake of Katrina, Black Lives Matter, and the injustices blacks have endured in our society as a tapestry of T and A, and wigs and weaves!  As such it seems that I have the only question yet to be posed:  Come on, Bey!  How come you be blonde?

Katrina.  That was back in 2005, y'all!  The fact that portions of New Orleans remain filled with empty lots, abandoned and broken, houses covered with unconscionable to me.  The general lack of preparedness, the lackadaisical, ineffective management of government leaders before, during and after the storm, with a disproportionate number of blacks and poor communities left to suffer the most - remains a blot on our national history.  The 45 bodies pulled out of Memorial Medical Center after the storm is a story of stupidity, injustice and medical malpractice that SHOULD haunt us all.  This hospital lost power and supplies when the levees broke (Whole 'nother story there, peeps!!!) BECAUSE - despite knowing they lived in a city below sea level, despite the fact that within weeks of its opening in 1926, the hospital flooded!!! 2005....the generators and supplies remained housed in the frequently flooded basement!!!!!  How is all of this okay?

How do we as a society fail to recognize and address the perpetuating nature of poverty, lack of education and opportunity, and its deleterious effects on minorities and marginalized communities?  As Dostoevsky noted...after serving a little time..."You can judge a society by how well it treats its prisoners."  Clearly, that reflection starts with who we, as a society, imprison and why.  The fact that the majority of folks arrested and imprisoned in this country are from minority groups cannot be an accident nor appropriate.  There are good people and horrible people of every race, sex, creed, and color.  To look at the penal system in the United States you would have to believe otherwise.  The fact that a man walks free after killing an unarmed teen, while that man was armed with a gun - IN A VEHICLE - in "self defense"....says what exactly?  About us?  To us?  For us?  We should rectify our inequalities and the problems within our society that creates them!  But, it's not easy is it?

It is far easier to carpet bomb something that seems very clear and different...foreign.  It is easier to define the origin and horrors of Radical Islamic terrorists with their killing and mayhem inflicted on innocents on 9/11, in Paris and San Bernardino, than it is to face the good 'ol white boys with a Momma and a Daddy, often sitting at home with their Second Amendment arms, listening to hate stirring, free speech commentators, singing a siren song, who do the same:  Dylan Roof - killed 9 praying in their church in South Carolina.  Timothy McVeigh - responsible for 173 dead in Oklahoma City.  James Holmes - 12 killed for watching a movie in Aurora.  Adam Lanza - killed 26 elementary school children and teachers in Sandy Hook.  Harris and Klebold - murdered 13 of their classmates at Columbine.  Ted Kaczynski created terror by mailing bombs for 20 years!!!!  I could go on...but I'm feeling ill.  It is hard to carpet bomb the freaks of human nature when they live next door, isn't it?

We SHOULD decry exclusive old white men clubs!  The KKK.  The voting block for the Oscars.  The United States Congress.  ALL institutions should be judged on their merits and their reflection of the society they claim to represent.  West Point allowed women entry only in 1980. In 2015, the first two women graduated from U.S. Army Ranger School and women held only 104 of the 535 seats in Congress.  Still, the 114th Congress is the most diverse it has ever been, with non-whites making up 17% of its members though that is far from the 38% they constitute of the National population.  Male blacks attained the right to vote in 1869.  Even so, in 1940, only 3% of eligible African Americans in the South were registered.  Women did not gain the right to vote until 1920! But, at some point, women and blacks have to recognize that we can't ask for equality and special treatment at the same time.  I can't expect you to hold the door for me, cast your vote for me (Yes, I'm talking to you, Madeleine!!), allow me to join an elite branch of the military or enter the college of my choosing JUST because I am a woman.  Rather, I deserve these things either on the basis of human for another...or because I earned them.  Similarly, while institutions like Ebony, BET, The Black Caucus American Library Association, Miss Black America, etc. all served a necessary and essential purpose in the fight for societal equality - there will come a time when the black community will have to reassess, as Howard and other institutions have done, whether their exclusivity remains deserved and appropriate - or simply an additional bastion of elitism and segregation.

"I like cornbreads and collard greens, bitch. Oh, yes, you best to believe it."  Oh, yes, I do, girrl!!!  Born and raised on beans and greens.  Had some for supper just the other night.  Yep.  I know all about being BAMA!!  Born and bred.  I have traveled the world, read more than many, attained a Master's Degree, and remain proud of where I'm from.  Like, Bey, I make no apologies for that.  And, yes, there are those who after a look and a listen, dismiss my ability to retain thoughts or have something meaningful to say simply on the basis of my being a female with a southern accent.  It used to bother me more.  But's their loss.

Finally ~ Bey, why you be blonde?  Now understand, this is coming from a girl who ain't had her 'natural hair' for more than 20 years!!!  But, I ain't been telling anybody to keep their natural fro and nose either! And, know you can't find 24+ amazing dancers with their hair 'natural' and cut just so!!!  Just say'n!!

In the end,  I think 'Formation' and its hubbub is a good thing.  No matter which side of the discussion you fall on....even if it's a little bit on both....Beyonce got us talking.  Let's hope we all start doing something, too.

Cause:  "I slay, OK, I slay, OK.  We gon' slay, slay.  Gon' slay, OK.  We slay, OK!" - c

Thursday, February 11, 2016

Sunbelt Melanoma Trial Final Results: No survival benefit for interferon or complete lymph node dissection in patients with a single positive SLN!

Final Results of the Sunbelt Melanoma Trial: A Multi-Institutional Prospective Randomized Phase III Study Evaluating the Role of Adjuvant High-Dose Interferon Alfa-2b and Completion Lymph Node Dissection for Patients Staged by Sentinel Lymph Node Biopsy.  McMasters, Egger, Edwards, et al.  J Clin Oncol.  2016 Feb 8.

“The Sunbelt Melanoma Trial is a prospective randomized trial evaluating the role of high-dose interferon alfa-2b therapy (HDI) or completion lymph node dissection (CLND) for patients with melanoma staged by sentinel lymph node (SLN) biopsy.

Patients were eligible if they were age 18 to 70 years with primary cutaneous melanoma ≥ 1.0 mm Breslow thickness and underwent SLN biopsy. In Protocol A, patients with a single tumor-positive lymph node after SLN biopsy underwent CLND and were randomly assigned to observation versus HDI. In Protocol B, patients with tumor-negative SLN by standard histopathology and immunohistochemistry underwent molecular staging by reverse transcriptase polymerase chain reaction (RT-PCR). Patients positive by RT-PCR were randomly assigned to observation versus CLND versus CLND+HDI. Primary end points were disease-free survival (DFS) and overall survival (OS).

In the Protocol A intention-to-treat analysis, there were no significant differences in DFS  or OS  for patients randomly assigned to HDI versus observation. In the Protocol B intention-to-treat analysis, there were no significant differences in overall DFS  or OS  across the three randomized treatment arms. Similarly, efficacy analysis (excluding patients who did not receive the assigned treatment) did not demonstrate significant differences in DFS or OS in Protocol A or Protocol B. Median follow-up time was 71 months.

No survival benefit for adjuvant HDI in patients with a single positive SLN was found. Among patients with tumor-negative SLN by conventional pathology but with melanoma detected in the SLN by RT-PCR, there was no OS benefit for CLND or CLND+HDI.

Interesting.  Not really news in the case of interferon!  Can we finally be done with that "treatment" already???!!!!  As far as the complete lymph node dissection, I guess there remains one (at least) question...and that is....What about folks with obvious tumor in their sentinel lymph node?  This study reports that in these patients with sentinel nodes that were "negative by conventional pathology, but WITH melanoma detected via RT-PCR" testing, there was no overall survival benefit to the complete lymph node dissection.  Hmmm.... This study result does stand in contrast to data showing benefit from CLND in the 2,000 patients randomly studied by Balch and Faries in their 1994-2014 study where patients were observed OR treated with lymphadenectomy if a positive node was found.  On a personal note:  My initial primary lesion was only 0.61mm thick with no ulceration.  However, a sentinel node was positive for micrometastasis. I did elect to have a complete lymph node dissection of the area but declined interferon.  Still, I developed a second thin primary in another location 4 years later (removed, negative SLN, CLND), but advanced to Stage IV with brain and lung mets 3 years after that.  Still more we have yet to figure out...but we've come a long way baby!!!  Thanks, ratties! - c

Tuesday, February 9, 2016

Women and melanoma risk

Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age.  Tellez, Rueda, Conic, et al.  J Am Acad Dermatol. 2016 Jan 11.

“Melanoma is the fifth most common cancer in the United States, with recent reports indicating increasing incidence among young women.  This [retrospective] study sought to investigate histopathology, staging, risk factors, and outcomes of cutaneous melanoma in women younger than 50 years.
All female patients aged up to 49 years with biopsy-proven diagnosis of melanoma between 1988 and 2012 were included. Patients with a follow-up of less than 2 years were excluded. A total of 462 patients were identified, with mean age of 34.7 years. Invasive melanoma was less common in women 19 years of age or younger. Positive sentinel node status, recurrence rates, metastatic disease, and death rates  were higher for women ages 40 to 49 years. The 41 patients with a pregnancy-associated melanoma had a significantly worse prognosis in comparison with a control group of nonpregnant patients, with a 9-fold increase in recurrence, 7-fold increase in metastasis and 5-fold increase in mortality.
The increasing incidence of melanoma for women younger than 50 years suggests that regular skin checks and self-examinations are warranted. In addition, in women given the diagnosis of melanoma during or within 1 year after childbirth, regular follow-up and monitoring for recurrence are recommended.”

This post covers several articles that looks at the odds for positive sentinel nodes and recurrences in folks with thin melanoma lesions - also noting being less than age 40 increases risk: With melanoma you can never be too rich or too thin! But, you can be too young! 

The article covered here indicates:  "the only clinicopathologic factors associated with longer Progression Free Survival (PFS) and OS were being female and a normal pretreatment serum lactate dehydrogenase (LDH) level."  Being female with low LDH and no ulceration in primary and BRAF V600 positive = increased survival rates with BRAFi 

And then there is this:  Melanoma risk significant among pregnant women

For what it's worth - c 

Sunday, February 7, 2016

Christmas in February!!!

With busy schedules, combined with pragmatism, The Morris Bunch has managed to spread Christmas over 4 months!!!!!

There was Rosie's Christmas November!!!
Her afghan to match in December!
Ruthie got some sunshine for her feet and couch - also in December...
And you may recall Carla's afghan and pillow.
Then there was the Chaotic Apron just a week ago!!!  While B and Fred-o were putting together ANOTHER computer (don't ask!!!)...
Irina and I made a cute art/photography apron for her!!!
Fred-o was super excited!!!  So much so...his hair stood on end!!!!

Parallel play!

IT guys, baby!

Great pics, Irina!!!

A boy and his dog!

And this week...we got to visit Ruthie!  Roo sent her owl push pins...
English Breakfast tea...and...
...a Tea Rex Tee!!!! Hee hee!
Carla made me (and Ruthie!!) an amazing tray from reclaimed wood as well as other pieces!  It is so lovely, looking like the most beautiful parquet floor you've ever seen!!!  (As you can see, B is already putting it to good use!)
Ruthie made both of us incredible coats from beautiful woolens with special buttons, sized perfectly, and button loops made from strands of the actual fabric used....raveled and re-braided!!!!
Awesome, right?!
Just wanted you to be able to see some of the detail!
The back hangs so prettily!
And...TODAY!  Rosie got an amazing teacher/phone/girl on the town bag! Made by Ruthie!

Along with a beautiful, purple, cozy coat!!! Ruthie is one amazing sewist!!!

It's always a good day when you can have Christmas in February and ALL your "dead animals" lined up on the windowsill!

Thanks to all of you who make my days, Christmas and otherwise, special.  Love, c

Saturday, February 6, 2016

Fasciitis and encephalopathy after treatment with pembro/Keytruda

Eosinophilic fasciitis and acute encephalopathy toxicity from pembrolizumab treatment of a patient with metastatic melanoma.  Khoja, Maurice, Chappell, et al. Cancer Immunol Res.  2016 Jan 28

"Anti-PD1 inhibitors have significant activity in metastatic melanoma. Responses often occur early and may be sustained. The optimal duration of treatment with these agents is unknown. Here we report the case of a 51-year-old woman treated with pembrolizumab, as part of the Keynote-001 trial, as first line treatment for metastatic disease. She experienced a complete response after 13.8 months of treatment with no adverse events. One month after the last drug infusion and 18 months from starting treatment, the patient presented with eosinophilic fasciitis. She then developed acute confusion and weakness, thought to be secondary to intracranial vasculitis. High dose steroids were initiated with resolution of the fasciitis. Aspirin was commenced for presumed vasculitis with resolution of the neurological symptoms. To our knowledge, there are no previous reports of eosinophilic fasciitis or cerebral vasculitis due to anit-PD-1 agents. This case demonstrates that toxicity may occur in association with pembrolizumab treatment after a prolonged period of treatment without toxicity. Future trials should explore the optimal duration of treatment with pembrolizumab."

Myasthenia gravis exacerbation associated with Pembrolizumab.  Zhu and Li.  Muscle and Nerve. 2016 Jan 23.  (You can do a search to read the article if interested.)

Hopefully, both of these events will remain rare in melanoma patients treated with Pembro.  After all, when facing 'Stage V', what is a Stage IV melanoma patient to do???!!!  But, I figure the more we know about possible sequalae/side effects (rare though they may be) the better off we will be in our search for help should strange symptoms arise during and even after treatment.  Best - c

Wednesday, February 3, 2016

Neutrophils as a prognostic predictor in patients treated with ipi/Yervoy

Back in June, I posted this:  Lab values that may predict response to ipi/Yervoy   The article discussed baseline neutrophil-to-lymphocyte ratios specifically.  Here is an expanded study by the same lead author.

Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab.  Ferrucci, Ascierto, Pigozzo, et al.  Ann Oncol. 2016 Jan 22.

"Clinical responses to ipilimumab are variable in terms of onset, magnitude and duration. Upfront identification of patients who are more likely or unlikely to benefit from treatment is a major need.
Prospectively collected data from 720 advanced melanoma patients treated with ipilimumab 3 mg/kg within the Italian expanded access programme were analyzed. The derived neutrophil-to-lymphocyte ratio (dNLR) was calculated from baseline peripheral blood cell counts, and receiver operating characteristic curve was used to evaluate the best cut-off for this marker. Patients were stratified according to dichotomized baseline absolute neutrophil counts (ANC), dNLR, and their combination. The prognostic values of ANC and dNLR for survival were assessed using multivariate Cox proportional hazard models. A subgroup analysis including LDH in the models was also performed.
The median follow-up was 16.5 months. The optimal cut-off for dNLR was 3. 

Baseline ANC and dNLR were significantly associated with outcome of ipilimumab-treated melanoma patients, in terms of disease progression and death. Further, for each elevated variable, prognosis worsened. Patients with both ANC≥7500 and dNLR≥3 had a significantly and independently increased risk of death  and of progression compared to patients with both lower ANC and dNLR. Patients with one of the two factors elevated displayed an intermediate risk of progression and death. The 1-year and 2-years survival rates were 2% and 0%, respectively, for patients with ANC≥7500 and dNLR≥3, and 43% and 24%, respectively, for patients with both lower ANC and dNLR."

So....elevated absolute neutrophil counts as well as elevated neutrophil-to-lymphocyte ratios did not bode well for the 720 melanoma patients treated with ipi in this study.  The risk for progression and death was even greater when both of those values were increased.  This report is consistent with the findings from the initial, smaller study of  214 melanoma patients treated with ipi in which:  "Patients with baseline NLR (neutrophil-to-lymphocyte ratio) less than 5, had a significantly improved progression free survival and overall survival compared to those with a NLR equal or greater than 5."

For what it's worth....c