Wednesday, May 30, 2012

I love.... sweet girl who has never slept, with a mind like a steel trap, whose green eyes and charming smile can banish a bad mood just like her incredible eye lashes can bat away flies, and is the best valet/style maven a girl could have. boy, who always 'gets' his goofy mommy, even when we are the only two who do, who can dance and sing and mimic anything (when he wants to), who always makes me smile.
...surprise cakes and pennies and movies.
...notes with my lunch and "unexpected" flowers. peeps....who know with a nod....that:  "Girrrrrrl , I don't know what she was thinking!!!"....or..."Holy mackerel, batman!!!  What the heck is that stench???"...."I don't know...but THEY don't smell it!!!!"...or..."Angel-man...NO...Williams Syndrome!!!"
...when you know to hold my hand.
...when you save stories to make my difficulties better.
...when you defend me before you know the whole story...and even more vociferously when you do.
...when you try to make small things special...and they are.
...a good book, a nice breeze, a silly dog, a sincere thank you, when you notice, a job well done, a smile that says....I know you....and I still like you....mucho.
For all my peeps...who make my world...I love you.   c

Saturday, May 26, 2012

You have become a man, my son.

I was lucky enough to be able to visit my sister and her family with Rosie earlier this week.  What a great time!!!  Fun road trip with Rosie driving all the way...through rain and road as a cucumber!  Good job, Rosie.  We had to leave before Shane's graduation, but the Morris bunch was definitely there in spirit!!!!  Shane, your loyalty, intelligence, and tremendous work ethic, while grounded with a strong sense of humor and fun, make you someone that I love to be around and admire a great deal.  I can't wait to see where you go!  Enjoy the ride.

Go Boss Shane!!!  You're AWESOME!

If you can keep your head when all about you
     Are losing theirs and blaming it on you;
If you can trust yourself when all men doubt you,
     But make allowances for their doubting too;
If you can wait and not be tired by waiting,
     Or, being lied about, don't deal in lies,
Or, being hated, don't give way to hating,
     And yet don't look too good, nor talk too wise;

If you can dream - and not make dreams your master,
     If you can think - and not make thoughts your aim;
If you can meet with triumph and disaster
     And treat those two impostors just the same,
If you can bear to hear the truth you've spoken
     Twisted by knaves to make a trap for fools,
Or watch and have things you gave your life to broken,
     And stoop and build them up with worn out tools;

If you can make one heap of all your winnings
     And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
     And never breathe a word about your loss;
If you can force your heart and nerve and sinew
     To serve your turn long after they are gone,
And so hold on when there is nothing in you
     Except the Will that says to them:  "Hold on";

If you can talk with crowds and keep your virtue,
     Or walk with kings - nor lose the common touch;
If neither foes nor loving friends can hurt you;
     If all men count with you, but none too much;
If you can fill the unforgiving minute
     With sixty seconds' worth of distance run -
Yours is the Earth and everything that's in it,
     And - which is more - You'll be a Man, my son!!!
                                                                                         (Thanks, Mr. Kipling!!)

And, so you are...a man, my son.  Love you, Shane.   -c

Sunday, May 20, 2012

Rosie...the artist

Persist:  to continue to exist; to go on resolutely or stubbornly in spite of opposition; to continue in spite of interference or treatment. (Her mantra....and a good one for us all!!)
The persistent artist!
Preparing in her purple room, for her new apartment, with the colors of Provence!!  Thanks, Ruthie!

Shiitake shish kabobs!!!!!...or...much ado about shrooms

Oral ingestion of Lentinula edodes mycelia mice   From:  Cancer Science, March, 2011
By:  Tanaka, Ishikawa, Matsui, et al., The Japanese Cancer Association.

Poor little mice "were inoculated subcutaneously in the footpad with B16 melanoma and fed L.E.M. extract [shiitake mushroom juice].  Ingestion of L.E.M. extract significantly inhibited tumor growth, and this in vivo anti-tumor effect was not observed in nude mice, suggesting a T cell-dependent mechanism. In addition, ingestion of [shiitake juice] led to significant restoration of H-2K(b)-restricted and melanoma-reactive T cells in the spleen and draining lymph nodes of melanoma bearing mice....furthermore, an in vitro assay revealed than an immunosuppressive activity of CD4(+) T cells from melanoma-bearing mice was canceled by ingestion of [shiitake juice].  Our results indicate that oral ingestion of L.E.M. extract restores immune responses of class 1-restricted and melanoma-reactive CD8(+) T cells in melanoma-bearing mice, presumably by a mitigation of regulatory T cells-mediated immunosuppression."

So...if you're a hairy mouse, who happens to get melanoma and belong to an individual willing to feed you shiitake mushroom juice, you should do very well!!!  On the day B was pontificating about this new finding over dinner, we happened to be eating mushrooms and broccoli.  However, they were not shiitakes, on that occasion...and yes lentinula edodes are:  shiitakes!
I fear that I shall soon be on a daily diet of shiitakes with turmeric.  I think I need whiskers, a longer tail and more hair!!! - c

Abstract on anti-PD1 (MDX 1106)...

...or...BMS-936558 if you prefer the Bristol Myers handle.  ASCO abstract from:  Hodi, Sznol, McDermott, Carvajal, Lawrence, Topalian, Wigginton, McDonald, Kollia, Gupta, Sosman.....AT:  Dana-Farber (Boston), Yale (New Haven, CT), Beth Israel (Boston), Memorial Sloan-Kettering (New York), Massachusetts General (Boston), John Hopkins (Baltimore), Vanderbilt (Nashville, TN)

NOTE:  My synopsis:

"BMS-936558...given IV every 2 weeks, to [240] patients [95 were patients with previously treated advanced melanoma] with various solid tumors at...0.1 to 10mg/kg...Patients got up to 12 cycles (4 doses per cycle) or until progressive disease or complete response.  RESULTS: Of 240 patients treated as of July 1, 2011, 95 melanoma patients were 0.1 (n=13), 0.3 (n=17), 1 (n-28), 3 (n=17), or 10mg/kg (n=20).  The majority of [the melanoma] patients (60/95) had...prior immunotherapy, primarily interferon or IL-2 (prior anti-CTLA-4 [ipi...was] excluded).  Prior B-raf...was noted in 7/95.  Sites of metastatic disease: lymph node (n=60), liver (n=32), lung (n=55), bone (n=10).  Median duration of therapy was 15 weeks (max = 120 weeks) with 40 patients still on treatment.  ...Grade 3/4 adverse events = 19% and included GI (4%), endocrine (2%), hepatobiliary (1%).  No drug related deaths [reported] in the melanoma patients. Clinical activity was noted at all drug levels.  Of 20 patients with overall response at time of data lock, 12 had overall response >/= 1 year, and 6 patients with overall response had duration between 1.9 and 11.3 months.  Several patients had prolonged stable disease. Some patients had a persistent decrease in overall tumor burden in presence of new lesions and were not categorized as responders.  CONCLUSION:  Drug had durable clinical benefit in patients with advanced melanoma, including those with prior immunotherapy.  Further development is ongoing."

My thoughts:  No brain mets were allowed.  Response rate is roughly 21% thus far, but apparently 40 patients are still in treatment, therefore their response has yet to be tabulated.  So...if you look at it as 20 patients out of 55 (since 40/95 still have treatment ongoing) then the response rate could be calculated as 36%. could just listen to Bentie and he says in the is going to be a 30% response rate...just like all the other MDX-1106 studies have been showing.  (And, I have to say...this sounds good only because the next best thing offers a 10% response rate and the next - 5%!!)  Responses acquired appear to be durable. (Hopefully, even more durable than this report, as the trial is still in progress...and this is just the tally from the point at which they instituted the data lock.)  Interesting that all drug dosages gained a response, even the 0.1mg/kg which is one tenth of the dose I am on...and I am getting the lowest dose in my particular study.

For what it's worth....rock on good lab rats!!  - c

Saturday, May 19, 2012

Vaccines, melanoma and vitiligo

While an excellent plan in theory, given the immunosuppressive properties of melanoma cells, vaccines have had a very poor showing in treatment of the disease. Overall response rates to vaccines alone is roughly only 3%.

Another abstract at ASCO relates the findings from a study (out of Ochsner Cancer Institute in New Orleans) using Hyperacute Melanoma Vaccine plus pegylated interferon.  "25 patients (resected stage III or recurrent/refractory stage IV melanoma patients) were treated. 21 completed the trial. 4 stopped due to progressive disease. Of 16 stage IV patients:  there were 2 complete responders, 2 with stable disease and 3 who were NED after resection.  Of 9 stage III patients: 3 remained NED, 1 had slowly progressive disease. Median overall survival is 29 months, with 50% surviving 2 years and 48% still alive at time of report.  Vitiligo developed in 4 of 25 patients (25%) and correlated with 2 complete responses and 2 NED's."  (So....reading between the lines...there were 2 complete responders both of whom were stage IV and both of those patients must have developed vitiligo.  Interesting.)

A study in Russia using a dendritic cell vaccine,  reports that 4 patients out of 108, developed vitiligo and found it was associated more durable time to progression and overall survival.

So....who knows what all this means? Who knows whether the vaccine component in my study will improve the outcomes as compared to studies yet to be completed using MDX 1106 alone?  Guess for now, I'll just have to raise a glass to my ever increasing white blotches.  Rosie says they are much increased and I am turning into a whiter, little white woman.  I'll have to post more lovely pics soon. - c 

Anti-PD1/vaccine report at ASCO (my sister study)

The American Society of Clinical Oncology (ASCO) will be holding its annual meeting the first week of June in Chicago.  However, some of the abstracts have already been released (and gone over with a fine tooth comb by the Brentster!!).  What follows is my synopsis of the abstract, released by Kudchadkar, Gallenstein, Martinez, Yu, and Weber...out of Moffitt Cancer Center in Tampa, FL.

(Basically, these are the results thus far on my sister study, the 30 matching patients taking my same vaccines, MDX 1106 at 1, 3, and 10mg/kg on the same schedule....except they are all stage IV melanoma, NON-resected.  Folks in my position, going into the study with no evidence of disease, are more difficult to utilize in determining effect and outcomes.  Sadly, while I feel this is the time to strike the disease, because of this difficulty, few trials are offered to stage IV NED fact, I know of no new ones at this time.)

"30, HLA A*0201 positive patients [required due to the vaccine component] with unresectable, previously treated melanoma, received MART-1gp100/NY-ESO-1 peptides with adjuvant Montanide ISA 51 injected subcutaneously with BMS-936558 [The same as MDX 1106, so named when company managing product was Mederex. The name changed to the BMS blah blah when Bristol-Myers took over!] at 1, 3, and 10 mg/kg IV every 2 weeks for 24 weeks, followed by BMS-936558 alone every 3 months. No patient had prior [ipi]....RESULTS: Median age = 63, 14 men, 16 women. 73% had M1c disease. [There are 3 categories of metastatic disease. a = distant skin mets, normal LDH. b = lung. c = other distant mets, or any of the above with elevated LDH.] One patient had dose limiting optic neuritis; one had dose limiting grade 3 interstitial pneumonitis. Of 10 patients at 1mg/kg: 2 had confirmed partial responses (PR), both one year from initiation of study. Of 13 patients at 3 mg/kg: 3 patients did not complete more than 3 doses [due] to progressive disease and one withdrew consent. Of 12 evaluable patients: 3 had confirmed PR's and 2 unconfirmed PR's. In the 10 mg/kg group:  6 patients have completed one cycle with 2 unconfirmed PR's and one patient is stable.  Only 2 of the 9 responders after one cycle have progressed with median follow-up of 7 months. 2/6 failing BMS-936558 responded to [ipi].  CONCLUSION:  BMS-936558 in combination with a peptide vaccine is well tolerated at 1 and 3 mg/kg.  Accrual to 10 mg/kg is..ongoing. Responses have been observed at all levels.  Further study determine optimal dose."

SO...there you have it.  Please check out the ASCO abstracts for yourself! - c

Friday, May 18, 2012

Article about ipi (April 2012)...

Ipilimumab in advanced melanoma (via PubMed) by:  Farolfi, Ridolfi, Guidoboni, et al.

"Ipilimumab, an anticytotoxic T lymphocyte-associated antigen-4 antibody...has shown promise. In this report, advanced melanoma patients receiving [ipi] were scored according to a novel immune-related response criteria (irRC) in an attempt to capture additional response patterns and to avoid premature treatment cessation.  Thirty-six heavily pretreated metastatic melanoma patients received [ipi] within 5 international trials at our institution [Morgagni-Pierantoni Hospital in Italy] from May 2006 to August 2008.  Disease progression was defined as an increase in tumor burden by at least 25% compared with the nadir, irrespective of any initial increase in baseline or the appearance of new lesions.  We report unusually long-lasting responses in patients treated with [ipi] 10mg/kg.  An overall response was observed in 6 of 30 patients (20%), a complete response in 3 (10%), and disease control in 11 (37%), which seemed to be of a long duration (median of 16 months; complete response 36+, 34+, and 41+ months).....Interestingly, we found a correlation between the presence of a grade 3/4 immune-related adverse event and response, time to progression, and overall survival."

So....bottom line....ipi is working pretty well, and the worse your problems with immune related side effects, the better your response. Biggest news trying to get a new evaluation system accepted since ipi works slowly and patients may demonstrate some "progression" and even new lesions initially, that diminish in time. and research institutions and those that fund such things...should not stop ipi because of that initial finding.  GIVE IT TIME!!!!  So, there you have it....thanks to the docs in Italy and the Brentster!

Great May for Steven, too!

YAY!  So glad your scans showed no progression, Steven!  Enjoy the coming months with your kids.  Mine are kicking my butt!  (In a good way...and somewhat literally!!!)  Fred's trail runs, Rose leading me through INSANITY workouts AND runs after...albeit, mine are much briefer than hers...are putting me through my paces!  ROSIE'S A BEAST!!!!  Today was a run followed by sprints which she totally rocked and then more core work!  We've gotten teeth cleaned, rooms cleaned, done needed shopping (and a little un-needed, but necessary!!!), worked on recipes, played games together, cooked out, and generally had a great time!  LOVE my binga-heads!!!  More Great May to it up! - c

Wednesday, May 16, 2012

JAY fights like a girl!!

We love you, Jay!  You're the best!!!  Love from all the Morris peeps and PC peeps, too!! c

Tuesday, May 15, 2012

Covered, smothered and mothered.....

Guess you have to be familiar with Waffle House...but anyhow.... 

Had a great Mother's Day weekend with my creatures.  A fun trail run with Fred leading the way, Rosie cheering me on, and B bringing up the rear through the woods, down the trail to the be rewarded by sweet smelling, lovely mountain laurel in full bloom.  I have had many wonderful Mother's Days in this manner and it is a lucky thing indeed.  It is followed by multiple sets of steep,  rocky trails...but between Mother Nature and the beautiful peeps...there is no better way to spend Mother's Day.  Thanks, guys.  I love you, ever so much.

But, I have been lucky enough to be more than mothered.  Mothers never judge.  Mothers do not keep score, or tallies, or lists of debts.  Mothers are there when no one else is.  Mothers know your inner thoughts and worries and think you are wonderful...still.  Mothers listen.  Mothers hear.  Mothers do no harm.  Mothers may council, try to show the way...but respect your choice....your right to choose.  Mothers believe.  Mothers defend...before they know the facts...and even after they do.  Mothers encourage.  Mothers stay up-to-date.  Mothers SEE you.  Mothers smile.  Mothers caress.  Mothers accept your friends and lovers as mere extensions of you, thereby wonderful in their own right.  Mothers are proud...annoyingly so.  Mothers see the better angels of our nature.  Mothers are there....even when there is nothing they can do.  Mothers can be male or female, relatives or not.  I am fortunate.  I have been covered, smothered, and many.  I am grateful - c.

Pink party today for Jay!!!

Cause she fights like a girl!!!  Had such a fun morning with Fred and Rose and my Peds Care peeps...all turning out to honor Jay.  She came to work everyday after radiation.  She had a smile and a kind word for everyone.  Of how many people can you say that when they are NOT even under such trying times?????  I love you, Jay.  You have been there for me and mine...consistently, daily, without fail.  You are wonderful; an inspiration to us all.  Thanks for sharing you...with me.  (Embarrassing pics to follow!  Not really! YES!  Embarrassing:  NO!)  May you all be so lucky as to have....a Jay! - c

Monday, May 14, 2012

Scan Time for Steven!!!

Go Steven!  Go Steven!!  There's a whole bunch of folks you don't even know rooting for you all the way.  How cool is that?  You're awesome and I just know your scans will show it!  Hang in there. - c

Thursday, May 10, 2012

Super great May!!!!

So happy for my two J's!!!  Both are done with radiation and getting good reports!  EXCELLENT!  Can't keep good boys and girls down for long!!!  Still got fingers crossed for my buddy Steven and his scans coming up on the 14th.  I know they will have lots of good news as well!

Plus, the pork goulash is all ready for the kiddo's who will be heading this way today.  Z gets a big 'ol bone out of the deal....I'm sure Karm with have a nice comfy bed with Fred....

AND....I get to work on planning a PARTY!!!!

It's all good!   Happy May! - c

Monday, May 7, 2012

Where is the little girl I carried????

In Knoxville, having a happy 20th!!!!!!! birthday and getting ready for her final, final exams of this semester.  Twenty wonderful years have gone by in a blink.  So glad big bro is making her day special with stuffed portabellas and lemon pepper chicken.  I like a man who can cook!!!!  Love to both my binga heads.  Can't wait to see you!!!
Enjoy every minute - c.