Wednesday, June 29, 2016

Surgical management and adjuvant therapy for high risk melanoma....many questions...still waiting on answers!!!



Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma. Akkooi, Atkins, Agarwala, Lorigan.  Am Soc Clin Oncol Educ Book. 2016

Wide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future. 

Here are the results of my Nivo/Opdivo study for 33 Stage IV, NED ratties:  Cest moi! Results in my Nivo/Opdivo trial published!!

That trial started in 2010!  Results were published in 2014.  I realize folks are waiting to see what will happen to us...but come on, researcher peeps!!!!  Let's get to tallying some more numbers and looking at what happens to us with no treatment as a comparator.   Plenty of folks need answers sooner rather than later!!!  Hang in there, ratties!!! - c

6 comments:

  1. I am going to MDA to see if I can qualify for this. Thanks so much for sharing this. I had a nodule pop up on my lung on my last CT scan that my oncologist missed telling me about on my last visit. Also I have to say I love your sewing posts. I am trying to find a vintage sun dress pattern from the early 80's

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    1. Hang in there. I wish you luck. Did you see the dress I made for my daughter? http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/sew-chaotically-pinkie-pink-power-girl.html
      Is the sort of thing you are looking for? Be happy to share!

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  2. Hi Hope you are having a good Sunday. I am in the Seattle area and Summer hasn't arrived yet. Anyway, I saw my oncologist last Wednesday and he said my lung nodule was probably nothing. I had my records sent to MD Anderson and as soon as they call I will set an appointment up to see if I qualify for treatment. They do not have anything to offer in Seattle beside ipi. I have the sundress you made for your daughter. I was looking for a pattern that is strapless and wraps and ties in the back.

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  3. Sorry nothing is easily available to you locally! Good luck at MDA. Just saw this by Colette patterns! https://www.colettepatterns.com/catalog/eclair

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  4. Hi !
    Yes this is exactly what I was looking for!
    It chilly up here in the PNW but I'm going to start it anyway. Hope you are having a great summer. We are going to MDA August 22-25. I'm nervous but trying to stay busy
    Thanks for all you do
    Vicki

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    1. I know what you mean re chilly! I happen to be in Victoria, BC at the moment! But, yay! For the dress....plus I just saw that the pattern is on sale! Let me know how the dress and the visit turns out! Hang in there!

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