Across SEVEN Aprils!!!

WOW!  Who would'a thunk it?  Seven years ago today the right upper lobe of my lung was removed three days after having had another melanoma met zapped in my brain.  Here's are some of ~ My Aprils

April ~ Perhaps the most beautiful month on my mountain.  April 2010 ~ The month my melanoma journey devolved into complete chaos after having already dealt with the beast for 7 years.  April 1861 ~ The Civil War began.  Across Five Aprils ~ Irene Hunt's beautiful story of the Creighton family, struggling to survive as their country and family were torn apart in the border state of Illinois during all the years of the Civil War.  April 11, 1865 ~ Two days after General Lee's surrender, Abraham Lincoln began his last speech, "We meet this evening, not in sorrow, but in gladness of heart."  April 14, 1865 ~ Lincoln was shot by John Wilkes Booth at a theater in Washington D.C.  He died the next day.  April 2010 ~ I started this blog.  Writing this: Chaotically Precise  And this: Life  April 2017 ~ Fourteen years after a melanoma diagnosis.  7 years Stage IV.  I am here.  Still...

So.....here is my view THIS April...from my bit of mountain...

No matter where you are, no matter what position you currently find yourself in...  Happy Spring! Too often, my melanoma peeps endure an incredibly difficult civil war within. However, there is beauty, there is hope, there is strength others can share when we are too tired to go it alone.  My Bentie's love and care are in full bloom each day of every year...but never more pointedly than now....through the cherry trees he planted...for me...ten years ago...

They bloom for you, too.  ...Not in sorrow, but in gladness of heart. ~ love, les

Sew Chaotically! - V8944 - DOTS!!!

Picked this pattern up for a couple of bucks at a Vogue discontinued pattern sale along with some rather odd fabric that JoAnn had in the denim section but is more like a substantial knit (not all the way to scuba) cause...well...it's blue and there were dots!!!!

While the pattern called for a lining and was in fact much looser fitting in reality than is depicted in the pattern pic, as many other sewists who evaluated it on patternreview.com had noted.....I kind'a winged it!  Oh, NO!!!!  I've become one of THOSE people!!!

Since I wanted this as an easy summer dress and the fabric was plenty substantial, I decided to skip the lining.  Given the pattern instructions used the lining to finish the neck and arms, I had planned to use bias binding instead.  But, again, as substantial and oddly stiff as this fabric was, despite its stretch, I decided to simply fold over and stitch with a cute little zigzag.

I considered leaving off the back zipper given the fabric's stretch, but feared that doing so might end up popping the stitches used across the bust and at the waist when I put it on.  So...I kept it in.  The seam across the bust did work out very well (at least for my small busted self!!) as a cool way to make a curved dart.  I did have to take the sides in a great deal from the size 12 that was supposed to fit my measurements.  Additionally, I ended up having to add two little darts at the back of the neck in order to avoid having it look as though it was made for Quasimodo.  Whether that was due to the pattern or the strange way this fabric behaved, I'm not quite sure.

Don't know that it will hold up for a life time, but, it washes up well, works as a jumper until spring turns to summer, and is a pretty fun little dress.  Haven't decided if I will give this pattern another go or not...

Happy Spring!  Sew Chaotically!!! - les

Features of resistance to anti-PD-1

Clinical features of acquired resistance to anti-PD-1 therapy in advanced melanoma. Wang, Eroglu, Ozgun, et al. Cancer Immunol Res. 2017 Apr 10.

Anti-PD-1 therapy has improved clinical outcomes in advanced melanoma, but most patients experience intrinsic resistance. Responding patients can develop acquired resistance to anti-PD-1. We retrospectively reviewed 488 patients treated with anti-PD-1 from three academic centers and identified 36 patients with acquired resistance, defined as disease progression following objective response. The incidence, timing, disease sites, post-progression survival (PPS), and outcomes were evaluated descriptively. The acquired-resistance cohort consisted of 67% with more than 1 feature of poor prognosis (stage M1c, elevated LDH, or brain metastasis), and 67% had previously received ipilimumab. Partial and complete responses were achieved in 89% (n = 32) and 11% (n = 4) of patients, respectively, and median time to resistance (progression-free survival; PFS) was 11.1 months (range 4.3-32.8 months). Most progression was isolated (78% of patients, n = 28) and occurred while receiving therapy (78%, n = 28). The median PPS was 12.8 months (range 0.1-51.8 months), and the median overall survival was 33.7 months. Among isolated progressors, 15 received localized therapy (12 with surgery, 3 with radiation). Patients with isolated vs. systemic progression exhibited a trend for improved PPS, and patients with an initial PFS greater or =to 15 months showed significant PPS improvement. Two patients experienced subsequent responses to anti-PD-1 resumption. In conclusion, acquired resistance to anti-PD-1 was frequently associated with excellent clinical outcomes and often presented as isolated progression amenable to localized therapy (surgery or radiation) or systemic progression sensitive to therapy resumption.

This report is mostly confirmation of what we already know ~

1.  Anti-PD-1 (both nivo/Opdivo and pembro/Keytruda) have roughly a 40% response rate.
2.  Folks with increased LDH, brain mets, and worse staging do less well.
3.  Folks respond less well to anti-PD-1 if it is taken after ipi (See this post:  Sequential nivo then ipi = ORR of 41%. Ipi followed by nivo = ORR of 20%!!!! FDA! Are you listening??????? )

On the good side.....even WITH progression on anti-PD-1 there is hope ~
1.  Localized therapy with surgery or radiation improved survival.
2.  Some folks experienced subsequent responses to anti-PD-1 with resumption of treatment.

Wishing you all my best. - c

Earth Day and The God of Small of Things

No matter how incredible, horrific, beautiful, incomprehensible, infinite, human, alien ~ it comes down to the small things.  So, on earth day I celebrated all the science we may never fully understand.  Though it IS our responsibility to ensure that those who follow us get to experience its wonder....

A walk in the woods....

...in Cade's Cove...with my bestie!

Squirrel corn.

Humble trilliums.

May Apple....or Fairy Pagoda.  You choose....

Wild ginger.

Brook Lettuce.

Spiderwart.

Silver Bells...in the trees above and a carpet below....

Squaw Root..."a rare and unusual find!"

Jack in the Pulpit...thanks to the sharp eye of a friendly fellow hiker.

See the Little Brown Jug????

Lady Slippers!

Beauty.

A beautiful break.  Thanks, Bentie.  Thanks to the God of Small of Things. Thanks Mother Earth.  - c