Late summer rainy afternoons bring ~

 ~ so much beauty.  Were the Jammer just a bit older we would definitely have been on a fairy hunt!!  As it is, I went on one to share with you...

There were lots of creatures.  Whole rings of dancing fairies.  Though they are hard to catch in photos!  We have been very tickled with our little fig tree, who despite suffering many near death experiences via late freezes over the years, has produced three batches of figs so far this season!  

Hoping your world has lots of critters, color, toadstools, and deliciousness for you to share and enjoy. ~ les

Sew Chaotically! ~ More scrap busting and fall wardrobe sorted for my Biddy Buddy!

The Jammer Man be grow'n!!!  As little ones so quickly do.  As briefly as things are worn at this age, I used every scrap of these lovely knits to create some silly, but useful, comfy, cozy little duds to protect crawling knees and provide a light cover for cooler weather.

More Purl Soho Baby Pants.  A free pattern intended for wovens, for which it works wonderfully, but I stitched these up in knit scraps and they worked a treat!  I love the little booties, best!

Next up, a slightly strange but workable solution!!!  Having outgrown and stained the upper portion of several plain onesies, I decided to extend their life by cutting off the top and replacing it with a short new one.  And....they work!!  I used a shortened version of another free pattern - Spoonflower Baby Bodysuit.  This fix succeeded in getting rid of the stained portion, added needed length and used up every SMIDGE of these fabrics!

Now it's - HAMMER - I mean: JAMMER TIME!!! Bahaha! I couldn't help myself with this one.  Guess this is just what happens when your mom's fav color is purple!  Again, using the Spoonflower pattern cut off as a top.

Finally, a little more restrained version!

Fun makes that got rid of lots of scraps too good to toss!!!  It really is Jammer Time! Sew and live chaotically! ~ les

Surgery After Systemic Treatment for Melanoma

 In this time of neo-adjuvant treatment for melanoma, two concepts are at odds with previous melanoma treatment plans.  

1.  The response to therapy may be better by actually leaving the tumor in place.  

2.  The premise that by waiting on surgery, the treatment may decrease the size of the lesion (and thereby diminish the size/damage from said surgery) or perhaps evaporate the lesion altogether so that surgery is not needed at all.  The impact of these new aspects of melanoma treatments makes decisions about surgery for melanoma even more complicated.  Here are zillions of reports about neoadjuvant treatment:  Neo-Adjuvant treatment for melanoma  That said - there are plenty of good reasons to have surgery to remove your melanoma lesions.  We know that, neo-adjuvant care aside, folks with the lowest tumor burden respond better.  We know that sometimes, one lesion remains persistently present even if all other lesions resolve.  Some patients will become NED after systemic treatment but later develop a lesion.  There are folks who haven't responded well to systemic therapy may need radiation and surgery to tackle their lesions.  The varied reasons for needing surgery are just as mixed as melanoma can be itself.  Still, there is a significant body of evidence indicating the benefit of the adage - "When in doubt, cut it out!" 

There is this from 2019 ~ Cut it out!!! Prolonged overall survival following metastasectomy in Stage IV melanoma

And this from 2020 ~ Surgical removal of melanoma lesions -

That said, there are these reports on varied circumstances that looked at surgery and melanoma patients:

Re-defining the role of surgery in the management of patients with oligometastatic stage IV melanoma in the era of effective systemic therapies.  Ch’ng, Uyulmaz, Carlino,…Long, Menzies.  Eur J Cancer.  Aug  2021.

Although previously the mainstay of treatment, the role of surgery in the management of patients with oligometastatic stage IV melanoma has changed with the advent of effective systemic therapies (most notably immunotherapy). Contemporary treatment options for patients with asymptomatic solitary or oligo-metastases include upfront surgery followed by adjuvant immunotherapy or upfront immunotherapy with salvage surgery as required. For suspected solitary or oligo-metastases, surgery serves both diagnostic and therapeutic purposes. Advances in radiological technology allow metastases to be detected earlier and surgery to be less morbid. Surgical morbidities are generally more tolerable than serious immune-related adverse effects, but surgery may be less effective. Upfront immunotherapy ensures that futile surgery is not offered for rapidly progressive disease. It also provides an opportunity to assess response to treatment, which predicts outcome, and may obviate the need for surgery. However, it is important not to miss a window of opportunity for surgical intervention, whereby if disease progresses on immunotherapy it becomes unresectable. In situations where local therapy is recommended but surgery is not desired, stereotactic radiosurgery may be an effective alternative. The decision-making process regarding upfront surgery versus immunotherapy needs to take place within a specialist melanoma multidisciplinary setting and be customized to individual patient and tumor factors. Ultimately, high-level clinical trial evidence is required to resolve uncertainties in the management of patients with oligometastatic stage IV melanoma but the complexity of the varying presentations may make trial design challenging.

Survival Outcomes of Salvage Metastasectomy After Failure of Modern-Era Systemic Therapy for Melanoma.  Li, Vakharia, Lo, et al.  Ann Surg Oncol.  Aug 2021.

Background: Metastasectomy for selected patients with melanoma was associated with improved survival in the era before effective systemic therapy. Emerging evidence shows that these benefits persist even in this era of BRAF-targeted therapy and immune checkpoint inhibitor immunotherapy. This study aimed to evaluate the outcomes of salvage metastasectomy after failure of systemic therapy.

Methods: Stage 3 or 4 melanoma patients with extracranial disease progression after at least 4 weeks of systemic treatment between 2009 and 2020 were identified and categorized as resected to no evidence of disease (NED), non-progressive residual disease (NPRD), or progressive residual disease (PRD). Systemic therapy was stratified into BRAF-targeted therapy, immune checkpoint inhibitor immunotherapy, or both. The end points of overall survival (OS), progression-free survival (PFS), and locoregional disease control (LRC) were assessed using Kaplan-Meier curves. Uni- and multivariable Cox regression procedures were used to examine factors associated with OS, PFS and LRC.

Results: The study enrolled 190 patients. Among all the patients, the 5-year OS from metastatectomy was 52%, the 3-year PFS was 21%, and the 5-year LRC was 61%. After resection to NED, NPRD, and PRD, the 5-year OS values were 69%, 62% and 8%, respectively. Fewer lines of preoperative therapy, use of preoperative immunotherapy, and resection to NED were predictors of improved OS. After resection to NED, NPRD, and PRD, the 3-year PFS values were 23%, 24% and 10%, and the 5-year LRC values were 61%, 72% and 34%, respectively.

Conclusions: Salvage metastasectomy was associated with durable survival and disease control, particularly after resection to NED, preoperative immunotherapy, and fewer lines of preoperative systemic therapy

The role of local therapy in the treatment of solitary melanoma progression on immune checkpoint inhibition: A multicentre retrospective analysis.  Versluis, Hendriks , Weppler, et al..  Eur J Cancer. 2021 Jul.

Introduction: In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma.

Patients and methods: Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. Follow-up and survival are reported from ICI initiation.

Results: We identified 294 patients with solitary progression after stable disease in 15%, partial response in 55% and complete response in 30%. The median follow-up was 43 months; the median time to solitary progression was 13 months, and the median time to subsequent progression after treatment of solitary progression (TTSP) was 33 months. The estimated 3-year overall survival (OS) was 79%; median OS was not reached. Treatment consisted of systemic therapy (18%), local therapy (36%), both combined (42%) or active surveillance (4%). In 44% of patients treated for solitary progression, no subsequent progression occurred. For solitary progression during ICI (n = 143), the median TTSP was 29 months. Both TTSP and OS were similar for local therapy, ICI continuation and both combined. For solitary progression post ICI (n = 151), the median TTSP was 35 months. TTSP was higher for ICI recommencement plus local therapy than local therapy or ICI recommencement alone, without OS differences.

Conclusion: Almost half of patients with melanoma treated for solitary progression after initial response to ICI had no subsequent progression. This study suggests that local therapy can benefit patients and is associated with favourable long-term outcomes.

For what it's worth!!  Hang tough.  Melanoma is never easy, but there is hope. - c

Summer time and the living is...

 ...hot...and fun...and worrying (What is happening here in the states, people????) ...and busy...and full of growing babies!!!  As B was leaving the house the other day, he called me to get a peek of these two!

The little one has grown so much, while Momma has a taste for flowers!  She has moved on from the hostas she started with, to buds and blossoms from lilies to roses - yes, the actual flowers!!!  Delish!!!

Despite what we have fed to critters, we did have a pretty good crop of tomatoes this year!  Corn and zucchini are from the market...

 

YUM!!!

A little back to school sewing for my girl!  Are these not the cutest pockets ever?????

Did some serious bits of scrap/stash busting to add a few basics to Teach Moore's wardrobe!  A little sleeveless shift went with the pockets.  Made a sweet little top (already nabbed and taken home!) and this skirt from a remnant of the knit floral from one of her maternity dresses.  Re-vamped a black maternity skirt I had not terribly successfully designed to a rock'n pencil.  Stitched up a simple gathered skirt from the last smidge of a pretty blue dotted challis.  And though it is a bit lost in this vivid floral crepe left over from Roo's maternity/shower dress, I made this cute little gored skirt with a flat front and back elasticated waist.

Speaking of growing babies!  The Jammer certainly couldn't be left out of stash busting plans.  I stitched up these sweet little pants - a free pattern from Purl Soho - 

They are great!  That back gusset is just perfect for little diapered booties getting ready to crawl!

Other preparations have been made for the Jamboree as well.  Closets have been cleaned.  Porch floor sanded and re-stained.  Interior decluttered and baby proofed with space to roam.  Play stations set up.  And as prep for an outdoor Jammer space, B made these benches and table.  I finished the table top with tiles left over from a shower stall project. 

 All sturdy, climbable and indestructible!  Cute, too!  If I say so myself!!!

We are blessed in so many ways.  Ms. Turtle agrees!  Live and grow and love ~ chaotically! - les

Sew Chaotically ~ Annie #3 ~ The start to some stash/scrap busting tops

In 2017, I made two Tessuti Annie tops.  The first in a navy linen with sashiko embroidery to the bodice.  The second in a lined gauze with cross stich detail.  

When going through my stash, I found a cream piece of linen I had already cut out for another bodice and just enough of a pale blue linen scrap to finish it up.  So, I did!

This time I used a different sashiko design.  Thanks to Roo for help deciding the color palate!  Of course you need not embellish the front yoke, but I just can't resist!  Either way, Annies are PERFECT for summer!!!  Sew chaotically! - les

July Reads - began with lighter fare, after the heavy but important reads of June...

Paris for One - Jojo Moyes.  Short stories.  Okay.  Some better than others. Not close to "Me Before You" - but a nice diversion from recent heavier reading.

Trains and Lovers - Alexander McCall Smith.  Interesting dissertation on love - of various sorts.  McCall Smith - always able to preach without a sermon.

The Beekeeper's Apprentice - Laurie R. King.  Lovely introduction to Holmes in retirement and his young friend Russell.  King is able to keep the tenor of Arthur Conan Doyle's Holmes resonant without being redundant or reductive.  Enjoyed!

A Monstrous Regiment of Women - Laurie R. King.  This sadly felt incredibly pertinent to today's perils for women's rights as each chapter was introduced by incredibly infuriating quotes from all manner of men and the Bible deriding the rights and abilities of women, though they eventually morph into quotes that recognize female ability and what women accomplish daily.  As does Holmes.

The Marriage of Mary Russell - Laurie R. King.  Short story covering the only wedding possible for Holmes and Russell.  Nicely done.

Garment of Shadows - Laurie R. King.  Holmes and Russell - abduction and espionage in Morocco.  

Dreaming Spies - Laurie R. King.  Another Russell and Holmes tale, much of it taking place in Japan.

The Murder of Mary Russell - Laurie R. King.  Mostly the tale of Mrs. Hudson and Billy.  A nice addition to how Mrs. Hudson came to be Holmes' housekeeper!

Riviera Gold - Laurie R. King.  A continuation of Mrs. Hudson's story.  Not quite as good.  But loved getting to travel to Nice and Antibes again!!!

Everything I Never Told You - Celeste Ng.  The story of a Chinese American Family.  Their efforts to fit in, yet retain their culture in America as Americans.  The death of a daughter (no spoiler - it is revealed in the first sentence) unravels at least a portion of the secrets, expectations, and fears they (and we) fail to share with those we are closest to.

Crying in H Mart - Michelle Zauner.  Zauner shares her life growing up with her Korean mom and American dad.  Her difficulty fitting in - simultaneously desiring to be more Korean for her mom and aunts, yet more accepted as a regular American kid among her school mates.  Her teenage pull against her mom's exhortations, knowing all the while they are rooted in her mother's tremendous love for her.  Culminating in her mother's diagnosis, treatment and death from cancer.  Through it all, it was their powerful connection through their mutual love for Korean food that kept them close and in the end, allowed Zauner to cope with the loss of her mom.  Sharing H Mart with my girl made her story real and even more touching for me.

Read chaotically! ~ les