Sharing the love...

Had so much fun making this:

For a sweet and amazing girl who has flown the coop!!!  See more here:

The Kid has her own place!!!!!

It is a never ending wonder to me to see the unlikely circumstances that can lead to support, kindred spirits, great kindness, and shared love!!!

Enjoy it all, girlies!!!  May the wonder continue! love, les

Sew Chaotically! - Little denim shirt dress - Simplicity 8014!

I have been loving various versions of denim shirt dresses as seen in magazines and the amazing one Ruthie made!!!  So, when I saw this pattern, noted that it got rave reviews on Patternreview.com, and found the perfect weight chambray...I had to give it a try!!!

I already have the next one cut out!!!

I really have no complaints....no adjustments needed!

I love the curved hem and the double top stitching...though I have to admit I wasn't brave enough to do a contrasting thread...and I did want to keep this look as versatile as possible.  Maybe next time...

I was proud of my insides, too!

And if the thought of making a two piece collar makes you hot under yours while making this face.....

No worries!!!  It went together really well!!!

Maybe it's a little short for 5'9" and 52 years.  But, you know what?  I like it!!!

I think it will be good in the fall with tights and a striped shirt layered beneath....or with a chunky sweater over it....or....    Sew Chaotically!!!! - c

BRAF testing via blood rather than tumor tissue

BRAF Mutation Testing in Cell-Free DNA from the Plasma of Patients with Advanced Cancers Using a Rapid, Automated Molecular Diagnostics System.  Janku, Huang, Claes, Falchook, et al.  Mol Cancer Ther. 2016 May 20.

Cell-free (cf) DNA from plasma offers an easily obtainable material for BRAF mutation analysis for diagnostics and response monitoring. In this study, plasma-derived cfDNA samples from patients with progressing advanced cancers or malignant histiocytosis with known BRAF ^V600 status from formalin-fixed paraffin-embedded (FFPE) tumors were tested using a prototype version of the Idylla BRAF Mutation Test, a fully integrated real-time PCR-based test with turnaround time about 90 minutes. Of 160 patients, BRAF ^V600 mutations were detected in 62 (39%) archival FFPE tumor samples and 47 (29%) plasma cfDNA samples. The two methods had overall agreement in 141 patients. Idylla had a sensitivity of 73% and specificity of 98%. A higher percentage, but not concentration, of BRAF ^V600 cfDNA in the wild-type background was associated with shorter overall survival and in patients with BRAF mutations in the tissue, who were receiving BRAF/MEK inhibitors, shorter time to treatment failure . Longitudinal monitoring demonstrated that decreasing levels of BRAF ^V600 cfDNA were associated with longer TTF . In conclusion, testing for BRAF ^V600 mutations in plasma cfDNA using the Idylla BRAF Mutation Test has acceptable concordance with standard testing of tumor tissue. A higher percentage of mutant BRAF ^V600 in cfDNA corresponded with shorter OS and in patients receiving BRAF/MEK inhibitors also with shorter TTF.

Quantitative assessment of BRAFV600 mutant circulating cell-free tumor DNA as a tool for therapeutic monitoring in metastatic melanoma patients treatd with BRAF/MEK inhibitors.  J Transl Med. 2016 Apr 19.  Schreuer, Meersseman, Van Den Herrewegen, et al.

BRAF V600 mutant circulating cell-free tumor DNA (BRAF V600mut ctDNA) could serve as a specific biomarker in patients with BRAF V600 mutant melanoma. We analyzed the value of BRAF V600mut ctDNA from plasma as a monitoring tool for advanced melanoma patients treated with BRAF/MEK inhibitors.

Allele-specific quantitative PCR analysis for BRAF V600 E/E2/D/K/R/M mutations was performed on DNA extracted from plasma of patients with known BRAF V600 mutant melanoma who were treated with dabrafenib and trametinib.

245 plasma samples from 36 patients were analyzed. In 16 patients the first plasma sample was obtained before the first dosing of dabrafenib/trametinib. At baseline, BRAF V600mut ctDNA was detected in 75 % of patients (n = 12/16). BRAF V600mut ctDNA decreased rapidly upon initiation of targeted therapy and became undetectable in 60 % of patients (n = 7/12) after 6 weeks of treatment. During treatment, disease progression (PD) was diagnosed in 27 of 36 patients. An increase of the BRAF V600mut ctDNA copy number and fraction, identified PD with a sensitivity of 70 % (n = 19/27) and a specificity of 100 %. An increase in the BRAF V600mut ctDNA fraction was detected prior to clinical PD in 44 % of cases (n = 12/27) and simultaneously with PD in 26 % of patients (n = 7/27).

Quantitative analysis of BRAF V600mut ctDNA in plasma has unique features as a monitoring tool during treatment with BRAF/MEK inhibitors. Its potential as an early predictor of acquired resistance deserves further evaluation.

The sensitivity and specificity numbers are pretty good here!  Plus, if we really could detect progression via a lab draw...earlier than we can with other assessments techniques....wouldn't that be awesome?  Patients...especially in the case of BRAFi could be placed on other therapies sooner...not to mention the earlier the heads-up in melanoma...no matter the treatment...the better!!

Prior posts regarding PCR testing: 
Nov 2015:  PCR testing for melanoma
Dec 2015:  Circulating tumor cells - how they may eventually impact melanoma diagnosis and response to therapy
Dec 2015:  PCR testing for circulating melanoma DNA - one more.... 
March 2016:  Biomarkers....  

Wishing you all my best - c

Can dad build it? Yes, he can!!!

Whatever they get a hankering to build...forts, swings, rodent traps, sling shots, roller coasters, a wide variety of "items" from PVC pipes, to more recent computers and landscaping.....

Daddy does the job!!!!  Happy father's day to the best dad ever!!! - c

Ipi/Nivo combo approved for 'advanced' melanoma in the UK - Thanks, Lori!!

Thankfully more advanced melanoma patients (not sure exactly what that means...but...) will be able to gain access to the immunotherapy combo ipi/nivo in the UK. Here's the story from the Guardian: Drug combination (Nivolumab/Ipilimumab) approved by NHS

I am certain that this is a direct result of activism on the part of melanoma patients like Lori Murdoch. Here's her story: Merde again! With love to friends and family of an amazing woman...

Never, ever think your voice is not important, can't be heard or won't make a difference.

Thanks, Lori.  -  love, c

Vit D and melanoma - Part 2

The pendulum for and against, or neither, regarding whether Vitamin D levels matter in the development of....or outcomes in...melanoma patients...keeps swinging.  I posted these articles earlier:  Vitamin D and Melanoma

Now there is this:

Association of Vitamin D Levels With Outcome in Patients With Melanoma After Adjustment For C-Reactive Protein.  Fang, Sui, Wang, et al.  J Clin Oncol. 2016 Mar 21. 

To evaluate for an association between 25-hydroxyvitamin D levels (vitamin D) and outcome measures in patients with melanoma after evaluation is controlled for systemic inflammatory response (SIR) on the basis of simultaneous C-reactive protein (CRP) measurement.  Plasma samples from 1,042 prospectively observed patients with melanoma were assayed for vitamin D and CRP. The associations of demographics and CRP with vitamin D were determined, followed by a determination of the association between vitamin D and stage and outcome measures from the date of blood draw. The vitamin D level was considered sufficient if it was 30 to 100 ng/mL. Kaplan-Meier and Cox regression analyses were performed.  The median vitamin D level was 25.0 ng/mL. The median follow-up time was 7.1 years. A lower vitamin D was associated with the blood draw during fall/winter months, older age, increased CRP, increased tumor thickness, ulcerated tumor, and advanced melanoma stage. On univariate analysis, lower vitamin D was associated with poorer overall survival, melanoma-specific survival, and disease-free survival. The effect of vitamin D on these outcome measures persisted after adjustment for CRP and other covariates. Multivariable hazards ratios per unit decrease of vitamin D were 1.02 for OS, 1.02 for MSS, and 1.02 for DFS.  Lower vitamin D levels in patients with melanoma were associated with poorer outcomes. Although lower vitamin D was strongly associated with higher CRP, the associations of lower vitamin D with poorer OS, MSS, and DFS were independent of this association. Investigation of mechanisms responsible for these associations may be of value to patients with melanoma.

For what it's worth.  I happen to take 2000 units of Vitamin D daily.  Not saying you should....just say'n I do.  - c

Excellent Melanoma Presentation

If you like graphs, cool pics and fairly clear descriptions of how things work....this PDF is for you!!! (Click on the link below!!!)

2016 Presentation: Lessons Learnt - Melanoma - Academic Perspective

Presented by Paolo Ascierto, MD it covers:

• Meta-analysis of outcomes in melanoma before 2011
• Time line of drug approvals since 2011
• Breaks down treatments according to mutational status
• Breaks down targeted therapy:  including rapid response, return of disease on progression, OS in vemurafenib studies, how BRAFi impacts the immune response, how resistance develops, the impact of MEKi with BRAFi, OS graphs from the COMBI-d, COMBI-v, and CoBRIM trials, baseline factors that influence response.
• Immunotherapy:  how it works, graphs from early ipi studies, the development of response criteria due to the use of immunotherapy, graphs of response patterns, graphs of response in pembro vs ipi study, OS graphs in study with nvio vs dacarbazine, time to response graphs with nivo, unconventional responses to nivo, pseudoprogression, the CTLA4 vs PD-1 pathways, graphs of results of ipi/nivo combo study.
• PD-L1 expression:  correlation with response, OS and PFS
• Changes in the target lesion with nivo alone vs ipi/nivo combo
• Immune related side effects
• Changes in the target lesion in nivo/ipi vs pembro/epacadastat

A great review, clear graphs, a well done picture of the path we melanoma folks have traveled with a look to the future.  Way to go, ratties.  Thanks, Dr. Ascierto. - c