I believe #DrChristineBlaseyFord and after catching up on today's #KavanaughHearing I realize I should have expected even less from a man nominated by our current administration. Of course he's going to have rage issues and get oddly vague and defensive about his drinking.
And of course they won't pause for an investigation into serious allegations because the whole point is to "ram through" someone who mysteriously had up to $200k of personal debt mysteriously wiped away last year, not to hear and believe victim(s) of sexual assault.
I thought I knew why sexual violence was underreported based on stories from loved ones and friends. But to see it done like this in the Senate...wow. I had no idea. How brave. How can anyone ever seriously claim someone is doing it for attention/revenge/money/politics?
From a purely practical political standpoint: if you're conservative aiming to gut regulation/unions/Roe v Wade, there are like a dozen other "qualified" people (mostly men) with those views. You had to go with a guy with financial, substance abuse, and violence red flags?
I reject against the idea that physicians should remain silent to "remain professional." We all work hard to treat patients as best we can no matter the politics/religion/SES/sexual orientation/etc. We should stop muzzling ourselves when we see injustices being committed.
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I am excited to share our manuscript "Therapeutic Implications of Detecting MAPK-Activating Alterations in Cutaneous and Unknown Primary #Melanomas" published at @CCR_AACR. I think it offers important clinical and translational insights into melanoma. 1/x
This will be a loooong thread for my fellow #melanoma geeks! All other melanoma-curious oncologists and #medtwitter can skip towards the end where I try to highlight some themes for investigating other tumors. 3/x
Hey everyone, the first-in-human clinical trial of tebentafusp, the HLA-specific fusion protein targeting gp100, is now online @CCR_AACR! Cool mechanistic proof of concept that you can get CD3+ cells into a poorly infiltrated tumor like #uveal#melanoma.
A prelim efficacy signal for uveal melanoma in this trial with a dose (50mcg weekly) that is lower than the 68mcg weekly dose later expanded upon and presented at ASCO last year. Fingers crossed for our patients with this rare disease!
Cytokine Release Syndrome: uncommon but potentially serious side effect. Manageable with everyone's growing experience with adoptive T cell therapy. This trial predated the approval of tocilizumab for severe CRS. Hospitalization mandatory for first 3 doses on study.
1) Why UM is unique 2) When does(n’t) immunotherapy work for UM 3) Why we prefer clinical trials for advanced UM
1/x
UM affects about 5/million, and about 3-5% of advanced melanomas in the US arise from the uveal tract (iris, ciliary body, choroid). Of these, iris is rarest + least aggressive, so we often call it “choroidal” melanoma.
Get your dilated eye exams, folks!
2/x
Choroid and cilio-choroid melanomas can be aggressive. ~50% of the largest tumors metastasize; about 20% of medium ones do.
Look at that lack of plateau! Plenty of mets happen late, >5 years out. It's sad but fascinating when immune system controls disease for years, then (🤬)
Throughout our medical training, many of us were taught it was "unprofessional" to voice our beliefs or broadcast political opinions. But we must acknowledge most of the (well-meaning) people counseling us to stay silent stood to gain by maintaining the status quo. #medtwitter
Those who maintain political activism harms the soul of medicine suggest it cripples the patient-doctor relationship. But I find this simplistic, even disingenuous. Surely most people can divorce political stance from compassionate care? Can't we trust them to make that decision?
When I am in a patient room, their well-being is paramount. When I leave that room, I need to apply that same level of dedication to bettering my community. We should be welcoming, not punishing, people who enter into political discourse.
A few thoughts on outpatient oncology care here in #NYC.
10 days ago, we melanoma med onc @sloan_kettering agreed to cut back in person clinic from 1-2x / week to once / 1-2 weeks. My clinic frequency was quartered. I was excited to leave the apt (I'm allergic to combs).
My commute to work is entirely by foot, and I'm privileged to be able to do so. Ordinarily I walk by hundreds of people in 15 min.
Today, I counted about 30 people. We are successfully distancing! Yay!
The in person visits that remain are the most complicated ones, where infusion and scan review are done on same day. Our (very smart) new visitor policy doesn't allow family members to attend, with rare exceptions.
Beautiful retrospective work suggesting the clone of melanoma that recurs after an initial complete response to checkpoint inhibitors is often different than the one that presented initially.
Our group has taken these data to heart. I've changed a few things about my approach in clinic as a result:
1) When patients ask if we can just retry the same medicine if the disease comes back, I try to take time to say "yes, but it may not work the same way as before."
2) This recurrence rate was a little higher than the clinical trial recurrence risks of 10-15%. While length of tx wasn't statistically associated with recurrence, I now am much more reticent to stop therapy if no toxicity and length of therapy is only 6 months.