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Dr. Douglas B. Johnson is a physician-scientist and professor of medicine in the Division of Hematology/Oncology at Vanderbilt University Medical Center, where he leads the melanoma clinical research program, located in Nashville, Tennessee.

For Melanoma Awareness Month, Dr. Douglas Johnson explains how stage and features of the disease can guide treatment decisions after diagnosis.

Expert Shares Key Insights During Melanoma Awareness Month

Immune therapy is generally safer than chemotherapy, allowing more patients with melanoma and other conditions like heart or lung issues receive treatment.

Immune Therapy Expands Melanoma Treatment to More Patients 

The woman who raised me and I did not always see eye to eye. In fact, as two stubborn, opinionated characters we frequently bickered, challenged and exchanged choice words with one another. 

As I reflect on 25 years strong with Mom, here are some of my favorite words that we exchanged. We gave each other many cards over the past few years, one of which she had told me she looked for a long time searching for the right message to express her feelings. It reads:

"When you have a daughter who makes you proud, makes you laugh and, very often, makes your day ... you know what joy is. When you have a daughter who is a good person with a gracious heart and generous spirit ... you know what peace is. When you have a daughter whose beauty (inside and out) is matched only by her compassion for others ... you know what love is. Because I have you for my daughter, I know what it is to be truly blessed."

When I first read those words — as I read them now — I feel so close to my mom. Recently, I found a card with the words that expressed how I feel about her. I read this aloud to her on Christmas Day.

"Dear Mom, I'm so grateful for the way I was raised. You were never afraid to be my mother — to put your foot down, to teach me right from wrong, to make sure I did my best. You always let me know I had a mama who cared about me, who believed in me, who was there for me no matter what. Growing up with that kind of love and support made such a difference in my life; it made me who I am today."

My mother was never afraid to voice her opinion or be one to mince words, to put it lightly; but she was always pure in her intentions and true in her actions, and I feel so clearly, so humbly loved. As I go forward, I remember her strength and purity, her fierce sense of pride, her generous heart and sensitivity, her sense of humor (she once packed me a peanut-butter-jelly-and-ham sandwich because I refused to pick one of the two). 

Throughout her life and especially in her fight against lung cancer, Mom set us an example in unconditional devotion, taught our family valuable life lessons and never lost her indomitable spirit.

I know Mom is with us now and always. Goodbyes are only for those who love with their eyes, because for those who love with heart and soul there is no such thing as separation. I love you Mom, Happy New Year. Rest in peace and God bless.

For more news on cancer updates, research and education, don’t forget to

The narrative reflects on a complex yet deeply loving relationship between a daughter and her mother, characterized by mutual respect and understanding despite frequent disagreements. The daughter cherishes the heartfelt words exchanged through cards, highlighting the mother's pride, love, and unwavering support. The mother, who battled lung cancer, exemplified strength, devotion, and humor, leaving a lasting impact on her family. The daughter expresses gratitude for her upbringing and acknowledges the enduring connection with her mother, emphasizing that true love transcends physical separation.

Tumor

A Tribute to Mom

Personalized therapeutic approaches are essential for treating patients with urologic cancers, such as bladder and kidney cancer, according to Dr. Armine Smith, a urologist at Johns Hopkins University in Washington, DC.

She went on to emphasize that these personalized treatment decisions typically involve bladder preservation or partial nephrectomy. These approaches depend on multiple individualized factors that vary with each patient, including tumor characteristics, overall health and functional outcomes. Overall, the goal is to maximize quality of life and long-term organ function, Smith says.

Smith is also the director of urologic oncology at Sibley Memorial Hospital and co-director for women's bladder cancer program at Johns Hopkins University and Greenberg Bladder Cancer Institute.

CURE: For patients newly diagnosed with bladder cancer, especially those considering bladder preservation, what are the key factors you weigh when determining if this approach is suitable, and how do you personalize the treatment plan?

: So, when considering bladder preservation, we'll look at the standard information that comes with it, like bladder tumor grade stage. There are some other additional factors that may make the patient more suitable or not for bladder preservation. [These factors include] if there are multifocal tumors, if there are any advanced stage that's present, if the tumor is unresectable, as well as [the] urological subtypes of these bladder cancers.

Those are all the important pieces of information we consider. To preserve the bladder, we need to have a functioning bladder that will give the patient good quality of life afterwards. Some other factors to consider. This is a pretty complex process. Some of the factors are just patients’ overall morbidities, you know, their health, their ability to adhere to these very stringent surveillance protocols [and] the ability to undergo these treatments.

So currently, the bladder preservation includes treatments with chemotherapy, or immunotherapy with radiation to the bladder, and resections of the bladder and the ability to continue the monitoring. All of this information comes together when we find the right personalized approach to every patient for this.

With advancements in minimally invasive and robotic surgery for kidney cancer, such as partial nephrectomy, what are the potential benefits for patients regarding recovery time and long-term kidney function?

Robotic and minimally invasive kidney surgery has been a game changer because it results in less blood loss for patients, quicker recovery, less pain during recovery, and shorter hospital stays. The robotic approach, building upon the minimally invasive approach, has allowed us to treat more complex tumors because the robotic instruments have an additional degree of motion compared to laparoscopic instruments.

As far as long-term function, partial nephrectomy preserves a significant portion of the kidney, which allows patients to have better kidney function going forward and avoid dialysis. Some studies suggest that better kidney function helps patients with their cardiovascular health, although the definitive link between surgical intervention and this benefit is still being researched.

Nevertheless, we generally aim to preserve kidney function when possible and perform minimally invasive surgery to optimize recovery and minimize pain and scarring.

What factors determine if a patient is a good candidate for partial nephrectomy?

Candidates for partial nephrectomy are usually those with tumors that are not too large, localized to the kidney, and technically resectable. Other considerations that come to mind when deciding if this is the proper treatment for the patient are their overall kidney function and select cases where preserving kidney function is crucial, such as people with a solitary kidney. In these patients, we might attempt kidney preservation even with larger tumors.

Another scenario involves younger individuals who develop kidney tumors and whom we believe might be at risk of developing more tumors in the future; these patients sometimes undergo periodic efforts to perform partial nephrectomies.

What are some of the most common misconceptions you encounter regarding urologic cancers, and what advice would you give to patients seeking reliable information and support resources?

I think what comes to mind when you ask this question is bladder cancer. One misconception is that some people don't realize smoking causes bladder cancer; they think it only causes lung cancer. The other misconception I hear is that bladder cancer is a disease of male smokers. However, it can happen in men and women, young and old. Smoking is one of the known risk factors, but chemical exposures and sometimes a genetic predisposition can also lead to it.

Another misconception is that there's a one-size-fits-all approach to these cancers. Again, talking about bladder cancer, some cases are easily treatable and don't pose a risk to life, while others require ongoing treatments and surveillance and carry the risk of progressing to metastatic disease.

When I talk to patients, I usually provide them with reliable sources of information they can turn to, such as the Bladder Cancer Advocacy Network, the American Urological Association, and many larger institutions, including ours, have web pages that provide more information about these kinds of disease states.

Transcript has been edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to 

Personalized therapeutic approaches are crucial for treating urologic cancers, focusing on bladder preservation and partial nephrectomy based on individual patient factors. These factors include tumor characteristics, overall health, and functional outcomes, aiming to enhance quality of life and organ function. Minimally invasive and robotic surgeries for kidney cancer offer benefits like reduced recovery time and improved long-term kidney function. Misconceptions about urologic cancers, such as the belief that smoking only causes lung cancer, highlight the need for reliable information and support resources for patients.

Dr. Armine Smith discusses the importance of personalized therapeutic approaches for the treatment of urologic cancers, such as bladder or kidney cancer.


The Importance of Personalized Treatment Approaches for Urologic Cancers

Mary Anderson, B.S.N., RN, OCN, embodies the spirit of an Extraordinary Healer, having dedicated more than 35 years to oncology nursing through different roles in pediatric oncology, infusion nursing and oral oncology, and now spearheading a national community for nurses through the National Community Oncology Dispensing Association (NCODA).

In all of these roles, she has embodied care for her patients and a desire to advocate for the role of oncology nurses. As senior manager of nurse initiatives at NCODA, Mary elevates the role of oncology nurses within medically integrated care teams across the country, empowering them with knowledge, confidence and tools to provide exceptional patient-centered care.

When Mary was an oral chemotherapy nurse navigator at Norton Cancer Institute in Louisville, Kentucky, she assisted the clinic with formalizing an oral anticancer treatment navigation program.

Mary’s influence on this topic extends to her co-authorship of the Oncology Association of Nurse Navigation practice guidelines for oral oncolytic management, ensuring best practices are widely accessible. Mary’s dedication to advancing and advocating for oncology nursing is evident in her work as a conference presenter and peer reviewer for a nursing journal, providing critical insights that elevate the profession. Her leadership includes serving as president of the Greater Louisville Oncology Nursing Society and earning recognition as Nurse of the Year in 2019 from the Norton Cancer Institute.

Mary Anderson’s lifelong commitment to innovation, education and advocacy improves the lives of patients and empowers her peers. She truly exemplifies what it means to be an Extraordinary Healer.

Mary Anderson’s lifelong commitment to innovation, education and advocacy improves the lives of patients and empowers her peers.

Mary Anderson, a seasoned oncology nurse with over 35 years of experience, has significantly contributed to the field through various roles, including pediatric oncology and oral oncology. As the senior manager of nurse initiatives at NCODA, she enhances the role of oncology nurses in integrated care teams. Her work includes co-authoring practice guidelines for oral oncolytic management and leading initiatives at the Norton Cancer Institute. Recognized as Nurse of the Year in 2019, her dedication to innovation and advocacy continues to empower patients and peers alike.

Mary Anderson, B.S.N., RN, OCN, embodies the spirit of an Extraordinary Healer.

Conference

A Lifelong Advocate and Innovator 

The phase 2 GIANT trial will evaluate Opdivo with or without relatlimab in IDH-wildtype newly diagnosed glioblastoma.

Clinical Trial to Evaluate Opdivo, Opdualag in Glioblastoma

Following the results of a hypothesis-generating study of immunotherapy in glioblastoma, a type of brain cancer, a phase 2 clinical trial is set to evaluate Opdivo (nivolumab) with or without relatlimab, a combination known as Opdualag, among patients with isocitrate dehydrogenase (IDH)-wildtype newly diagnosed glioblastoma.

The GIANT trial, set to be held in the United States at Duke University in Durham, North Carolina, was designed by professor Georgina Long, following up on her research into glioblastoma that was published in 

Long is the medical director of Melanoma Institute Australia (MIA) and chair of melanoma medical oncology and translational research at MIA and Royal North Shore Hospital, The University of Sydney. 

 article looked at the case of one patient with IDH-wild-type, MGMT promoter unmethylated glioblastoma who received treatment with a single dose of triplet immunotherapy followed by surgery who, after 17 months, showed no definitive sign of recurrence.

“It really showed that, despite what the oncology field thinks about glioblastoma, the immune system is not able to be activated against it; you can actually do that in certain circumstances,” Long said. “So when I came up with the idea and the hypothesis, because I developed drugs in melanoma — yes, we are curing over 50% of patients with immune stimulants or immunotherapy, [but] we still have 45% of patients who die from melanoma, and they die quickly — from my experience in the translational lab and in the clinic, because I'm a medical oncologist and translational researcher, my thinking about those sort of patients and the resistance to immunotherapy is what I applied to the glioblastoma.”

In light of the findings, the GIANT trial has an estimated start date of June 1, 2025, and will enroll approximately 92 patients, according to its listing on clinicaltrials.gov.

Long discussed her findings and the upcoming GIANT trial in an interview with 

The principles are: First of all, choose the right immunotherapies. You need to use CTLA-4. That's very important as part of your regimen in these terrible, terrible tumors. No. 2, use it early. Immunotherapy is best if you're going to test it. Test it early. No. 3, that publication was hypothesis-generating. We don't want to give false hope. We now need to show clinical benefit in a trial, and we are opening that. In fact, I designed that within six weeks and got the drugs within 10 weeks of that diagnosis of that patient. Then No. 4, the science showed activation of T cells infiltrating the glioblastoma after treatment, and [the] drug bound to the T cells. They're the four principles from that piece of work that I led, and now the trial should open in 2025 across America and Australia. It's an Australian trial driven by the Australians, but the Americans came on board, and now it's co-led by Duke University and the [Walter and Eliza Hall Institute of Medical Research] and [Peter MacCallum Cancer Centre] in Australia, but that came from the work I did and I put together.

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An artificial intelligence (AI) tool accurately predicted the risk of relapse in patients with pediatric cancer compared with other traditional approaches, according to a recent article from the 

Furthermore, the AI tool may be broadly adaptable to track and predict risk for patients with other cancers and chronic diseases undergoing surveillance imaging, according to study findings published in

The temporal learning model predicted recurrence of low- or high-grade glioma within one year post treatment with 75% to 89% accuracy, significantly outperforming single-image predictions, which have hovered at approximately 50%. Accuracy improved when more posttreatment images were used.

The AI tool is trained to analyze multiple brain scans over time, according to the news article. These results may lead to improved care for children with brain tumor gliomas, which, as noted in the article, are typically treatable but vary in risk of recurrence.

“Many pediatric gliomas are curable with surgery alone, but when relapses occur, they can be devastating,” corresponding author Dr. Benjamin Kann said in the article. “It is very difficult to predict who may be at risk of recurrence, so patients undergo frequent follow-up with magnetic resonance imaging for many years, a process that can be stressful and burdensome for children and families. We need better tools to identify early which patients are at the highest risk of recurrence.”

Kann is from the Artificial Intelligence in Medicine (AIM) Program at Mass General Brigham and the Department of Radiation Oncology at Brigham and Women’s Hospital in Boston. He is also an assistant professor of radiation oncology at Harvard Medical School.

The study included nearly 4,000 scans from 715 pediatric patients. A technique was then employed, called temporal learning, which has not been used previously for medical imaging AI research, and trained the AI tool to synthesize multiple brain scans taken over the span of several months after surgery. Researchers first trained the model to sequence postsurgery MRIs chronologically, helping it learn to detect subtle changes. They then refined the model to link those changes with later cancer recurrence when appropriate.

“Many pediatric gliomas are curable with surgery alone, but when relapses occur, they can be devastating,” Kann said in the article.

The researchers cautioned that further validation in additional settings is needed before clinical use. They want to launch clinical trials to determine whether AI-informed risk predictions can improve care by reducing imaging for low-risk patients or offering early targeted therapies to those at high risk.

“We have shown that AI is capable of effectively analyzing and making predictions from multiple images, not just single scans,” first author Divyanshu Tak, of the AIM Program at Mass General Brigham and the Department of Radiation Oncology at Brigham and Women’s Hospital, said in the article. “This technique may be applied in many settings where patients get serial, longitudinal imaging, and we’re excited to see what this project will inspire.”

Pediatric cancer is a term for cancers diagnosed from birth through age 14. These rare cancers differ from adult cancers in growth, spread, treatment and response. Common types include leukemia, brain and spinal cord tumors, lymphoma, neuroblastoma, Wilms tumor, retinoblastoma and cancers of the bone and soft tissue.

Most children with glioma undergo frequent brain MRIs due to unpredictable recurrence patterns, but deep learning may help improve personalized monitoring, according to the study.

“Longitudinal Risk Prediction for Pediatric Glioma with Temporal Deep Learning” by Divyanshu Tak, et al., 

An AI tool has demonstrated superior accuracy in predicting relapse risk in pediatric cancer patients, particularly those with gliomas, compared to traditional methods. The tool, utilizing a temporal learning model, analyzes multiple brain scans over time, achieving 75% to 89% accuracy in predicting glioma recurrence within a year post-treatment. This approach significantly outperforms single-image predictions. The study, involving nearly 4,000 scans from 715 patients, highlights the potential for AI to enhance personalized monitoring and care, though further validation and clinical trials are necessary before widespread clinical application.

An AI model using serial brain scans predicted glioma recurrence in children with up to 89% accuracy, outperforming single-image methods.

AI Tool Predicts Pediatric Glioma Recurrence With Up to 89% Accuracy

Danyelza is now recommended by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology as an NCCN category 2a treatment option for patients with high-risk neuroblastoma, a type of brain cancer, according to a news release from Y-mAbs Therapeutics.

“We are very pleased with NCCN’s update of the NCCN guidelines to include [Danyelza]. We believe this decision reinforces the importance of [Danyelza] as a leading anti-GD2 therapy of choice for physicians treating patients with relapsed/refractory high-risk neuroblastoma,” Doug Gentilcore, senior vice president, head of Danyelza business unit, said in the news release.

Patients in two clinical trials experienced meaningful responses that led to approval of the treatment, with tumors shrinking in the bone, bone marrow or both. In a trial entitled Study 201, 45% of 22 patients saw their cancer shrink, and 30% maintained this response for at least six months. In another trial, Study 12-230, 34% of 38 patients responded; nearly a quarter of patients maintained benefit for at least six months.

Danyelza received accelerated U.S. Food and Drug Administration approval on Nov. 25, 2020, for use with granulocyte-macrophage colony-stimulating factor (GM-CSF) in certain patients with relapsed or refractory high-risk neuroblastoma in the bone or bone marrow who had a partial response, minor response or stable disease after prior treatment. Continued approval may depend on results from a confirmatory trial. Danyelza is not approved for osteosarcoma in any country. The approval was based on results from two single-arm trials in this population: Study 201 and Study 12-230.

GM-CSF is a cytokine that helps the body make more white blood cells — especially granulocytes, macrophages and cells that develop into platelets — used as a blood-forming agent in supportive cancer care.

In the two trials, the most commonly reported side effects associated with Danyelza — occurring in at least 25% of patients in either trial — included infusion-related reactions, pain, tachycardia (rapid heartbeat), vomiting, cough, nausea, diarrhea, decreased appetite, hypertension (high blood pressure), fatigue, erythema multiforme (a type of skin reaction), peripheral neuropathy, urticaria (hives), fever, headache, injection site reactions, edema (swelling), anxiety, localized swelling and irritability.

Grade 3 (severe) or 4 (life-threatening) laboratory abnormalities occurring in more than 5% of patients included reductions in lymphocytes, neutrophils, hemoglobin, platelet count, potassium, glucose, calcium, albumin, sodium and phosphate levels, along with elevated alanine aminotransferase (a liver enzyme).

The prescribing information for Danyelza includes a boxed warning about the risk of serious infusion-related reactions and neurotoxicity, such as severe neuropathic pain, transverse myelitis and reversible posterior leukoencephalopathy syndrome.

The recommended regimen includes Danyelza at 2.25 milligrams per kilogram on days 2, 4, 9 and 11, combined with Temodar (temozolomide; 150 milligrams per square meter, days 1 to 5), Camptosar (irinotecan; 50 milligrams per square meter, days 1 to 5) and Leukine (sargramostim; 250 micrograms per square meter, days 6 to 10) in each 28-day cycle. An alternative regimen, based on Unituxin (dinutuximab), uses the same chemotherapy components and carries a category 2a recommendation.

Danyelza has been recommended by the NCCN as a category 2a treatment for high-risk neuroblastoma, following its accelerated FDA approval in 2020. This recommendation is based on positive outcomes from two clinical trials, where significant tumor shrinkage was observed. Danyelza is administered with GM-CSF and other chemotherapy agents. Common side effects include infusion reactions and neurotoxicity, with severe laboratory abnormalities noted in some patients. The NCCN, a coalition of cancer centers, aims to enhance cancer care quality and accessibility through research and education.

Danyelza is now a recommended treatment in NCCN guidelines for relapsed or refractory high-risk neuroblastoma, a type of brain cancer.

Dr. Douglas B. Johnson

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