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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

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.

Transcript has been edited for clarity and conciseness.

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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., 

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

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.

NCCN, a not-for-profit alliance of 33 leading cancer centers, is committed to improving the quality, effectiveness, equity and accessibility of cancer care and prevention through patient care, research and education. The organization does not guarantee the content it provides and disclaims responsibility for how it is used or applied.

Neuroblastoma is a cancer that starts in immature nerve cells, often in the adrenal glands, abdomen, chest or near the spine. It most commonly affects children younger than 5 years old and is usually diagnosed as the tumor grows, causing symptoms.

For more news on cancer updates, research and education, 

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.

Danyelza Added to NCCN Guidelines for High-Risk Neuroblastoma

Baseline assessments conducted before breast cancer treatment increased the chance of identifying breast cancer-related lymphedema at an earlier stage after treatment, according to data from the PREVENT trial, which were shared in a news release from ImpediMed.

Without a pretreatment baseline, up to 71% of patients monitored with bioimpedance spectroscopy and up to 88% of those monitored with tape measure would not have been identified as having early signs of lymphedema, potentially missing the opportunity for earlier, more effective treatment, according to findings from PREVENT. Notably, this trial is the largest randomized controlled trial to evaluate lymphedema prevention, the news release emphasized.

PREVENT evaluates 1,200 patients and tracks progression to chronic breast cancer-related lymphedema following early intervention, as assessed by both bioimpedance spectroscopy and traditional tape measurement.

"This evidence reinforces the critical importance of establishing an easy-to-perform, baseline measurement for fluid and body composition, one that improves the likelihood of detecting [breast cancer-related lymphedema] as early as possible so lymphedema treatment can begin at its most reversible stages," Dr. Steven L. Chen, the study’s lead author and ImpediMed's chief medical officer, said in the news release. "These findings highlight the importance of paying attention to lymphedema risk even as the cancer treatment is being planned."

ImpediMed offers the only U.S. Food and Drug Administration (FDA)-cleared bioimpedance spectroscopy solution for the clinical assessment of lymphedema — SOZO Digital Health Program. The platform is now recommended nationwide in clinical practice guidelines and is generally accepted and recognized for accurate and effective screening of lymphedema.

SOZO, a noninvasive bioimpedance spectroscopy device, provides a fluid and tissue snapshot in under 30 seconds using 256 data points across multiple frequencies. Cleared by the FDA and designed for use across health systems, SOZO helps detect secondary lymphedema, track fluid status in patients with heart or kidney failure and support overall health monitoring.

Furthermore, the National Comprehensive Cancer Network updated its Breast Cancer Clinical Practice Guidelines recently, which advises on baseline pretreatment screening for patients with lymphedema risk factors. This reinforces the importance of measuring at baseline to support early detection of lymphedema.

"I'm proud to support research that highlights the benefits of closer monitoring for breast cancer survivors," Scott Long, newly appointed senior vice president of sales at ImpediMed, said in the news release. "It's rewarding to see survivorship care gaining momentum — something I've championed throughout my 30-year career in breast cancer biopsy and device development."

The PREVENT trial enrolled patients across 10 sites in the U.S. and Australia, including 13 hospitals such as Vanderbilt University, Mayo Clinic and The University of Texas MD Anderson Cancer Center. Conducted over six and a half years, the study followed patients for up to three years to evaluate whether early intervention after subclinical detection of extracellular fluid buildup via bioimpedance spectroscopy could reduce lymphedema progression compared with detection with a tape measure. The findings were published in 

Results showed a 7.9% rate of chronic lymphedema in patients monitored with L-Dex technology and treated early with compression garments compared with 19.2% in those assessed with tape measure. The 11.3% difference was statistically significant and represented a 59% relative reduction in progression at three years, offering meaningful clinical benefit for patients and clinicians, as per the release.

Additional insights based on these findings will be presented during a poster session at the 2025 American Society of Breast Surgeons Annual Meeting in Las Vegas, Nevada, on Friday, May 2, at 6:00 p.m. The study is titled, "The Importance of a Pre-Treatment Baseline When Screening Patients for Breast Cancer–Related Lymphedema." The study will be presented by Chen.

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Baseline assessments before breast cancer treatment significantly enhance early detection of lymphedema, as demonstrated by the PREVENT trial. This large-scale study, involving 1,200 patients, underscores the importance of pre-treatment measurements using bioimpedance spectroscopy and traditional methods. Findings reveal that without baseline data, a substantial percentage of early lymphedema cases could be missed. The trial highlights the efficacy of the SOZO device, an FDA-cleared bioimpedance tool, in reducing lymphedema progression. These insights are supported by updated NCCN guidelines and will be further discussed at an upcoming medical conference.

New results from a breast cancer-related lymphedema study show the importance of measuring fluid and body composition before treatment begins.

Side Effect Management

Pretreatment Baseline Screening for Breast Cancer-Related Lymphedema

A message I recently received from my personal health portal rubbed me the wrong way. I do not know whether it came from a robot with a name or a human with a robot-like personality, but I wrote back that I, a breast cancer survivor, was never delinquent in scheduling annual mammograms.

The message began, “Hi, Felicia. Breast cancer screenings save lives! If you're due for a mammogram, you can schedule it quickly and easily right through MyChart. If you've already had your mammogram this year, please let us know or upload a copy to MyChart so we can keep your record up to date.”

It continued: “This message was sent as part of a routine outreach to help keep you on track with preventive care. If you have any questions or concerns, feel free to reply to this message — we’re here to help! Thank you for taking care of your health.”

“Thank you for taking care of your health” can be a good reminder. It can also sound passive aggressive, as in, “You are not taking care of your health and need to try harder.” How much harder can I try? My annual mammogram is scheduled (the order transparent in MyChart). I received a mammogram (MyChart showing results) in December.

Feedback can educate bots and/or humans, so write back when inspired. I wrote, “You can see in [health provider] and MyChart that I had a mammogram. I am a cancer survivor and would not miss one. Please fix your system. Thanks!” The response was short but sweet: “This has been fixed.” Good!

If I were sending an automated message regarding the value of mammograms, though, this is what I would say: “Breast cancer screenings can save lives! We hope you have scheduled or completed your annual mammogram. This message is being shared as part of a routine outreach. If you have any questions or concerns, feel free to reply to this message — we’re here to help! Thank you for taking care of your health.”

Notice how I delete “to help keep you on track with preventive care.” Imagine somebody just diagnosed with breast cancer receiving the breezy message from a bot/human that does not know the recipient’s current situation. Plus, a mammogram can be preventive but can also be diagnostic, initiating an arduous cancer journey. Additionally, “save” and “can save” have two very different meanings. Mammograms do save lives, but not always.

Despite that clumsy message, MyChart is a handy resource. I also recommend following advice from Breastcancer.org: “Keep copies of all your test results. As you receive each new test result, it’s a good idea to get into the habit of saving your own copy. Develop a system that works for you for saving a complete set of all your test results and medical records in one place, whether that’s a digital folder or a file on a shelf. Having your own complete set of records can make managing your care easier, including getting second opinions and applying for a clinical trial.”

A personal medical portal, or patient portal, can be a useful tool. Remember, though, that you, the consumer, can always provide feedback if it needs some tweaking. What would you like a mammogram reminder to look like?

The message from a personal health portal about mammogram scheduling was perceived as passive-aggressive by a breast cancer survivor. The recipient, who had already scheduled and completed her mammogram, responded to correct the system. The article emphasizes the importance of feedback to improve automated messages and suggests a more sensitive approach to communication. It highlights the dual role of mammograms in both prevention and diagnosis. Additionally, it underscores the value of maintaining personal medical records and encourages feedback to enhance patient portals.

I reflect on how a generic mammogram reminder overlooked my experience as a breast cancer survivor and how thoughtful messaging could make a difference.

Dr. Douglas B. Johnson

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