ASCO done! And, ??? best reason for a melanoma specialist

Forums General Melanoma Community ASCO done! And, ??? best reason for a melanoma specialist

  • Post
    Bubbles
    Participant

      Since May 22 I've posted the best abstracts I could glean from ASCO 2016.  I did not include all of them.  But I grouped them and noted what seemed most pertinent to melanoma treatment today and in the future…as best I could.  This last post is a little more "out there" than the rest…but the one addressing what general oncologists know and use from trial data is rather horrifying and downright embarassing.  Many us of old-timers here repeat it over and over….if you are dealing with melanoma….you NEED a melanoma specialist!!!  Not your local onc.  Not an oncology surgeon.  You may get help from these folks, along with oncology radiologists, dermatologists and many others.  But to help you find your treatment and supervise your care…a melanoma specialist and usually an institution that treats lots of melanoma patients will serve you best.  And when defining a melanomoma specialist…this is not a one-trick pony who may have done something well in the 80's.  It must be someone who is willing to move from past treatments, from past methods of treating side effects…to the best and the now.  Just think…the treatment (Nivolumab/Opdivo) that I am certain saved my life was not FDA approved in 2010 when I took it!  It was certainly not available in 2003 when I first started all this mess!!!  You need someone in your corner who KNOWS the latest…and is willing to help you find what's next!!!!

      http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-final-odds-and-endsa-study.html

      Hope it helps.  I wish you all my best.  Celeste

    Viewing 11 reply threads
    • Replies
        jennunicorn
        Participant

          Great post, Celeste, I hope it helps some newer patients understand a little more why it is SO important to have a knowledgeable melanoma specialist by your side! I especially love your prayer at the end, AMEN! 

          ๐Ÿ™‚

          jennunicorn
          Participant

            Great post, Celeste, I hope it helps some newer patients understand a little more why it is SO important to have a knowledgeable melanoma specialist by your side! I especially love your prayer at the end, AMEN! 

            ๐Ÿ™‚

            jennunicorn
            Participant

              Great post, Celeste, I hope it helps some newer patients understand a little more why it is SO important to have a knowledgeable melanoma specialist by your side! I especially love your prayer at the end, AMEN! 

              ๐Ÿ™‚

              Charlie S
              Participant

                I so wish that it was possible to tell  the people that come here that due to the recent advances in reserarch  and FDA drug approval ,  that the diagnosis ,and treatment for early stage or advanced melanoma has now been made easy and straighforward and  is therefor ;for those diagnosed with any Stage of Melanoma to find  effective answers and treatment with ease.

                 Bubbbles has set forth some stuff which I would like to expand

                1) You are your own best advocate

                2) Do not be afraid to question medical decisions —-or authority.

                3) The "best" is subjective".  If a doctor will not listen or discuss or answer your concerns or questions…………..his or her credentials are of no concern.

                4) There is a reason we are equipped with two ears and one mouth.

                All in all, in many ways,  it is still the same as what I faced many years back.

                Just like docrtors, not all treatments are created equal nor apply the same to any two of us.

                The absolute best person to have in your corner is a pissed off, questioning and answer driven person.

                That is YOU.

                I get it though that not everybody is good with that in your face approach; so if that is not you, enlist someone.

                ASCO and every doctor aside……………………………………….we are each responsible for our own destiny and health , and I will not, ever give that up.

                An old blues singer,now dead,  Katie Webster, once told me about her "state of pisstivity" at a small gathering in Burlington NC ;  that was a good lesson.

                Seems to me that somehow  Katie sprinkled some dust on you Bubbles !

                Cheers,

                Charlie S

                 

                 

                 

                Charlie S
                Participant

                  I so wish that it was possible to tell  the people that come here that due to the recent advances in reserarch  and FDA drug approval ,  that the diagnosis ,and treatment for early stage or advanced melanoma has now been made easy and straighforward and  is therefor ;for those diagnosed with any Stage of Melanoma to find  effective answers and treatment with ease.

                   Bubbbles has set forth some stuff which I would like to expand

                  1) You are your own best advocate

                  2) Do not be afraid to question medical decisions —-or authority.

                  3) The "best" is subjective".  If a doctor will not listen or discuss or answer your concerns or questions…………..his or her credentials are of no concern.

                  4) There is a reason we are equipped with two ears and one mouth.

                  All in all, in many ways,  it is still the same as what I faced many years back.

                  Just like docrtors, not all treatments are created equal nor apply the same to any two of us.

                  The absolute best person to have in your corner is a pissed off, questioning and answer driven person.

                  That is YOU.

                  I get it though that not everybody is good with that in your face approach; so if that is not you, enlist someone.

                  ASCO and every doctor aside……………………………………….we are each responsible for our own destiny and health , and I will not, ever give that up.

                  An old blues singer,now dead,  Katie Webster, once told me about her "state of pisstivity" at a small gathering in Burlington NC ;  that was a good lesson.

                  Seems to me that somehow  Katie sprinkled some dust on you Bubbles !

                  Cheers,

                  Charlie S

                   

                   

                   

                  Charlie S
                  Participant

                    I so wish that it was possible to tell  the people that come here that due to the recent advances in reserarch  and FDA drug approval ,  that the diagnosis ,and treatment for early stage or advanced melanoma has now been made easy and straighforward and  is therefor ;for those diagnosed with any Stage of Melanoma to find  effective answers and treatment with ease.

                     Bubbbles has set forth some stuff which I would like to expand

                    1) You are your own best advocate

                    2) Do not be afraid to question medical decisions —-or authority.

                    3) The "best" is subjective".  If a doctor will not listen or discuss or answer your concerns or questions…………..his or her credentials are of no concern.

                    4) There is a reason we are equipped with two ears and one mouth.

                    All in all, in many ways,  it is still the same as what I faced many years back.

                    Just like docrtors, not all treatments are created equal nor apply the same to any two of us.

                    The absolute best person to have in your corner is a pissed off, questioning and answer driven person.

                    That is YOU.

                    I get it though that not everybody is good with that in your face approach; so if that is not you, enlist someone.

                    ASCO and every doctor aside……………………………………….we are each responsible for our own destiny and health , and I will not, ever give that up.

                    An old blues singer,now dead,  Katie Webster, once told me about her "state of pisstivity" at a small gathering in Burlington NC ;  that was a good lesson.

                    Seems to me that somehow  Katie sprinkled some dust on you Bubbles !

                    Cheers,

                    Charlie S

                     

                     

                     

                    MoiraM
                    Participant

                      I really enjoyed reading your blog post. Thank you.

                      I know that this an American website but I also know that many people living in other countries, like me, use it. I am in the UK.

                      I would like to make the point that we don't all have access to cutting-edge clincal trials. However that does not mean that we cannot have the best care possible within our local framework.

                      My consultant is not working at the leading edge of melanoma research. However, she is aware of it. My PhD was about the behaviour of tumour cells and she has always been able to answer all my questions. She sends me research papers after our consultations.

                      What she is is an expert on treating people with melanoma. It is all she and her team does, day in and day out.. She offers the best treatment that is available within the NHS. She treats the person not the disease. She and her team have managed to treat me despite my phobia of doctors and hospitals. They work closely with other teams in the hospital when their patients have more than one condition.

                      She only has access to standard treatment approved by the NHS and funded by the NHS or the UK Cancer Drugs Fund. If one of her patients qualified for one of the drug trials in the UK and she thought it gave him or her a better chance, she would tell him or her about it. I am confident that she knows about every one of them.

                      The downside is that melanoma patients in the UK may have less access to experimental treatments.

                      The upside is that the 'approved' treatment is pretty good and is moving on reasonably quickly. What makes the difference is how good your local melanoma team is.

                      Mine is great.

                       

                       

                      MoiraM
                      Participant

                        I really enjoyed reading your blog post. Thank you.

                        I know that this an American website but I also know that many people living in other countries, like me, use it. I am in the UK.

                        I would like to make the point that we don't all have access to cutting-edge clincal trials. However that does not mean that we cannot have the best care possible within our local framework.

                        My consultant is not working at the leading edge of melanoma research. However, she is aware of it. My PhD was about the behaviour of tumour cells and she has always been able to answer all my questions. She sends me research papers after our consultations.

                        What she is is an expert on treating people with melanoma. It is all she and her team does, day in and day out.. She offers the best treatment that is available within the NHS. She treats the person not the disease. She and her team have managed to treat me despite my phobia of doctors and hospitals. They work closely with other teams in the hospital when their patients have more than one condition.

                        She only has access to standard treatment approved by the NHS and funded by the NHS or the UK Cancer Drugs Fund. If one of her patients qualified for one of the drug trials in the UK and she thought it gave him or her a better chance, she would tell him or her about it. I am confident that she knows about every one of them.

                        The downside is that melanoma patients in the UK may have less access to experimental treatments.

                        The upside is that the 'approved' treatment is pretty good and is moving on reasonably quickly. What makes the difference is how good your local melanoma team is.

                        Mine is great.

                         

                         

                        MoiraM
                        Participant

                          I really enjoyed reading your blog post. Thank you.

                          I know that this an American website but I also know that many people living in other countries, like me, use it. I am in the UK.

                          I would like to make the point that we don't all have access to cutting-edge clincal trials. However that does not mean that we cannot have the best care possible within our local framework.

                          My consultant is not working at the leading edge of melanoma research. However, she is aware of it. My PhD was about the behaviour of tumour cells and she has always been able to answer all my questions. She sends me research papers after our consultations.

                          What she is is an expert on treating people with melanoma. It is all she and her team does, day in and day out.. She offers the best treatment that is available within the NHS. She treats the person not the disease. She and her team have managed to treat me despite my phobia of doctors and hospitals. They work closely with other teams in the hospital when their patients have more than one condition.

                          She only has access to standard treatment approved by the NHS and funded by the NHS or the UK Cancer Drugs Fund. If one of her patients qualified for one of the drug trials in the UK and she thought it gave him or her a better chance, she would tell him or her about it. I am confident that she knows about every one of them.

                          The downside is that melanoma patients in the UK may have less access to experimental treatments.

                          The upside is that the 'approved' treatment is pretty good and is moving on reasonably quickly. What makes the difference is how good your local melanoma team is.

                          Mine is great.

                           

                           

                            Bubbles
                            Participant

                              That sounds great, Moira!  There is no title, even here in the states…of melanoma specialist.  It really does mean just what you described….oncologists (who may participate in trials and research here in the US) who stay aware of the latest data and changes in melanoma care and who take care of a great deal of melanoma patients.  The regular oncologist can be a great melanoma care giver should they CHOOSE and WORK to be!!!!  Sadly, the study clearly shows that sometimes, at least, the effort is not made.  I am glad you found a thoughtful, caring and well versed professional to help you guide your care!!  c

                              vickiaa0529
                              Participant

                                Hi

                                Thanks for the post Celeste. Since I am rather new and not real impressed with my team at the Seattle Cancer Care Alliance is there a way to find another melanome specialist? Right now it seems like the only option I am given for 3b is ipi at the high dose. I know that there are other hosiptal around the West Coast and since i am familar with Md Anderson that would be an option too. I am considering San Fran. Any help would be really appreciated.

                                Thanks

                                 

                                 

                                Janner
                                Participant

                                  SCCA has a good reputation, Dr. Thompson especially.  There aren't a lot of options for stage 3B except Interferon or IPI at 10mg.  That's all that is FDA "approved" for your stage and NED.  I guess some can get their docs to do IPI at 3mg off protocol but I'm not sure how universal that is.  Insurance may not pay for anything off protocol.  Other than that, it is clinical trials.  SCCA does participate in clinical trials but there still aren't a ton of trials out there for stage III NED.  It never hurts to have a second opinion but you need to be realistic about what the options really are in terms of treatment.

                                  vickiaa0529
                                  Participant

                                    Thanks so much, its just so hard to get info and try to be proactive. We moved to Whidbey for the summer and I am scared of being this far from a hospital in case of emergency, but I will get thru it. If I start on ipi and something else gets approved will I be eligilbe? Can I switch?

                                     

                                    Janner
                                    Participant

                                      You can switch, stop or start "approved" treatments at any time — working with your team (and insurance, unfortunately).  Approved treatments are always an option with the caveat that targeted treatments might require you to have certain mutations. Clinical trials are a different beast and there are many exclusion criteria that determine if you can join including previous treatments. 

                                      Janner
                                      Participant

                                        You can switch, stop or start "approved" treatments at any time — working with your team (and insurance, unfortunately).  Approved treatments are always an option with the caveat that targeted treatments might require you to have certain mutations. Clinical trials are a different beast and there are many exclusion criteria that determine if you can join including previous treatments. 

                                        Janner
                                        Participant

                                          You can switch, stop or start "approved" treatments at any time — working with your team (and insurance, unfortunately).  Approved treatments are always an option with the caveat that targeted treatments might require you to have certain mutations. Clinical trials are a different beast and there are many exclusion criteria that determine if you can join including previous treatments. 

                                          vickiaa0529
                                          Participant

                                            Thanks so much, its just so hard to get info and try to be proactive. We moved to Whidbey for the summer and I am scared of being this far from a hospital in case of emergency, but I will get thru it. If I start on ipi and something else gets approved will I be eligilbe? Can I switch?

                                             

                                            vickiaa0529
                                            Participant

                                              Thanks so much, its just so hard to get info and try to be proactive. We moved to Whidbey for the summer and I am scared of being this far from a hospital in case of emergency, but I will get thru it. If I start on ipi and something else gets approved will I be eligilbe? Can I switch?

                                               

                                              Janner
                                              Participant

                                                SCCA has a good reputation, Dr. Thompson especially.  There aren't a lot of options for stage 3B except Interferon or IPI at 10mg.  That's all that is FDA "approved" for your stage and NED.  I guess some can get their docs to do IPI at 3mg off protocol but I'm not sure how universal that is.  Insurance may not pay for anything off protocol.  Other than that, it is clinical trials.  SCCA does participate in clinical trials but there still aren't a ton of trials out there for stage III NED.  It never hurts to have a second opinion but you need to be realistic about what the options really are in terms of treatment.

                                                Janner
                                                Participant

                                                  SCCA has a good reputation, Dr. Thompson especially.  There aren't a lot of options for stage 3B except Interferon or IPI at 10mg.  That's all that is FDA "approved" for your stage and NED.  I guess some can get their docs to do IPI at 3mg off protocol but I'm not sure how universal that is.  Insurance may not pay for anything off protocol.  Other than that, it is clinical trials.  SCCA does participate in clinical trials but there still aren't a ton of trials out there for stage III NED.  It never hurts to have a second opinion but you need to be realistic about what the options really are in terms of treatment.

                                                  vickiaa0529
                                                  Participant

                                                    Hi

                                                    Thanks for the post Celeste. Since I am rather new and not real impressed with my team at the Seattle Cancer Care Alliance is there a way to find another melanome specialist? Right now it seems like the only option I am given for 3b is ipi at the high dose. I know that there are other hosiptal around the West Coast and since i am familar with Md Anderson that would be an option too. I am considering San Fran. Any help would be really appreciated.

                                                    Thanks

                                                     

                                                     

                                                    vickiaa0529
                                                    Participant

                                                      Hi

                                                      Thanks for the post Celeste. Since I am rather new and not real impressed with my team at the Seattle Cancer Care Alliance is there a way to find another melanome specialist? Right now it seems like the only option I am given for 3b is ipi at the high dose. I know that there are other hosiptal around the West Coast and since i am familar with Md Anderson that would be an option too. I am considering San Fran. Any help would be really appreciated.

                                                      Thanks

                                                       

                                                       

                                                      Bubbles
                                                      Participant

                                                        That sounds great, Moira!  There is no title, even here in the states…of melanoma specialist.  It really does mean just what you described….oncologists (who may participate in trials and research here in the US) who stay aware of the latest data and changes in melanoma care and who take care of a great deal of melanoma patients.  The regular oncologist can be a great melanoma care giver should they CHOOSE and WORK to be!!!!  Sadly, the study clearly shows that sometimes, at least, the effort is not made.  I am glad you found a thoughtful, caring and well versed professional to help you guide your care!!  c

                                                        Bubbles
                                                        Participant

                                                          That sounds great, Moira!  There is no title, even here in the states…of melanoma specialist.  It really does mean just what you described….oncologists (who may participate in trials and research here in the US) who stay aware of the latest data and changes in melanoma care and who take care of a great deal of melanoma patients.  The regular oncologist can be a great melanoma care giver should they CHOOSE and WORK to be!!!!  Sadly, the study clearly shows that sometimes, at least, the effort is not made.  I am glad you found a thoughtful, caring and well versed professional to help you guide your care!!  c

                                                        Bubbles
                                                        Participant

                                                          Hi Vicki….

                                                          I have been messaging a Vicki one my blog…might it be you???  At any rate, Anon seems to think your current location provides good care.  I am not familiar with it….not that that means anything.  These two oncs have amazing reps in melanoma: 

                                                          Omid Hamid:  http://www.theangelesclinic.org/Home/MeetOurTeam/Doctors/tabid/19273/Default.aspx

                                                          Antoni Ribas:  http://www.cancerresearch.org/our-strategy-impact/people-behind-the-progress/scientists/antoni-ribas

                                                          However, that doesn't mean you don't have other options.  Huntsman has a good rep.  There are tons of melanoma specialists in NY and at Yale, etc.  MD Anderson in Tx.  Folks are doing good stuff at Loyola.  There is the NIH in Bethesda.  Moffitt in Tampa.  I was just thinking of those because they are great and nearer your side of the US.  You can always consult with a specialist to get started in a good direction and gain better understanding of your options, even if you don't use them to directly manage your care.

                                                          Ipi is not a bad treatment option.  Anon had it right….you can start any trial or treatment that you choose….and stop…any trial or treatment you choose.  It is YOUR choice.  The only caveat is that some treatments might stand in the way of other trials in the future.  But, that is a game that is hard to play and predict.

                                                          I have one more point but the spam blocker won't allow more than two links at a time…c

                                                           

                                                            Bubbles
                                                            Participant

                                                              To finish….if you are Stage IIIB….you DO qualify for the first trial listed in this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-two-adjuvant-studies-for.html

                                                              You can look it up on:  https://clinicaltrials.gov/  

                                                              to see locations that are offering it.  I am not pushing it.  But it is something that is available.  Trials are not easy.  They can be hard and confusing.  They can be life saving.  I traveled to Moffitt in Tampa from Chattanooga for 2 1/2 years (plus follow-up) for my trial.  I don't know how I did it…but it can be done.  There are agencies that can help fund travel costs if you qualify.

                                                              Again….while ipi (esp at its current dosage for Stage III folks) is not quite the adjuvant treatment I would wave my (nonexistant) magic wand to create for you…it is still pretty darn good.

                                                              Hang in there.  Asking questions and searching for answers is a great starting point.  You will get to where you need to be.  I wish you well.  Celeste

                                                               

                                                              Bubbles
                                                              Participant

                                                                To finish….if you are Stage IIIB….you DO qualify for the first trial listed in this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-two-adjuvant-studies-for.html

                                                                You can look it up on:  https://clinicaltrials.gov/  

                                                                to see locations that are offering it.  I am not pushing it.  But it is something that is available.  Trials are not easy.  They can be hard and confusing.  They can be life saving.  I traveled to Moffitt in Tampa from Chattanooga for 2 1/2 years (plus follow-up) for my trial.  I don't know how I did it…but it can be done.  There are agencies that can help fund travel costs if you qualify.

                                                                Again….while ipi (esp at its current dosage for Stage III folks) is not quite the adjuvant treatment I would wave my (nonexistant) magic wand to create for you…it is still pretty darn good.

                                                                Hang in there.  Asking questions and searching for answers is a great starting point.  You will get to where you need to be.  I wish you well.  Celeste

                                                                 

                                                                Bubbles
                                                                Participant

                                                                  To finish….if you are Stage IIIB….you DO qualify for the first trial listed in this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-two-adjuvant-studies-for.html

                                                                  You can look it up on:  https://clinicaltrials.gov/  

                                                                  to see locations that are offering it.  I am not pushing it.  But it is something that is available.  Trials are not easy.  They can be hard and confusing.  They can be life saving.  I traveled to Moffitt in Tampa from Chattanooga for 2 1/2 years (plus follow-up) for my trial.  I don't know how I did it…but it can be done.  There are agencies that can help fund travel costs if you qualify.

                                                                  Again….while ipi (esp at its current dosage for Stage III folks) is not quite the adjuvant treatment I would wave my (nonexistant) magic wand to create for you…it is still pretty darn good.

                                                                  Hang in there.  Asking questions and searching for answers is a great starting point.  You will get to where you need to be.  I wish you well.  Celeste

                                                                   

                                                                  vickiaa0529
                                                                  Participant

                                                                    Hi

                                                                    Thanks. Yes it is the same Vicki. Thanks again for all of your info. I am going to look into some of the other trials. My appointment is tomorrow.I will give an update. I am leaning towards staying in Seattle because time is running out. My surgery was April 4th. I feel a lot better since I know I can switch if ipi doen't work for me. I was hoping for a better chemistry with my oncologist but I can live without that. My husband is retiring in October and we can move anywhere we chose at this point so I love that I have options.

                                                                    Thanks again for your blog and all you do

                                                                    Vicki

                                                                     

                                                                    vickiaa0529
                                                                    Participant

                                                                      Hi

                                                                      Thanks. Yes it is the same Vicki. Thanks again for all of your info. I am going to look into some of the other trials. My appointment is tomorrow.I will give an update. I am leaning towards staying in Seattle because time is running out. My surgery was April 4th. I feel a lot better since I know I can switch if ipi doen't work for me. I was hoping for a better chemistry with my oncologist but I can live without that. My husband is retiring in October and we can move anywhere we chose at this point so I love that I have options.

                                                                      Thanks again for your blog and all you do

                                                                      Vicki

                                                                       

                                                                      vickiaa0529
                                                                      Participant

                                                                        Hi

                                                                        Thanks. Yes it is the same Vicki. Thanks again for all of your info. I am going to look into some of the other trials. My appointment is tomorrow.I will give an update. I am leaning towards staying in Seattle because time is running out. My surgery was April 4th. I feel a lot better since I know I can switch if ipi doen't work for me. I was hoping for a better chemistry with my oncologist but I can live without that. My husband is retiring in October and we can move anywhere we chose at this point so I love that I have options.

                                                                        Thanks again for your blog and all you do

                                                                        Vicki

                                                                         

                                                                      Bubbles
                                                                      Participant

                                                                        Hi Vicki….

                                                                        I have been messaging a Vicki one my blog…might it be you???  At any rate, Anon seems to think your current location provides good care.  I am not familiar with it….not that that means anything.  These two oncs have amazing reps in melanoma: 

                                                                        Omid Hamid:  http://www.theangelesclinic.org/Home/MeetOurTeam/Doctors/tabid/19273/Default.aspx

                                                                        Antoni Ribas:  http://www.cancerresearch.org/our-strategy-impact/people-behind-the-progress/scientists/antoni-ribas

                                                                        However, that doesn't mean you don't have other options.  Huntsman has a good rep.  There are tons of melanoma specialists in NY and at Yale, etc.  MD Anderson in Tx.  Folks are doing good stuff at Loyola.  There is the NIH in Bethesda.  Moffitt in Tampa.  I was just thinking of those because they are great and nearer your side of the US.  You can always consult with a specialist to get started in a good direction and gain better understanding of your options, even if you don't use them to directly manage your care.

                                                                        Ipi is not a bad treatment option.  Anon had it right….you can start any trial or treatment that you choose….and stop…any trial or treatment you choose.  It is YOUR choice.  The only caveat is that some treatments might stand in the way of other trials in the future.  But, that is a game that is hard to play and predict.

                                                                        I have one more point but the spam blocker won't allow more than two links at a time…c

                                                                         

                                                                        Bubbles
                                                                        Participant

                                                                          Hi Vicki….

                                                                          I have been messaging a Vicki one my blog…might it be you???  At any rate, Anon seems to think your current location provides good care.  I am not familiar with it….not that that means anything.  These two oncs have amazing reps in melanoma: 

                                                                          Omid Hamid:  http://www.theangelesclinic.org/Home/MeetOurTeam/Doctors/tabid/19273/Default.aspx

                                                                          Antoni Ribas:  http://www.cancerresearch.org/our-strategy-impact/people-behind-the-progress/scientists/antoni-ribas

                                                                          However, that doesn't mean you don't have other options.  Huntsman has a good rep.  There are tons of melanoma specialists in NY and at Yale, etc.  MD Anderson in Tx.  Folks are doing good stuff at Loyola.  There is the NIH in Bethesda.  Moffitt in Tampa.  I was just thinking of those because they are great and nearer your side of the US.  You can always consult with a specialist to get started in a good direction and gain better understanding of your options, even if you don't use them to directly manage your care.

                                                                          Ipi is not a bad treatment option.  Anon had it right….you can start any trial or treatment that you choose….and stop…any trial or treatment you choose.  It is YOUR choice.  The only caveat is that some treatments might stand in the way of other trials in the future.  But, that is a game that is hard to play and predict.

                                                                          I have one more point but the spam blocker won't allow more than two links at a time…c

                                                                           

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