New primary melanoma in a patient under triple therapy with vemurafenib, cobimetinib, and atezolizumab for metastatic melanoma

New primary melanomas (NPMs) in the era of combination treatments for melanoma constitute a challenge for physicians, especially due to the increased incidence of NPMs in patients treated with BRAF inhibitors. We present the unique case of a patient that developed an invasive NPM while under treatment with a combination of vemurafenib, cobimetinib, and atezolizumab. A 39-year-old white male was treated with vemurafenib, cobimetinib, and atezolizumab for a stage IV (T0, N3, M1) BRAF-V600E mutated malignant melanoma in the context of a clinical trial. Eight months from treatment initiation he was diagnosed with an NPM on his back that was found to be BRAF-wild type and neuroblastoma ras mutated, while he was in complete remission. Wide excision of the lesion followed, and the patient was not withdrawn from study treatment. Twenty-two months from treatment initiation, he is still in complete remission. NPMs are a well-known adverse effect of BRAF inhibitors and pose a challenge for the treating physician since these lesions are BRAF-wild type and usually have aggressive biologic behaviour. Invasive NPMs require an aggressive management strategy with clear guidelines to prevent the emergence of advanced or metastatic disease. The emergence of invasive NPMs in patients treated with triple regimens with BRAF/mitogenactivated protein kinase kinase inhibitors and PD1/ PDL1 inhibitors is at least unexpected and constitutes a therapeutic stalemate for the physician. Through this case report, we aim to increase awareness about the diagnosis and management of patients with NPM and to express our concerns regarding further management of NPMs in patients under triple combination treatment. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

From Remote Media Immersion to Distributed Immersive Performance

We present the architecture, technology and experimental applications of a real-time, multi-site, interactive and collaborative environment called Distributed Immersive Performance (DIP). The objective of DIP is to develop the technology for live, interactive musical performances in which the participants - subsets of musicians, the conductor and the audience - are in different physical locations and are interconnected by very high fidelity multichannel audio and video links. DIP is a specific realization of broader immersive technology - the creation of the complete aural and visual ambience that places a person or a group of people in a virtual space where they can experience events occurring at a remote site or communicate naturally regardless of their location. The DIP experimental system has interaction sites and servers in different locations on the USC campus and at several partners, including the New World Symphony of Miami Beach, FL. The sites have different types of equipment to test the effects of video and audio fidelity on the ease of use and functionality for different applications. Many sites have high-definition (HD) video or digital video (DV) quality images projected onto wide screen wall displays completely integrated with an immersive audio reproduction system for a seamless, fully three-dimensional aural environment with the correct spatial sound localization for participants. The system is capable of storage and playback of the many streams of synchronized audio and video data (immersidata), and utilizes novel protocols for the low-latency, seamless, synchronized realtime delivery of immersidata over local area networks and widearea networks such as Internet2. We discuss several recent interactive experiments using the system and many technical cha..