Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act: a national database study

The Affordable Care Act (ACT) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes

Climate Assemblies:Situating a Legal Experimentation

The governance of climate change is experiencing a deliberative moment. Citizens’ assemblies on climate change are forums of deliberative democracy that bring together citizens representative of a country’s society to develop recommendations on how to reduce greenhouse gas emissions. They are designed to offer solutions to the failure of public authorities to mitigate and adapt to climate change, and have been gaining popularity in Europe. This chapter identifies four different ways in which climate assemblies, as a novel, experimental, tool in environmental governance, have been conceptualized. While closely related to existing concepts and practices in environmental law, they are at the same time highly anomalous, and offer promises and challenges for environmental law and its scholarship

Harm to the global commons on trial: The role of the prevention principle in international climate adjudication

Although the climate crisis is the result of a failure to prevent environmental harm, the principle of prevention has thus far remained discrete in domestic climate litigation. Similarly, in the context of international climate adjudication, reliance on the prevention principle could seem limited by two main obstacles: its anchor in bilateralism and its normative indeterminacy. This article argues that, on the contrary, the prevention principle could serve important functions in international climate adjudication. First, it shows that climate change falls within the reach of the prevention principle, which aims to protect the environment per se as a community interest. Then it explores two argumentative scenarios that are based on different constructions of the prevention principle, conceived either as a customary duty or as a general principle of international law. In both cases, recourse to the prevention principle can offer numerous advantages, which vary depending on the objectives strategically pursued

Development of Sézary syndrome following the administration of dupilumab

Dupilumab is a monoclonal antibody that inhibits interleukin-4 and interleukin-13 signaling. It is the first biologic agent to demonstrate efficacy in treating moderate-to-severe refractory atopic dermatitis [1, 2]. Although dupilumab provides promise for the treatment of atopic and allergic conditions, clinicians should take into account its novelty and the potential for unexpected adverse events. We present a patient who developed Sézary syndrome following the initiation of dupilumab

Clinical Efficacy of Romidepsin in Tumor Stage and Folliculotropic Mycosis Fungoides

AbstractBackgroundTumor stage and folliculotropic mycosis fungoides are uncommon subtypes of cutaneous T-cell lymphoma (CTCL) with an aggressive disease course. Romidepsin is a histone deacetylase inhibitor approved by the US Food and Drug Administration for patients with CTCL who have received ≥ 1 previous systemic therapy. In the present study, we examined the efficacy and safety of romidepsin in patients from the pivotal, single-arm, open-label, phase II study of relapsed or refractory CTCL with cutaneous tumors and/or folliculotropic disease involvement.Materials and MethodsPatients with CTCL who had received ≥ 1 previous systemic therapy received romidepsin at 14 mg/m2 on days 1, 8, and 15 of 28-day cycles. Responses were determined by a composite endpoint (assessments of the skin, blood, and lymph nodes). Patients with cutaneous tumors and/or folliculotropic disease involvement were identified by review of diagnosis and histology reports.ResultsThe objective response rate to romidepsin was 45% in patients with cutaneous tumors (n = 20) and 60% in patients with folliculotropic disease involvement (n = 10).ConclusionRomidepsin is active in subtypes of CTCL with less favorable outcomes, such as tumor stage and folliculotropic mycosis fungoides