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Saturday, October 7, 2023

Hamas attacks on Israel ‘funded’ by Biden, GOP 2024 candidates say

Critics tore into President Joe Biden as being responsible for Hamas’ assault on Israel Saturday by providing billions to Iran, which funds and supports the terrorist group.

In September, the Biden administration allowed the transfer of $6 billion in frozen assets to Iran — which funds and supports Hamas — in exchange for the release of five Americans.

The White House stressed at the time that Iran could only use the funds for “food, medicine, medical equipment that would not have a dual military use” — but Iran waved off the terms and publicly boasted they would deploy the cash “wherever we need it.”

GOP presidential candidates quickly slammed the Biden administration as playing a role in Saturday’s unprecedented attacks.

GOP presidential candidates quickly slammed the Biden administration as playing a role in Saturday’s bloody attacks.

Florida Governor Ron DeSantis said, “Iran has helped fund this war against Israel, and Joe Biden’s policies that have gone easy on Iran has helped to fill their coffers. Israel is now paying the price for those policies. We’re going to stand with the State of Israel, they need to root out Hamas and we need to stand up to Iran.”

“These Hamas attacks are a disgrace and Israel has every right to defend itself with overwhelming force. Sadly, American taxpayer dollars helped fund these attacks, which many reports are saying came from the Biden Administration,” former President Donald Trump said in a statement.

Former Vice President Mike Pence wrote on social media, “This is what happens when POTUS projects weakness on the world stage, kowtows to the mullahs in Iran with a $6 Billion ransom, and leaders in the Republican Party signal American retreat as Leader of the Free World. Weakness arouses Evil.”

“Hamas’ terrorist attack on Israel today is an assault on Western Civilization. The truth is though, Joe Biden funded these attacks on Israel,” South Carolina Sen. Tim Scott said. “America’s weakness is blood in the water for bad actors, but this is worse than that. We didn’t just invite this aggression, we paid for it. Iran is the biggest funder of Hamas. This is the Biden $6 billion ransom payment at work.”

Former UN ambassador Nikki Haley, a staunch supporter of Israel, also condemned the attacks and pointed to the Hamas-Iran connection.

“Make no mistake: Hamas is a bloodthirsty terrorist organization backed by Iran and determined to kill as many innocent lives as possible. The reports out of Israel are horrific with a stunning number of dead and wounded and should be universally condemned,” Haley said in a statement.

Conservative entrepreneur Vivek Ramaswamy said he was “appalled by the barbaric and medieval Hamas attacks” and called upon the US to stand with Israel.

Online the reaction was much the same, as critics of the Biden administration pounced on the cash giveaway.

“You gave the Iranian Regime $6 billion to launch this war. Resign!.” snapped Richard Grenell, a former Director of National Intelligence, in response to a tweet of condolence from Secretary of State Antony Blinken.

Amid the firestorm Under Sec. Brian Nelson claimed that: “All of the money held in restricted accounts in Doha as part of the arrangement to secure the release of 5 Americans in September remains in Doha. Not a penny has been spent.”

Israeli Prime Minister Benjamin Netanyahu said the nation was “at war” after Hamas — the militant ruling party in the Gaza Strip — launched its deadliest attack on the country in years, with at least 40 Israelis killed and hundreds wounds.

Biden released a statement on the attacks and stressed he was in close contact with Netanyahu.

“The United States unequivocally condemns this appalling assault against Israel by Hamas terrorists from Gaza, and I made clear to Prime Minister Netanyahu that we stand ready to offer all appropriate means of support to the Government and people of Israel. Terrorism is never justified. Israel has a right to defend itself and its people,” Biden said. “The United States warns against any other party hostile to Israel seeking advantage in this situation. My Administration’s support for Israel’s security is rock solid and unwavering.”

His national security team said the US condemns the attacks and that the administration stands firm with the US ally.

“The United States unequivocally condemns the unprovoked attacks by Hamas terrorists against Israeli civilians. There is never any justification for terrorism. We stand firmly with the Government and people of Israel and extend our condolences for the Israeli lives lost in these attacks. National Security Advisor Jake Sullivan has spoken to Israeli National Security Advisor Tzachi Hanegbi and we remain in close contact with our Israeli partners,” NSC spokesperson Adrienne Watson said in a statement.

The NSC did not immediately respond.

https://nypost.com/2023/10/07/gop-2024-candidates-hamas-attacks-israel-funded-biden/

EU Says It Can't Support Ukraine Without US

by Dave DeCamp via AntiWar.com,

The EU’s top diplomat on Thursday said the European bloc could not provide Ukraine with enough support without the US amid uncertainty about when Congress might authorize the next tranche of spending on the proxy war.

"Europe cannot fill the gap of the US," Josep Borrell said after arriving in Spain for a gathering of European leaders, according to POLITICO.

The EU is close to approving a new economic aid package for Ukraine worth 50 billion euros that would cover 2024-2027, although Hungary could further delay the package. European Commission President Ursula von der Leyen said the massive aid package should be approved within the next few months but said US support still remains crucial.

Von der Leyen also said she was "confident" that the US would continue supporting Ukraine but acknowledged she wasn’t sure when new spending would be authorized.

According to a report from The Wall Street Journal, the US has another tranche of economic aid worth over $1 billion to fund the Ukrainian government through the month of October. If a new aid package isn’t authorized by Congress in the next month, the funds will dry up.

The Pentagon has said it still has $5.4 billion in funds to send weapons to Ukraine but has warned it’s running out of money to replace weapons sent to Ukraine. Because of the uncertainty, the Pentagon has said it’s restricted the flow of some arms to the US’s own forces.

The majority of Congress still supports the proxy war, but it’s not clear when they will pass a new Ukraine aid bill after the ouster of Rep. Kevin McCarthy (R-CA) as House speaker.

President Biden is looking for an additional $24 billion in spending and has acknowledged he’s worried about the situation, although he also hinted there are other ways to get the money.

https://www.zerohedge.com/geopolitical/eu-says-it-cant-support-ukraine-without-united-states

Growing Number of Adults With Autism May Burden Medicaid

There is a considerable and growing population of adults with autism enrolled in Medicaid, a finding that mirrors rising autism rates in children — new findings that have implications for the Medicaid system.

METHODOLOGY:

Longitudinal cohort of adults 18 years and older enrolled in Medicaid between January 1, 2011, and December 31, 2019, with a claim for autism and a roughly 1% random sample of all adult Medicaid enrollees.
The prevalence of autism per 1000 Medicaid enrollees was calculated for each year.
The prevalence by race/ethnicity was calculated for study year 2019.

TAKEAWAY:

A total of 403,028 adults had a Medicaid claim for autism at any point during the 9-year study period (74% male, 74% White, 17% Black, 12% Hispanic, 3% Asian, < 1% Native American, Pacific Islander, and 4% multiple races).
Overall autism prevalence (per 1000) rose from 4.2 in 2011 to 9.5 in 2019.
The increase in prevalence over the study period was largest in adults 25 to 34 years (195%) and smallest in those 55 to 64 years (45%).
The prevalence was highest in White Medicaid enrollees and was nearly two times that of the prevalence in all other racial groups in all age categories.
In 2019, 46% of enrollees with autism claims had claims for intellectual disability (ID), down from 62% in 2011, a finding in line with the decreasing co-occurrence of ID over time, highlighting improved diagnostic approaches and awareness of autism without ID.

IN PRACTICE:

"The study findings suggest that despite difficulties in identifying autism in adults, there is a considerable and growing population of autistic adults enrolled in Medicaid. As children on the autism spectrum become autistic adults, Medicaid is an important insurance provider for an increasing number of autistic adults and can be a valuable resource for understanding the health of the autistic population," the authors write.

SOURCE:

The study, with first author Eric Rubenstein, PhD, from Boston University School of Public Health, Boston, Massachusetts, was published online October 4 in JAMA Psychiatry.

LIMITATIONS:

The study relied on ICD codes for autism. The prevalence estimates are based on adults identified with autism and served using Medicaid funds, which may miss undiagnosed adults or those without claims.

DISCLOSURES:

The study was funded by a grant from the National Institute on Aging. The authors report no relevant financial relationships.

https://www.medscape.com/viewarticle/997112

Immunotherapy in early-stage cancer

The impact of immunotherapy, specifically immune checkpoint inhibitors, in advanced and metastatic cancer quickly led to interest in using the therapy in earlier-stage disease. Most recently, the momentum has reached the neoadjuvant setting

opens in a new tab or window.

Currently, neoadjuvant immunotherapy has only two approved indications: triple-negative breast canceropens in a new tab or window and resectable non-small cell lung canceropens in a new tab or window. Ongoing studies are seeking to expand the indications to other types of cancer. A recent reviewopens in a new tab or window highlighted evidence suggesting that neoadjuvant immunotherapy "can expand and transcriptionally modify tumor-specific T-cell clones to enhance both intratumoral and systemic anti-tumor immunity." The effects could have applicability to numerous cancers.

"We consider this approach to cancer immunotherapy to be a gold mine for advancing our scientific knowledge of how an immune checkpoint blockade is working, to define better biomarkers that predict clinical outcomes, and to help us design the next generation of more effective treatments with combination therapies," said Suzanne Topalian, MD, of Johns Hopkins' Bloomberg-Kimmel Institute for Cancer Immunotherapy in Baltimore, lead author of the review article.

Topalian and co-authors identified several themes in their review of immune checkpoint inhibitor clinical trials:

Immunotherapy regimens that prove effective against advanced cancers also tend to be effective in the neoadjuvant setting
The extent of pathologic response after neoadjuvant therapy predicts the relapse-free interval after surgery
Besides priming the immune system's anti-tumor activity, immunotherapy may also improve surgical outcomes by shrinking tumors, potentially making surgery unnecessary in some cases
Pathology specimens after neoadjuvant immunotherapy provide a unique resource to learn more about how immune checkpoint inhibitors work

Melanoma: Where It All Began

Melanoma led the way with clinical proof of immunotherapy's potential for improving outcomes in cancer. Today, melanoma is one of the most active areas of investigation into neoadjuvant immunotherapy. For patients with clinical stage III disease, standard of care consists of surgical resection, lymph node dissection and/or resection of in-transit disease, and consideration for adjuvant systemic therapy. The condition is a high-risk clinical situation associated with high rates of regional recurrence and metastatic progression after surgery.

Neoadjuvant immunotherapy offers the potential to improve outcomes for those patients. However, clinical stage III disease accounts for only about 15% of all new melanoma diagnoses. Investigation into neoadjuvant immunotherapy is limited to that fraction of patients, said Rodabe Amaria, MD, of the University of Texas MD Anderson Cancer Center in Houston.

"Those patients, by definition, have a much higher risk than your average stage III melanoma that has microscopically involved nodal disease," Amaria told MedPage Today. "The approach of upfront surgery and adjuvant therapy is completely appropriate for that patient population."

Though emphasizing that her expertise is in melanoma, she said that the application of neoadjuvant immunotherapy in other cancers might also be limited to high-risk subgroups.

Neoadjuvant immunotherapy is not without potential downsides, Amaria and co-authors noted in a recent review articleopens in a new tab or window about the melanoma experience. Disease progression during neoadjuvant treatment could delay or even preclude surgery. Additionally, treatment-related adverse events could delay or complicate surgery. Even so, neoadjuvant immunotherapy for high-risk stage III melanoma "is an exciting paradigm shift supported by an increasing body of clinical data."

Immunotherapy has demonstrated superior survival versus targeted therapy for advanced melanoma and can be used as initial therapy in patients whose disease has targetable mutations. No targeted agents have approval for neoadjuvant treatment of melanoma, but the superiority of immunotherapy likely extends to the neoadjuvant setting.

"We don't have any randomized trials of neoadjuvant BRAF-targeted therapy versus immunotherapy, but in our observation of different trials and data, I can say that, unfortunately, we are seeing a lot more recurrences with neoadjuvant targeted therapy compared with immunotherapy," said Amaria.

Anticipation Builds

With approved indications in breast and lung cancer, oncologists have already begun applying neoadjuvant therapy to clinical practice. Additional approvals are expected in the near future, so oncologists who treat other types of cancer would not be premature in thinking about patient selection and other aspects of neoadjuvant therapy.

"The recommendation is still for clinical trials, if at all possible, but absolutely, I think people are already thinking that way in the community," said Amaria.

Results with neoadjuvant immunotherapy have been particularly encouraging for melanoma and cutaneous squamous-cell carcinoma, said Ravindra Uppaluri, MD, PhD, of Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston.

In a recent randomized trialopens in a new tab or window, neoadjuvant plus adjuvant pembrolizumab (Keytruda) led to better event-free survival in resectable stage III-IV melanoma as compared with adjuvant pembrolizumab. Another recent prospective studyopens in a new tab or window showed a high rate of pathologic complete response with neoadjuvant cemiplimab (Libtayo) in patients with resectable stage II-IV cutaneous squamous-cell carcinoma.

"Oncologists are feeling more comfortable to use neoadjuvant immunotherapy, and these tumor types will likely have upcoming approvals," Uppaluri said via email.

"Importantly, while many current studies in different tumor types are highlighting a possible approach for our patients with difficult-to-treat cancers, we need randomized clinical trial supportive data prior to integrating this approach as standard of care," he added.

A review articleopens in a new tab or window that coincided with the 2022 American Society of Clinical Oncology annual meeting included a list of almost 50 ongoing phase III trials of neoadjuvant immunotherapy for various types of cancer. The list comprised trials in muscle-invasive bladder cancer, several types of breast cancer, almost a dozen trials in gastrointestinal cancers, ovarian cancer, kidney cancer, head and neck cancer, and lung cancer.

"Administering immunotherapy preoperatively is a biologically sound approach because it is likely the setting in which such therapy can generate the optimal immune response, leading to high rates of pathologic response as well as improved long-term survival," authors of the review article concluded.

Disclosures

Amaria has disclosed relationships with Iovance Biotherapeutics, Novartis, Bristol Myers Squibb/Medarex, Obsidian Therapeutics, Merck, and Genentech.

Uppaluri reported no relevant relationships with industry.

https://www.medpagetoday.com/clinical-challenges/cancer-immunotherapy/106680

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