If youre having a hard time processing the scale of death produced by the COVID-19 pandemic, heres a California alternative for wrapping your mind around the carnage: Visit the largest, prettiest cemetery you can find.

I recommend the original Forest Lawn, in Glendale, the most Californian of cemeteries. I recently walked the 290 acres of this memorial park, the first of six Forest Lawn parks in Southern California, and found that it clarified my thinking and improved my mood.

It also helped me to put in perspective the full human toll of COVID-19. Since Forest Lawn opened 114 years ago, in 1906, it has interred 340,000 souls on this property. Under current projections, the United States will reach 340,000 COVID deaths in January.

If youre looking for global perspective, try Colma, the Bay Areas city of cemeteries, the final resting place for 1.5 million people. The world should surpass 1.5 million COVID deaths before Christmas.

Such statistics are tragic and reflect a fundamental human failure: We experience individual death intensely (be it a friends death or the killing of George Floyd) but struggle to recognize death in the aggregate. This myopia is why we need cemeteries right now.

Cemeteries are not just a place to reflect on the past, wrote longtime Forest Lawn chief executive John Llewelyn in A Cemetery Should Be Forever. They remind us to keep the present in perspective.

Especially when the present is so frightening.

Forest Lawns mission was about putting a sunny California spin on death.

I believe in a happy eternal life, Forest Lawns first real leader, Hubert Eaton, wrote in 1917. I therefore know the cemeteries of today are wrong, because they depict an end, not a beginning. I shall try to build at Forest Lawn a Great Park filled with towering trees, sweeping lawns, splashing fountains, singing birds, beautiful statuary, cheerful flowers, noble memorial architecture with interiors full of light and color, and redolent of the worlds best history and romances.

The resulting memorial park has been critiqued as a Disneyland of Death. But at this moment, I found visiting the happiest cemetery on earth soothing, and thought-provoking.

I encountered joggers, bikers, painters and babies in strollers. I heard birds sing as I enjoyed 360-degree Los Angeles views from the esplanade. A half-dozen people chatted amiably while admiring The Mystery of Life, a sculpture group of 18 human figures gathered at a stream that flows toward an unknown destination.

By its usual standards, Forest Lawn was pretty quiet. Its art museum which houses an important collection of stained glass and William Bouguereaus 1881 painting Song of the Angels was closed. There were no school field trips on the grounds. Tens of thousands of people, including Ronald Reagan, have been married at Forest Lawn, but during my visit there were no weddings in the cemeterys three churches, which were locked.

Still, I enjoyed the way the place resembles Southern California in miniature, with its varied topographies (windswept hills, cool valleys, a sprawling basin), and obsession with being big (Forest Lawns wrought-iron gates are twice as wide as those at Buckingham Palace, and the Hall of Crucifixion houses the worlds largest permanently mounted religious painting).

In an older, flatter cemetery section I walked amidst the century-old graves of people who died in their 20s of Spanish flu. In the Court of Freedom, I admired a giant outdoor reproduction of John Trumbulls Signing of the Declaration of Independence and reflected on Jeffersons wisdom in putting life before liberty and pursuit of happiness.

This pandemic is killing so fast that were not stopping to appreciate the lives lost. We will need to remember the plagues lessons, to honor its sacrifices, so we might see its afterlife as a beginning, not an end.

Here in California, we should memorialize every one of our pandemic dead, with a monument that is beautiful and big, and makes people happy when they visit it.

Joe Mathews wrote this column for Zcalo Public Square.

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Mathews: Two cemeteries put scale to the coronavirus carnage - The Mercury News

As the coronavirus pandemic drags on, Larimer County Director of Public Health Tom Gonzales and CSU President Joyce McConnell talk every day, by phone, text or video meeting. But they had not met in person until Friday, when the public health team paid a visit to the CSU Veterinary Diagnostic Laboratory, which is processing an average of 1,000 COVID-19 tests from county residents and Colorado skilled nursing facilities every day.

In the early days of the pandemic, university health and research leaders recognized that the laboratory was uniquely positioned to contribute to Larimer Countys testing capacity. In April, lab director Dr. Kristy Pabilonia worked with CSUsHealth and Medical Center and the office of the Vice President for Research to obtain Clinical Laboratory Improvement Amendments (CLIA) certification for laboratory testing performed on humans.

Since then, the lab has processed more than 60,000 COVID-19 tests, in addition to 95,000 veterinary cases, for pathogens such as rabies and tularemia. In a normal year, the lab processes over half a million animal tests.

People might not realize that weve been so strong in veterinary diagnostics for a long time. To make the transition to human testing so quickly demonstrates the wisdom of a university and all of its teams to be able to pull together and make that happen. I want to recognize Kristy and the people here the way they have mobilized has been extraordinary, McConnell said.

The conversion of the Veterinary Diagnostic Laboratory to serving human clinical needs during COVID is a great story that involves many across campus, Alan Rudolph, CSUs vice president for research, said after the tour. Indeed, the VDL has been amazing in executing 3,000-5,000 tests per week that have been supporting the state senior care workforce and saving lives. The lab is processing those tests as part of the Columbine Health Systems Center for Healthy Agings research project testing asymptomatic health care workers and residents in skilled nursing facilities.

As positive cases continue to rise, Gonzales (a 1996 CSU Environmental Health alum) and his team came away from the visit with bolstered confidence about the integrity of the testing process. The public can access the latest data on Larimer Countys dashboard.

We feel very confident that when a test is positive, its positive, and that helps with contact tracing, said Gonzales as he watched scientists handling samples behind thick glass in the labs Biosafety Level 3 facility. Seeing the people in action, the great work thats going on here, it is phenomenal. Its helping us to beat this pandemic.

The BSL-3 lab tests highly infectious bacteria and viruses, including SARS-CoV-2, using high-throughput equipment (real-time polymerase chain reaction assay) that can test 96 samples at a time. Machines run continuously and the staff has been working overtime to keep up with the rising demand. Labs across the country share hard-to-find supplies, even basics like alcohol and pipette tips.

Our public health system is fragile, fragile enough that sometimes we cant even get pipettes, McConnell said. Understanding the points in our process that are fragile is very important for the public to know. The entire system needs support.

Click to learn more about supporting the College of Veterinary Medicine and Biomedical Sciences Emerging Infectious Disease fund.

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'We roll up our sleeves and get it done.' More than 60000 COVID tests, and counting - Source

The Greek island of Alonissos has been honoured by National Geographic on its renowned Best of the World list of destinations for 2021.

National Geographics Best of the World 2021 list showcases 25 destinations selected by its Global Editors of International Travel.

The list tells stories of conservation successes, preservation achievements, cultural resilience, and tales of communities overcoming daunting obstacles to thrive despite the pandemic, says National Geographic in a recent release.

Sustainability, Family, Nature, Adventure and Culture have been chosen by National Geographic as the five categories for its 2021 list which is intended to serve as inspiration for future adventures.

With the new underwater museum where visitors can explore the remains of a 2500-year-old shipwreck and boasting the largest Marine Park in the World, Alonissos adorns the list in the Sustainability category which celebrates six superlative destinations across Europe, Africa and the United States.

Destinations in the Sustainability category also include New Caledonia in France, with its 1.3-million square kilometre marine park; the African country of Gabon, with more than 11 percent of the country being national parkland; Copenhagen, the sustainable solution creating cosmopolitan capital of Denmark; the university town of Freiburg in Germany that is schooling the world on the best green practices; and green giant of a city, Denver, Colorado with its goal of achieving 100 percent renewable electricity by 2030.

Alonissos, its surrounding waters and minor islands, including Peristera, Kyra Panagia, Gioura, Psathoura, Skantzoura and Piperi, form the Alonissos Marine Park, the largest of its kind in Europe.

Each of the seven main islands within the park possesses its own unique characteristics, charm and history.

Officially established by Presidential Decree in 1992, the National Marine Park of Alonissos spans an estimated 2,250 square kilometres of the Aegean Sea, making it the largest reserve of its kind in the Mediterranean.

From both a cultural and scientific point of view the Alonissos Marine Park is an area of great interest given the archaeological finds (shipwrecks, old monasteries and churches) dating back to the prehistoric era, the classical period or the Byzantine Empire.

In addition to its archaeological ruins, the Alonissos Marine Park is a place of unspoilt natural beauty that is also home to a fascinating variety of flora, fauna and marine life including the critically endangered Mediterranean monk seal.

Alonissos

Alonissos is the largest and only inhabited island in the group, offering several lovely villages to explore, great walking tracks and numerous beaches.

The beautiful Chora Village of Alonissos was the old capital before a major earthquake in 1965 destroyed the entire settlement. At that time all the inhabitants deserted the village and moved near the coast where they built Patitiri, the new capital of Alonissos.

Since that time, some parts of the old Byzantine wallshave been restored, as well as some houses that can today be seen as cafes, guest houses and local shops.

At just 14 kilometres long and 4 kilometres wide, Alonissos provides a wealth of riches when it comes to beautiful beaches, many of which are accessible only by sea along the more secluded east coast and around the southern tip.

The scientific and administrative centre of the National Marine Park is based on Alonissos as a rescue centre for the critically endangered Mediterranean monk seal.

Peristera

The island of Peristera, is separated from its nearest neighbour Alonissos by a narrow channel of water.

In these waters lies the remarkable ancient Peristera shipwreck. The Peristera shipwreck has only recently opened as the first underwater museum in Greece, becoming accessible to recreational divers only as of April 2019.

Believed to have sunk because of bad weather around 425 BC, the big merchant ship was laden with an estimated four thousand vases and amphorae of wine from Chalkidiki in Northern Greece and the island of Skopelos, Pari Kalamara, director of the Ephorate of Underwater Antiquities has said.

An amphora (Greek: amphoreus) is a jar with two vertical handles used in antiquity for the storage and transportation of foodstuffs such as wine and olive oil.

Called the Parthenon of shipwrecks, the eerie remains of the large Athenian cargo ship that sank in the fifth century B.C. is of major significance to historians.

The Peristera wreck is the largest ship of its time ever found and its discovery has changed archaeologists understanding of shipbuilding in antiquity.

Up to then, we thought that large ships that were carrying 1,500 amphoras and were up to 70 tons, they were built by the Romans in the 1st century B.C., explained Elpida Hadjidaki, the first archaeologist to excavate the site. Well, now we have a ship that was not built in the 1st century B.C., it was built in the 5th century B.C., it carried 4,000 amphoras and God knows what else and its 126 tonnes.

Kyra Panagia

Kyra Panagia, sitting just 7 kilometres off Alonissoss northern tip, is a small uninhabited island and the site of a 17th century monastery.

Like several minor islands in the Sporades, Kyra Panagia has remained the property of the Monastery of Megisti Lavra, since it was granted the island by the Byzantine emperorNikephoros II Phokasin 963.

The monks of Monastery of Megisti Lavra used Kyra Panagia as a place where they could grow food and make wine for their community and those of other monasteries on the flanks of Mount Athos.

In the bay of Agios Petros, one of the islands two natural harbours, an even older civilization has been found including the remains of an 11th century Byzantine shipwreck.

Excavations revealing ceramics, small statues, tools, and animal bones have found that this civilization dates from the Neolithic times, in about 6,000 B.C.

Gioura

Gioura, whose treeless hills and rugged cliffs make it appear unwelcoming, is uninhabited save for a freely roaming, autochthonous (native) species of rare wild goat known as Homers Cyclops and one or two guards that remain permanently on the island in order to protect the wildlife and the archeological sites.

The island is famous for a stalactite cave that sheltered Homers Cyclops known as Cyclops Cave, a Middle Neolithic settlement that was discovered in 1992 providing evidence that Gioura had been inhabited on and off for millennia.

Archaeologists have found decorated vessels, flint blades, stone artefacts, animal bones, primitive jewellery, bone hooks and part of a human skull thought to date back to the Mesolithic Era (9th-7th century BC).

Pottery from the Bronze Age has also been found.

Roman-era lamps found in remains on top of the cave have shown that the cave served as a sanctuary around the 2nd and 3rd century A.D.

Remains from the Hellenistic period have also been found deep inside the cave.

Not just a treasure trove for archaeologists, Cyclops Cave also provides wonder to geologists because of its numerous stalactites and stalagmites.

Psathoura

Isolated and uninhabited, Psathoura island was formed from a volcano that was active in the Pleistocene era.

The earthy, fertile and almost totally flat surface of Psathoura is home to a very unique range of plants, many of which, such as sea daffodils, heather and sand lilies, are not found on the other islands.

The shallow waters that surround the island barely cover the archaeological remains of a ruined city.

The village, presumably submerged by rising sea levels, was discovered in by divers from Kalymnos off the southern coast of Psathoura at a depth of 10 to 17 metres.

Standing at 28.9 metres tall, the Psathoura lighthouse, built in 1895, is one of the tallest in the Aegean.

Landmarks of Psathoura also include the idyllic, sandy Mandrako Beach with its exotic turquoise waters.

Skantzoura

Skantzoura is an 8 kilometre square island with large sections of its shores made of white marble.

The cliffs of Skantzoura provide one of the most important breeding habitats in the Aegean for rare species of birds including Audouins gull and Eleanoras falcon.

The island of Skantzoura is home to the remains of the 17th century Monastery of Evangelistria.

A diary belonging to a monk was discovered which tells the tale of a war between the native tribes of the island and the monastery, resulting in the abandonment of the monastery and the monks sailing back to their homeland.

The entity of monastic buildings includes the church, a vaulted room with a well in the floor plus several more stone-built storage rooms and stables.

Behind the monastery are wide terraces of former vineyards from which one can capture a view over the entire island of Skantzoura, the nearer and distant islands of the Marine Park of Alonissos.

Not far from the Monastery of Evangelistria lie the ruins of an even older, ancient monastery.

Piperi

Piperi island is the core of the National Marine Park of Alonissos and the most protected island in the archipelago.

It is completely off limits to visitors and boats may not sail within a 5 kilometre radius of its coast.

This is due to the fact that the critically endangered Mediterranean monk seals (Monachus monachus) live and breed in the caves and along the beached of Piperi.

Conservationists estimate that there are probably less than 500 pairs of monk seals existing in the world today.

Traditionally hunted for their skins, oil and killed by fishermen who considered them competition for fish, numbers of monk seals have dwindled even further of late as a result of disturbance and pollution by humans along the coasts they inhabit.

Female monk seals have a slow reproduction cycle and they are also extremely vulnerable when gestating. If unnaturally disturbed through the gestational process, a female monk seal can easily abort her young.

A 1st century grave discovered in excavations in Rhodes Harbour in 1999, contained the skeleton of a monk seal, buried with funerary honours in a family burial, together with the remains of humans and a dog, suggesting that the seal had been considered a family member.

These incredible finds displayed in the Rhodes Aquarium provide an amazing insight into not only the attitudes towards animals in ancient times but also the social and trusting nature of the seal.

Ironically however, it seems that this very sociability of the seal has led to it becoming one of the rarest mammals barely surviving in the world today.

Traveling by ferry to the beautiful, lush, island of Alonissos is now easier with Ferryhopper. Book your ferry tickets from Volos, Mantoudi, Skiathos or Skopelos to Alonissos in just 4 clicks and start planning your ideal holidays in Sporades islands.

The world isfull of wonderseven if theyre hard to reach, says National Geographic.

While the pandemic has brought our journeys to a standstill, it has not quieted our curiosity.

Ahead of a new yearwith the promise of a return to travelwe are eager to share these 25 timely tales of timeless places that will define our future itineraries.

Sustainability

Alonissos, Greece

Copenhagen, Denmark

New Caledonia, France

Freiburg, Germany

Gabon, Central Africa

Denver, Colorado

Family

England Coastal Path

Transylvania, Romania

Space Coast, Florida

Hortobagy, Hungary

Indigenous British Columbia, Canada

Adventure

Dominica

Svaneti, Georgia

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Alonissos Honoured By National Geographics Best Of The World List 2021 - Greek City Times - Greek City Times

Felix Gonzalez-Torres/Felix Gonzalez-Torres Foundation

Felix Gonzalez-Torres: Untitled, 1991

Often, these days, when Im in a museum or gallery, I find the artwork on offer surrounded by large helpings of didactic wall text telling me how to see what Im seeing. At the time of the 2019 Venice Biennale, for example, the Palazzo Grassi hosted a Luc Tuymans exhibition in which painting after painting was accompanied by an explanatory narrative. The signage for Orchid, a strikingly green close-up of a flower, for some reason told viewers that mens semen is becoming less and less dense and fertile at a time when plants are modifying and enriching their sexual characters in order to adapt and survive. The large and quite beautiful Still Life apples and other fruit with a jug of clear water in the backgroundis dated 2002 and the curators wanted us to know that we arent just seeing fruit and water, that the work is actually about the tragedy of 9/11. Not directly, of course: the painting doesnt respond to the terrorist attack as such, but instead turns it toward the viewer in an interrogative, mysterious or alarming manner. Then were told the point of the painting, that its not to show the explosion, the two smashed buildings, or the bodies buried under the rubble, but what is left beyond good and bad, after the catastrophe, once the cloud of dust has settled.

A passage in Walter Benjamins famous essay on art and mechanical reproduction made me wonder recently if the seed for the current kudzu of wall text hadnt been planted late in the nineteenth century. In Benjamins telling, the rise of photography initiated a historic shift, the move away from religious or ceremonial artworks destined to serve a cultto work made simply for exhibition. Photography at first carried forward some of arts old values, the cult of remembrance of loved ones, but when the human face disappeared from photographs, the shift toward exhibition value became clear. Benjamin singles out Eugne Atget as the man who, around 1900, pinpointed this new stage by taking photographs of empty Paris streets. It has quite justly been said of him that he photographed them like scenes of crime. The scene of a crime, too, is deserted; it is photographed for the purpose of establishing evidence. Atgets streets are not crime scenes, but how to make that clear? Free-floating contemplation is not appropriate to them and therefore picture magazines begin to put up signposts for the viewer. For the first time, captionsbecome obligatory. Captions are directives; they tell us how to see what we are seeing.

Early in his career, given the possible tension between images and texts, the American artist Felix Gonzalez-Torres (b. Cuba, 19571996) made a cunning move: he simply split the elements and made two kinds of art, captions without images and images without captions. The inspiration for that move may have come from the catalog for the Jewish Museums 1966 Ad Reinhardt retrospective, which included the artists own chronology of his life. Gonzalez-Torres never saw the show (he was a child in Cuba at that time), but he did eventually see the catalog and was taken with the way Reinhardt so thoroughly dispensed with the usual distinction between private life and public history:

1913 Born. New York, Christmas Eve. . .

1913 Malevich paints first geometric-abstract painting. . .

1915 Gets crayons for birthday, copies funnies, Moon Mullins, Krazy Kat and Barney Google.

1916 Juan Gris paints Dish of Fruit. . .

1917 Cuts up newspapers. Tears pictures out of books.

1917 October Revolution in Russia. Lenin replaces Kerensky. . .

And so on up to the time of the exhibition:

1964 Ten paintings in London get marked up.

1964 China explodes atomic bomb.

1965 Man walks in space.

1966 One hundred twenty paintings at Jewish Museum.

Gonzalez-Torres understood this sort of chronology as a form of self-portraiture andwhether prompted by Reinhardt or notit became his practice when making portraits to dispense with images and offer only dateline captions. In 1994, when Robert Vifian, who owned a famous Paris restaurant, commissioned a portrait from Gonzalez-Torres, the result was a painted frieze circling the walls of a room, a running set of captions (supplied by both Vifian and the artist):

Agent Orange 1961

First T.V. 1966 7 p.m.

The Berlin Wall 1989

and so on. In a letter to Vifian, Gonzalez-Torres explained his approach: Photographscan tell us almost anything (that is why captions are so important, not just for newspapers). I then, in these portraits, go the other way around. Rather than offering an image supported by a caption, Gonzalez-Torres provides a series of captions, each one just a phrase or coded word for which the viewer must then provide the image.

Gonzalez-Torres had been making such dateline works since 1987, the early ones printed as black photostats with the captions in white type. The first of these begins Bitburg Cemetery 1985, a caption that for some people will call to mind an image of Ronald Reagan visiting a Nazi graveyard in Germany or perhaps of the protest signs that met him. If I myself am to provide the image, however, what comes to mind is a cat. My family has the habit of naming cats after historical events, and so, for many years, the veterinarian and everyone else knew the kitten we adopted in 1985 as Bitburg. As for the images that I might provide for the other caption fragments of Gonzalez-Torress Bitburg photostat, they end up forming an idiosyncratic Lewis Hyde self-portrait:

Walkman 1979: I see an artist friend who removed the guts of his Walkman and kept them in a plastic bag, all the colorful little wires and transistors.

Cape Town 1985: I see a still from a film about South Africas Truth and Reconciliation Commission, a hysterical woman being led from the courtroom.

Water-proof mascara 1971: I see a woman diving into a swimming pool.

Personal computer 1981: I see my late father at his desk.

TLC: I draw a blank! Maybe a bottle of hand lotion.

On the other side of Gonzalez-Torress division of text and image, we get photographs without any directive captions at all. To approach these reticent images, it helps to know about Gonzalez-Torress resistance to one strain of art-world identity politics. Rather than presenting himself overtly as a gay artist, Gonzalez-Torres preferred to work as a sort of secret agent in the house of culture. He found a remark hed read by a right-wing activist inspiring. I want to be invisible, the man said. I do guerilla warfare, I paint my face and travel at night. You dont know its over until you are in the body bag. You dont know until election night. This is good! This is brilliant! said Gonzalez-Torres. I want to be a spy, too. I want to be the one who resembles something else. The puzzle then was how to make work that, in his words, was in some sense about homosexual desire but was nonetheless inclusive rather than oppositional. His solution was to move toward formalism, toward works that foreground the shape of things, leaving their content to be discovered. A formalist work doesnt showcase its politics; its title can always be Untitled. Political fights dont come up in the same way if you are interested in beautiful abstractions.

Formalist work is deadpan; it carries no directives, no reading instructions. Deadpan is cunning in this regard in that it places the burden of interpretation on the audience. Gonzalez-Torres was working in the 1980s and 1990s when public funding of the arts was under attack from conservative legislators, and he was amused to think of the quandary his work might present to those culture warriors. Were a congressman to come to the Hirshhorn Museum in Washington, D.C. and find that the government had supported an artist who hung two wall clocks next to each other, it would be hard for the politician to attack the work as homosexual art unless he were willing to share the fantasy life that had led him to that conclusion.

One of Gonzalez-Torress better-known captionless photographs shows the rumpled white sheets and the head-dented pillows of an empty double bed. The image was originally displayed in 1992 on twenty-four billboards scattered around the city of New York. The bed belonged to the artist and, in the months following the AIDS death of his lover, Ross Laycock, he photographed it, prompted in part by a memory of lines from a Wallace Stevens poem that both men admired: We made a dwelling in the evening air, / In which being there together is enough.

There are many ways to read this image, writes bell hooks in her essay on Gonzalez-Torres, adding that those who know the story will naturally find the power and pleasure of love and loss, the anguish of grief. As for those who know no such details, who stroll the streets of Manhattan and come across a bed on a billboard, the image is to be entered not through empathy with the artist, but by way of ones own relationship to. To what? To a current hot love affair? To a desire for high-end cotton sheets? To a crime scene? Granted, an empty bed is not quite like one of Atgets ambiguous deserted Paris streets, but still, as one curator tells us, for Gonzalez-Torres, the bed suggests not only personal and social realities, but another reality, which is the law. Much on his mind in those days was the 1986 Supreme Court decision upholding Georgias anti-sodomy law. Had those billboards been mounted in Atlanta in the 1980s, the double bed could plausibly have been taken for a crime scene.

The photo by itself asks for none of those readings, of course, nor did Gonzalez-Torres. As with most of his work, its title was Untitled and, when reproduced in books, the only other information added is Billboard. Dimensions vary with installation. And yet its worth noting that after bell hooks explains how the image can be read many ways, she herself cant do it; imagining the masses of viewers who saw this work without knowing the backstory, she offers no speculative range of readings but quickly returns to remembered grief. This formalist may be reticent, but once his story gets into your head, its hard to get it out.

Theres another way that Gonzalez-Torres imagined himself as an artist, not just as a spy in the house of culture but as a virus in the body politic. He once told the conceptual artist Joseph Kosuth that he had no interest in working outside the structures of power. No. I want to have power. I want to be like a virus that belongs to the institution. All the ideological apparatuses arereplicating themselves, because thats the way the culture works. So if I function as a virus, an imposter, an infiltrator, I will always replicate myself together with those institutions. Similarly, in a 1994 conversation with curator Hans Ulrich Obrist: the virus is our worst enemy, but should also be our model in terms of not being the opposition anymore, not being very easily defined, so that we can attach ourselves to institutions which are always going to be there.

Theres a lot going on in these remarks. To begin with the literal, remember that Gonzalez-Torres worked during the height of the AIDS epidemic, that his lover died of the disease, and that he himself carried HIV. So, of course, literally, the virus is our worst enemy, as he says, though then he adds a but and pivots to his metaphorical model. If we stick to the literal, however, that but can also point to medical history, which teaches that not all viruses are bad (the benign cowpox virus, for example, provides immunity against the malignant smallpox virus), or evolutionary history, which has shown that we would not be who we are without some viral help. Recent genome science has proposed that many features of the human body arose through horizontal gene transfer, entire packets of DNA moving sideways from one organism into another, acquired, that is, not by inheritance but by infection. Roughly 8 percent of the human genome consists of the remnants of retroviruses, science writer David Quammen tells us. We are at least one-twelfth viral.

Before any such historic virus benefits or any of the more present and common virus disasters can occur, the virus needs to find a way into the body and then, if it is to survive, to elude or suppress the immune system. HIV-1 became so literally deadly because it mastered both of those steps so well. As for a more metaphorical art virus, how might it get itself into the museums and galleries and how might it defeat their institutional defenses?

Gonzalez-Torress main suggestion is that viral works will do well to look like something else. He was always clear about his debts to and admiration for the minimalists who came before him. It isnt hard to see a link between a Carl Andre floor covered with a layer of metal tiles and a Gonzalez-Torres floor covered with a layer of blue-and-white candies; or a link between Donald Judds aluminum boxes and Gonzalez-Torress neat rectangular stacks of printed paper. Judds boxes, of course, have no social agenda, hidden or otherwise, but Gonzalez-Torress paper stacks do, each piled sheet bearing an often politically suggestive text (as with one that simply declares We Dont Remember in German: WIR ERINNERN UNS NICHT). The stacks look so powerful, says Gonzalez-Torres, they look so clean. Butwhen you get close to them you realize that they have been contaminated with something social.

Gonzalez-Torres also counted on the publics acquisitiveness and sweet tooth to help give his work its viral spread. Why does anyone take one of his free printed works home? To share in its beauty, perhaps, but also just to have it, to own it. And a candy taken from the piles on offer to gallery patronsa little sugar hit! The work may look minimalist but, in fact, it has what the minimalists typically resisted, a performative element. I need the public to complete the work, said Gonzalez-Torres. How do they do that? By accepting its free offerings, whereupon the pieces just disperse themselves like a virus that goes to many different placeshomes, studios, shops, bathrooms, whatever. The candies are sweet treats, yes, but they are also viral packets.

Felix Gonzalez-Torres/Felix Gonzalez-Torres Foundation

Felix Gonzalez-Torres: Untitled (Lover Boys), 1991

How does the split between image and text, installation and explanation, play out in this viral framework? Gonzalez-Torress Untitled (Lover Boys), a pile of candies individually wrapped in silver cellophane, first appeared at the 1991 Whitney Biennial. The accompanying signage was decidedly reticent. What if it hadnt been? Suppose there had been an explanatory notice of the sort I encountered at the Luc Tuymans exhibition:

If I do a portrait of someone, Felix Gonzalez-Torres has said, I use their weight. In this case, the pile of candy weighs about 355 pounds, the combined weights of the artist and his lover, Ross Laycock, now dead of AIDS. Visitors to the exhibition are invited to sample what the artist calls the endless supply of candy: Im giving you this sugary thing, he has said. You put it in your mouth and you suck on someone elses body . . . For just a few seconds, I have put something sweet in someones mouth and that is very sexy. Gonzalez-Torres has also described the work as very masochistic in that it symbolically invites the public to eat away at the Lover Boys bodies and in so doing to play the role of the AIDS virus which has already destroyed the body of Ross Laycock and promises to do the same to the artist. The candy in this case represents the virus itself and, in satisfying a hunger for something sweet and intimate, the public becomes the disease vector, acquiring an infection carried by sugar rather than by mens semen.

I myself have enjoyed a sweet taken from one of Gonzalez-Torress candy spills, but I probably would have held back if something like that had met me on the gallery wall.

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In his study of Japanese haiku, R.H. Blyth tells the story of a potter named Nonko, a masterful maker of black bowls used in tea ceremonies. Upon first glance, a bowl from Nonkos shop would seem plain and unappealing, but, handled again and again over the years, its deep beauty would slowly appear. The highest art of the artist is to hide rather than to reveal beauty, Blyth concludes.

It was the great wit of Gonzalez-Torress practice to bring a comparable understanding to the political portion of his work. Since Duchamp, it has often been said that the audience completes the work of art. The twist here is that the audience cannot do that without at the same time risking being infected, as it were, by Gonzalez-Torress concerns. It took considerable spycraft and aesthetic savvy to make that transmission possible. Long before his interest in viral invisibility, Gonzalez-Torres had made the useful split between image and textcaptions without images, images without directivesa move that continues to protect the work from having its point too readily declared. Not that its hard to find a point, but spectators must discover or create it for themselves. What they find will vary from person to person and from age to age, depending on whatever free associations, hungers, politics, and diseases are in the air. Meanwhile, the work sits there in silence, always untitled, always in endless supply.

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The Powerful Reticence of Felix Gonzalez-Torres | by Lewis Hyde - The New York Review of Books

Mangsirthe eighth month of the Nepali calendar system has two major connotations. For farmers of the country, this is the harvest season. For marriageable young men and women, however, this is the time to find their life partners or to tie conjugal knots with their loved ones.

Generally, four months, before Mangsir, are not considered auspicious for the wedding in the traditional Hindu astrology whereas the next month is also not a favourite. This years case is even harder; if any couple misses the chance of Mangsir, they will have to wait until Baishakh (mid-April to mid-May 2021) to find an auspicious date. Therefore, it is likely that you might have several wedding receptions to attend this Mangsir.

But, why is that?

We have some helpful information for you.

Astrologer Basudev Krishna Shastri says it is important for a wedding to happen on a holy date because it is one of the 16th samskaras (rites of passage) as per Hindu Vedic traditions.

Marriage is related to the continuation of human species in this world, he explains, The Vedic tradition, hence, considers a wedding as the combination of two souls that should be united with the blessings of all the gods and goddess from all four directions, the sun, the moon and the stars.

And because fire is also considered a god as well as an agent via which all other gods receive offerings given by humans, it is important that one weds beside a fire on an auspicious date, according to him.

The traditional calendar system divides a year into two halves, called Uttarayana and Dakshinayana. According to astrologer Laxmi Prasad Baral, most weddings take place in Uttarayana (Magh to Asaar or mid-January to mid-July). During these months, the sun travels to north from south in the celestial sphere, he says, But, Chaitra (mid-March to mid-April) is an exception when weddings cannot be scheduled.

The Yamalok lies in the south where the god of death, Yama, lives. Basically, the south is known as the direction of pitris (ancestors) and the north is of gods and goddesses, adds Baral, Therefore, the weddings in the Dakshinayana (when the sun travels towards the south from the north) are not considered good. But again, there is also an exception of Mangsir (mid-November to mid-December).

For him, the practice of performing weddings in the Mangsir month (one of the months of Dakshinayana) was lately developed considering that Lord Vishnu had also awoken from his four-month sleep by this time, describes Baral.

Shastri says astrologers calculate good dates for a wedding after studying the movement and positions of the sun, the moon and other planets in the solar system, mainly, Jupiter and Venus. Likewise, the five elements of time (Panchanga)tithi, nakshatra, yog, bar, and karanare also considered.

Among nine planets recognised in the traditional astrology, positions of Jupiter and Venus are important in fixing a wedding date. Jupiter is the guru of all gods whereas Venus has a role in reproduction, Shastri explains One can wed only when both Jupiter and Venus are on the rise (udaya).

The months of Magh and Phalgun this time (mid-January to mid-March 2021) do not have any wedding date. Jupiter will set on the western direction on January 17 and Venus will set on the eastern direction on February 12, Shastri informs, Jupiter will rise back on February 14, but Venus will be set beyond mid-March.

Meanwhile, Surya Prasad Dhungel, the member-secretary of Nepal Panchanga Nirnayak Samiti, the government authority assigned to decide festival dates and auspicious times, adds, There are only 11 (out of 27) nakshatras ideal for weddings. Hindu scriptures have also clearly mentioned the ideal tithis and months for weddings and other occasions. Also, weddings cannot be held during a malamaas or kshayamaas.

Understanding an exact calculation requires a deep study of astrology and a long time, Dhungel says, adding the avid learner consults astrological masterpieces such as Muhurta Chintamani while calculating wedding dates.

Because there are a few selected dates for weddings in a period, finding a space for wedding receptions on and around those dates is a real hurdle for residents of crowded cities such as Kathmandu. Moreover, families find it difficult to attend multiple parties on a single day.

That is why, nowadays, there are many who do not wait for the auspicious dates to get married. Likewise, people have begun considering weddings on other festivals such as Akshaya Tritiya, Bibaha Panchami, Krishna Janmashtami, and Navaratri as auspicious too.

But, Baral highlights weddings cannot take place on Krishna Janmashtami or Navaratri as Lord Vishnu, the main god of yagyas who grant the worshippers the fruit of yagyas, is asleep this time.

Moreover, Shastri finds the trend of defying set dates and marrying on other dates completely wrong and comments, If the wedding is to be performed as per Vedic tradition, the couples have to wait for an auspicious date. If not, there will negative consequences on their marital life. Also, there will be difficulty in reproduction; their child might be born with several disabilities.

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Another wedding season in Nepal: Why too few dates for too many couples every year? - Online Khabar (English)

In this Phase 2, multicenter, randomized, double-blind study (NCT02702388), 152 patients with RAI-refractory DTC were randomized to receive a daily oral dose of either 24 mg or 18 mg of LENVIMA. The objective of the study was to evaluate whether a lower starting dose of LENVIMA (18 mg) would provide comparable efficacy with an improved safety profile compared to the approved 24 mg starting dose of LENVIMA. The primary efficacy endpoint was noninferiority of LENVIMA 18 mg versus 24 mg for objective response rate (ORR) at Week 24 (ORRWK24) based on investigator assessment per Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. The primary safety endpoint was the occurrence ofany Grade 3 treatment-emergent adverse events (TEAEs) within 24 weeks after randomization.

"These investigational data reiterate that the approved dosing of LENVIMA delivers a clinically significant benefit and consistent safety profile for patients with RAI-refractory DTC," said Dr.Takashi Owa, Vice President, Chief Medicine Creation Officer and Chief Discovery Officer, Oncology Business Group at Eisai. "It's through studies like this we're able to show our dedication to enhancing healthcare providers' understanding of our medicines. This helps them to best serve patients with this difficult-to-treat cancer."

Results from the study showed:

Overall ORR was 64.0% (95% CI: 53.174.9) in the 24 mg arm vs. 46.8% (95% CI: 35.657.9) in the 18 mg arm. Overall, serious TEAEs occurred in 33.3% of patients in the 24 mg arm vs. 40.3% in the 18 mg arm. TEAEs resulted in dose reduction in 69.3% in the 24 mg arm vs. 59.7% in the 18 mg arm and treatment discontinuation occurred in and 14.7% and 16.9%, respectively. The most common any-grade TEAEs include:

Study 211 was conducted as a post-marketing commitment to the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA) and other regions following priority review designation and approval of LENVIMA for the treatment of patients with locally recurrent or metastatic, progressive, RAI-refractory DTC.

In March 2018, Eisai and Merck (known as MSD outside the United States and Canada), through an affiliate, entered into a strategic collaboration for the worldwide co-development and co-commercialization of LENVIMA.

This release discusses investigational uses for FDA-approved products. It is not intended to convey conclusions about efficacy and safety. There is no guarantee that any investigational uses of FDA-approved products will successfully complete clinical development or gain FDA approval.

About Thyroid Cancer

Thyroid cancer is the most common endocrine malignancy and global figures show that its incidence is on the rise. In 2020, it is estimated that there will be 52,890 new cases of thyroid cancer in the U.S. and that women are three times more likely to develop thyroid cancer than men. The most common types of thyroid cancer, papillary and follicular (including Hrthle cell), are classified as DTC and account for approximately 90% of all cases. While most patients with DTC are curable with surgery and radioactive iodine treatment, the prognosis for those patients whose cancers persist or recur is poor.

About LENVIMA (lenvatinib) Capsules

LENVIMAis indicated:

LENVIMA, discovered and developed by Eisai, is a kinase inhibitor that inhibits the kinase activities of vascular endothelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). LENVIMA inhibits other kinases that have been implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including fibroblast growth factor (FGF) receptors FGFR1-4, the platelet derived growth factor receptor alpha (PDGFR), KIT, and RET. In syngeneic mouse tumor models, lenvatinib decreased tumor-associated macrophages, increased activated cytotoxic T cells, and demonstrated greater antitumor activity in combination with an anti-PD-1 monoclonal antibody compared to either treatment alone.

Important Safety Information

Warnings and Precautions

Hypertension.In DTC, hypertension occurred in 73% of patients on LENVIMA (44% grade 3-4). In RCC, hypertension occurred in 42% of patients on LENVIMA + everolimus (13% grade 3). Systolic blood pressure 160 mmHg occurred in 29% of patients, and 21% had diastolic blood pressure 100 mmHg. In HCC, hypertension occurred in 45% of LENVIMA-treated patients (24% grade 3). Grade 4 hypertension was not reported in HCC.

Serious complications of poorly controlled hypertension have been reported. Control blood pressure prior to initiation. Monitor blood pressure after 1 week, then every 2 weeks for the first 2 months, and then at least monthly thereafter during treatment. Withhold and resume at reduced dose when hypertension is controlled or permanently discontinue based on severity.

Cardiac Dysfunction.Serious and fatal cardiac dysfunction can occur with LENVIMA. Across clinical trials in 799 patients with DTC, RCC, and HCC, grade 3 or higher cardiac dysfunction occurred in 3% of LENVIMA treated patients. Monitor for clinical symptoms or signs of cardiac dysfunction. Withhold and resume at reduced dose upon recovery or permanently discontinue based on severity

Arterial Thromboembolic Events.Among patients receiving LENVIMA or LENVIMA + everolimus, arterial thromboembolic events of any severity occurred in 2% of patients in RCC and HCC and 5% in DTC. Grade 3-5 arterial thromboembolic events ranged from 2% to 3% across all clinical trials. Permanently discontinue following an arterial thrombotic event. The safety of resuming after an arterial thromboembolic event has not been established and LENVIMA has not been studied in patients who have had an arterial thromboembolic event within the previous 6 months.

Hepatotoxicity.Across clinical studies enrolling 1,327 LENVIMA-treated patients with malignancies other than HCC, serious hepatic adverse reactions occurred in 1.4% of patients. Fatal events, including hepatic failure, acute hepatitis and hepatorenal syndrome, occurred in 0.5% of patients. In HCC, hepatic encephalopathy occurred in 8% of LENVIMA-treated patients (5% grade 3-5). Grade 3-5 hepatic failure occurred in 3% of LENVIMA-treated patients. 2% of patients discontinued LENVIMA due to hepatic encephalopathy and 1% discontinued due to hepatic failure.

Monitor liver function prior to initiation, then every 2 weeks for the first 2 months, and at least monthly thereafter during treatment. Monitor patients with HCC closely for signs of hepatic failure, including hepatic encephalopathy. Withhold and resume at reduced dose upon recovery or permanently discontinue based on severity.

Renal Failure or Impairment.Serious including fatal renal failure or impairment can occur with LENVIMA. Renal impairment was reported in 14% and 7% of LENVIMA-treated patients in DTC and HCC, respectively. Grade 3-5 renal failure or impairment occurred in 3% of patients with DTC and 2% of patients with HCC, including 1 fatal event in each study. In RCC, renal impairment or renal failure was reported in 18% of LENVIMA + everolimustreated patients (10% grade 3).

Initiate prompt management of diarrhea or dehydration/hypovolemia. Withhold and resume at reduced dose upon recovery or permanently discontinue for renal failure or impairment based on severity.

Proteinuria.In DTC and HCC, proteinuria was reported in 34% and 26% of LENVIMA-treated patients, respectively. Grade 3 proteinuria occurred in 11% and 6% in DTC and HCC, respectively. In RCC, proteinuria occurred in 31% of patients receiving LENVIMA + everolimus (8% grade 3). Monitor for proteinuria prior to initiation and periodically during treatment. If urine dipstick proteinuria 2+ is detected, obtain a 24-hour urine protein. Withhold and resume at reduced dose upon recovery or permanently discontinue based on severity.

Diarrhea.Of the 737 LENVIMA-treated patients in DTC and HCC, diarrhea occurred in 49% (6% grade 3). In RCC, diarrhea occurred in 81% of LENVIMA + everolimustreated patients (19% grade 3). Diarrhea was the most frequent cause of dose interruption/reduction, and diarrhea recurred despite dose reduction. Promptly initiate management of diarrhea. Withhold and resume at reduced dose upon recovery or permanently discontinue based on severity.

Fistula Formation and Gastrointestinal Perforation.Of the 799 patients treated with LENVIMA or LENVIMA + everolimus in DTC, RCC, and HCC, fistula or gastrointestinal perforation occurred in 2%. Permanently discontinue in patients who develop gastrointestinal perforation of any severity or grade 3-4 fistula.

QT Interval Prolongation.In DTC, QT/QTc interval prolongation occurred in 9% of LENVIMA-treated patients and QT interval prolongation of >500 ms occurred in 2%. In RCC, QTc interval increases of >60 ms occurred in 11% of patients receiving LENVIMA + everolimus and QTc interval >500 ms occurred in 6%. In HCC, QTc interval increases of >60 ms occurred in 8% of LENVIMA-treated patients and QTc interval >500 ms occurred in 2%.

Monitor and correct electrolyte abnormalities at baseline and periodically during treatment. Monitor electrocardiograms in patients with congenital long QT syndrome, congestive heart failure, bradyarrhythmias, or those who are taking drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics. Withhold and resume at reduced dose upon recovery based on severity.

Hypocalcemia.In DTC, grade 3-4 hypocalcemia occurred in 9% of LENVIMA-treated patients. In 65% of cases, hypocalcemia improved or resolved following calcium supplementation with or without dose interruption or dose reduction. In RCC, grade 3-4 hypocalcemia occurred in 6% of LENVIMA + everolimus treated patients. In HCC, grade 3 hypocalcemia occurred in 0.8% of LENVIMA-treated patients. Monitor blood calcium levels at least monthly and replace calcium as necessary during treatment. Withhold and resume at reduced dose upon recovery or permanently discontinue depending on severity.

Reversible Posterior Leukoencephalopathy Syndrome.Across clinical studies of 1,823 patients who received LENVIMA as a single agent, RPLS occurred in 0.3%. Confirm diagnosis of RPLS with MRI. Withhold and resume at reduced dose upon recovery or permanently discontinue depending on severity and persistence of neurologic symptoms.

Hemorrhagic Events.Serious including fatal hemorrhagic events can occur with LENVIMA. In DTC, RCC, and HCC clinical trials, hemorrhagic events, of any grade, occurred in 29% of the 799 patients treated with LENVIMA as a single agent or in combination with everolimus. The most frequently reported hemorrhagic events (all grades and occurring in at least 5% of patients) were epistaxis and hematuria. In DTC, grade 3-5 hemorrhage occurred in 2% of LENVIMA-treated patients, including 1 fatal intracranial hemorrhage among 16 patients who received LENVIMA and had CNS metastases at baseline. In RCC, grade 3-5 hemorrhage occurred in 8% of LENVIMA + everolimustreated patients, including 1 fatal cerebral hemorrhage. In HCC, grade 3-5 hemorrhage occurred in 5% of LENVIMA-treated patients, including 7 fatal hemorrhagic events. Serious tumor-related bleeds, including fatal hemorrhagic events, occurred in LENVIMA-treated patients in clinical trials and in the postmarketing setting. In postmarketing surveillance, serious and fatal carotid artery hemorrhages were seen more frequently in patients with anaplastic thyroid carcinoma (ATC) than other tumors. Safety and effectiveness of LENVIMA in patients with ATC have not been demonstrated in clinical trials.

Consider the risk of severe or fatal hemorrhage associated with tumor invasion or infiltration of major blood vessels (eg, carotid artery). Withhold and resume at reduced dose upon recovery or permanently discontinue based on severity.

Impairment of Thyroid Stimulating Hormone Suppression/Thyroid Dysfunction.LENVIMA impairs exogenous thyroid suppression. In DTC, 88% of patients had baseline thyroid stimulating hormone (TSH) level 0.5 mU/L. In patients with normal TSH at baseline, elevation of TSH level >0.5 mU/L was observed post baseline in 57% of LENVIMA-treated patients. In RCC and HCC, grade 1 or 2 hypothyroidism occurred in 24% of LENVIMA + everolimustreated patients and 21% of LENVIMA-treated patients, respectively. In patients with normal or low TSH at baseline, elevation of TSH was observed post baseline in 70% of LENVIMA-treated patients in HCC and 60% of LENVIMA + everolimustreated patients in RCC.

Monitor thyroid function prior to initiation and at least monthly during treatment. Treat hypothyroidism according to standard medical practice.

Impaired Wound Healing. Impaired wound healing has been reported in patients who received LENVIMA. Withhold LENVIMA for at least 1 week prior to elective surgery. Do not administer for at least 2 weeks following major surgery and until adequate wound healing. The safety of resumption of LENVIMA after resolution of wound healing complications has not been established.

Embryo-fetal Toxicity.Based on its mechanism of action and data from animal reproduction studies, LENVIMA can cause fetal harm when administered to pregnant women. In animal reproduction studies, oral administration of lenvatinib during organogenesis at doses below the recommended clinical doses resulted in embryotoxicity, fetotoxicity, and teratogenicity in rats and rabbits. Advise pregnant women of the potential risk to a fetus; and advise females of reproductive potential to use effective contraception during treatment with LENVIMA and for at least 30 days after the last dose.

Adverse Reactions

In DTC, the most common adverse reactions (30%) observed in LENVIMA-treated patients were hypertension (73%), fatigue (67%), diarrhea (67%), arthralgia/myalgia (62%), decreased appetite (54%), decreased weight (51%), nausea (47%), stomatitis (41%), headache (38%), vomiting (36%), proteinuria (34%), palmar-plantar erythrodysesthesia syndrome (32%), abdominal pain (31%), and dysphonia (31%). The most common serious adverse reactions (2%) were pneumonia (4%), hypertension (3%), and dehydration (3%). Adverse reactions led to dose reductions in 68% of LENVIMA-treated patients; 18% discontinued LENVIMA. The most common adverse reactions (10%) resulting in dose reductions were hypertension (13%), proteinuria (11%), decreased appetite (10%), and diarrhea (10%); the most common adverse reactions (1%) resulting in discontinuation of LENVIMA were hypertension (1%) and asthenia (1%).

In RCC, the most common adverse reactions (30%) observed in LENVIMA + everolimustreated patients were diarrhea (81%), fatigue (73%), arthralgia/myalgia (55%), decreased appetite (53%), vomiting (48%), nausea (45%), stomatitis (44%), hypertension (42%), peripheral edema (42%), cough (37%), abdominal pain (37%), dyspnea (35%), rash (35%), decreased weight (34%), hemorrhagic events (32%), and proteinuria (31%). The most common serious adverse reactions (5%) were renal failure (11%), dehydration (10%), anemia (6%), thrombocytopenia (5%), diarrhea (5%), vomiting (5%), and dyspnea (5%). Adverse reactions led to dose reductions or interruption in 89% of patients. The most common adverse reactions (5%) resulting in dose reductions were diarrhea (21%), fatigue (8%), thrombocytopenia (6%), vomiting (6%), nausea (5%), and proteinuria (5%). Treatment discontinuation due to an adverse reaction occurred in 29% of patients.

In HCC, the most common adverse reactions (20%) observed in LENVIMA-treated patients were hypertension (45%), fatigue (44%), diarrhea (39%), decreased appetite (34%), arthralgia/myalgia (31%), decreased weight (31%), abdominal pain (30%), palmar-plantar erythrodysesthesia syndrome (27%), proteinuria (26%), dysphonia (24%), hemorrhagic events (23%), hypothyroidism (21%), and nausea (20%). The most common serious adverse reactions (2%) were hepatic encephalopathy (5%), hepatic failure (3%), ascites (3%), and decreased appetite (2%). Adverse reactions led to dose reductions or interruption in 62% of patients. The most common adverse reactions (5%) resulting in dose reductions were fatigue (9%), decreased appetite (8%), diarrhea (8%), proteinuria (7%), hypertension (6%), and palmar-plantar erythrodysesthesia syndrome (5%). Treatment discontinuation due to an adverse reaction occurred in 20% of patients. The most common adverse reactions (1%) resulting in discontinuation of LENVIMA were fatigue (1%), hepatic encephalopathy (2%), hyperbilirubinemia (1%), and hepatic failure (1%).

In EC, the most common adverse reactions (20%) observed in LENVIMA + pembrolizumab - treated patients were fatigue (65%), hypertension (65%), musculoskeletal pain (65%), diarrhea (64%), decreased appetite (52%), hypothyroidism (51%), nausea (48%), stomatitis (43%), vomiting (39%), decreased weight (36%), abdominal pain (33%), headache (33%), constipation (32%), urinary tract infection (31%), dysphonia (29%), hemorrhagic events (28%), hypomagnesemia (27%), palmar-plantar erythrodysesthesia (26%), dyspnea (24%), cough (21%) and rash (21%).

Adverse reactions led to dose reduction or interruption in 88% of patients receiving LENVIMA. The most common adverse reactions (5%) resulting in dose reduction or interruption of LENVIMA were fatigue (32%), hypertension (26%), diarrhea (18%), nausea (13%), palmar-plantar erythrodysesthesia (13%), vomiting (13%), decreased appetite (12%), musculoskeletal pain (11%), stomatitis (9%), abdominal pain (7%), hemorrhages (7%), renal impairment (6%), decreased weight (6%), rash (5%), headache (5%), increased lipase (5%) and proteinuria (5%).

Fatal adverse reactions occurred in 3% of patients receiving LENVIMA + pembrolizumab, including gastrointestinal perforation, RPLS with intraventricular hemorrhage, and intracranial hemorrhage.

Serious adverse reactions occurred in 52% of patients receiving LENVIMA + pembrolizumab. Serious adverse reactions in 3% of patients were hypertension (9%), abdominal pain (6%), musculoskeletal pain (5%), hemorrhage (4%), fatigue (4%), nausea (4%), confusional state (4%), pleural effusion (4%), adrenal insufficiency (3%), colitis (3%), dyspnea (3%), and pyrexia (3%).

Permanent discontinuation due to adverse reaction (Grade 1-4) occurred in 21% of patients who received LENVIMA + pembrolizumab. The most common adverse reactions (>2%) resulting in discontinuation of LENVIMA weregastrointestinal perforation or fistula (2%),muscular weakness (2%), and pancreatitis (2%).

Use in Specific Populations

Because of the potential for serious adverse reactions in breastfed infants, advise women to discontinue breastfeeding during treatment and for at least 1 week after last dose. LENVIMA may impair fertility in males and females of reproductive potential.

No dose adjustment is recommended for patients with mild (CLcr 60-89 mL/min) or moderate (CLcr 30-59 mL/min) renal impairment. LENVIMA concentrations may increase in patients with DTC, RCC or EC and severe (CLcr 15-29 mL/min) renal impairment. Reduce the dose for patients with DTC, RCC, or EC and severe renal impairment. There is no recommended dose for patients with HCC and severe renal impairment. LENVIMA has not been studied in patients with end stage renal disease. No dose adjustment is recommended for patients with HCC and mild hepatic impairment (Child-Pugh A). There is no recommended dose for patients with HCC with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment.

No dose adjustment is recommended for patients with DTC, RCC, or EC and mild or moderate hepatic impairment. LENVIMA concentrations may increase in patients with DTC, RCC, or EC and severe hepatic impairment. Reduce the dose for patients with DTC, RCC, or EC and severe hepatic impairment.

LENVIMA (lenvatinib) is available as 10 mg and 4 mg capsules.

Please see Prescribing information for LENVIMA (lenvatinib) at http://www.lenvima.com/pdfs/prescribing-information.pdf.

About the Eisai and Merck Strategic Collaboration

In March 2018, Eisai and Merck, known as MSD outside the United States and Canada, through an affiliate, entered into a strategic collaboration for the worldwide co-development and co-commercialization of LENVIMA. Under the agreement, the companies will jointly develop, manufacture and commercialize LENVIMA, both as monotherapy and in combination with Merck's anti-PD-1 therapy KEYTRUDA (pembrolizumab).

In addition to ongoing clinical studies evaluating the KEYTRUDA plus LENVIMA combination across several different tumor types, the companies have jointly initiated new clinical studies through the LEAP (LEnvatinib And Pembrolizumab) clinical program and are evaluating the combination in 13 different tumor types (endometrial carcinoma, hepatocellular carcinoma, melanoma, non-small cell lung cancer, renal cell carcinoma, squamous cell carcinoma of the head and neck, urothelial cancer, biliary tract cancer, colorectal cancer, gastric cancer, glioblastoma, ovarian cancer, and triple-negative breast cancer) across 19 clinical trials.

About Eisai

Eisai is a leading global research and development-based pharmaceutical company headquartered in Japan, with approximately 10,000 employees worldwide. We define our corporate mission as "giving first thought to patients and their families and to increasing the benefits health care provides," which we call our human health care (hhc) philosophy. We strive to realize our hhc philosophy by delivering innovative products in therapeutic areas with high unmet medical needs, including Oncology and Neurology. In the spirit of hhc, we take that commitment even further by applying our scientific expertise, clinical capabilities and patient insights to discover and develop innovative solutions that help address society's toughest unmet needs, including neglected tropical diseases and the Sustainable Development Goals.

For more information about Eisai, please visit http://www.eisai.com(for global), us.eisai.com(for U.S.) or http://www.eisai.eu(for Europe, Middle East, Africa), and connect with us on Twitter (U.S.and global) and LinkedIn(for U.S.).

LENVIMA is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.

KEYTRUDA is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, N.J., U.S.A.

SOURCE Eisai Inc.

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Eisai Announces New Investigational Data from Study 211 Evaluating the Starting Dose of LENVIMA (lenvatinib) in Differentiated Thyroid Cancer at ESMO...