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BRAF genomic alterations are the most common oncogenic drivers in pediatric low-grade glioma (pLGG). Arm 1 (n = 77) of the ongoing phase 2 FIREFLY-1 (PNOC026) trial investigated the efficacy of the oral, selective, central nervous system-penetrant, type II RAF inhibitor tovorafenib (420 mg m$^{-}$$^{2}$ once weekly; 600 mg maximum) in patients with BRAF-altered, relapsed/refractory pLGG. Arm 2 (n = 60) is an extension cohort, which provided treatment access for patients with RAF-altered pLGG after arm 1 closure. Based on independent review, according to Response Assessment in Neuro-Oncology High-Grade Glioma (RANO-HGG) criteria, the overall response rate (ORR) of 67% met the arm 1 prespecified primary endpoint; median duration of response (DOR) was 16.6 months; and median time to response (TTR) was 3.0 months (secondary endpoints). Other select arm 1 secondary endpoints included ORR, DOR and TTR as assessed by Response Assessment in Pediatric Neuro-Oncology Low-Grade Glioma (RAPNO) criteria and safety (assessed in all treated patients and the primary endpoint for arm 2, n = 137). The ORR according to RAPNO criteria (including minor responses) was 51%; median DOR was 13.8 months; and median TTR was 5.3 months. The most common treatment-related adverse events (TRAEs) were hair color changes (76%), elevated creatine phosphokinase (56%) and anemia (49%). Grade ≥3 TRAEs occurred in 42% of patients. Nine (7%) patients had TRAEs leading to discontinuation of tovorafenib. These data indicate that tovorafenib could be an effective therapy for BRAF-altered, relapsed/refractory pLGG. ClinicalTrials.gov registration: NCT04775485 .

What would happen if this took place in New York Harbor? Looking at the different classes of ships that would be needed and if it is a terrorist act or simply poor seaman ship. In addition, how would the nation respond to the closure of the port as well as the economic impact? The nation had salvage response and how long it would take and cost. The cost would range in the hundreds of millions and require a two-step approach. The nation would need to start salvage operations and to start dredging. An event that would force the closure of one of the United States busiest ports would require a swift response to ensure that the flow of commerce would continue., The original document contains color images.

What would happen if this took place in New York Harbor? Looking at the different classes of ships that would be needed and if it is a terrorist act or simply poor seaman ship. In addition, how would the nation respond to the closure of the port as well as the economic impact? The nation had salvage response and how long it would take and cost. The cost would range in the hundreds of millions and require a two-step approach. The nation would need to start salvage operations and to start dredging. An event that would force the closure of one of the United States busiest ports would require a swift response to ensure that the flow of commerce would continue.