University of Pennsylvania Health System

Focus on Cancer

Tuesday, July 30, 2013

What is Targeted Molecular Cancer Therapy for Lung Cancer?



Targeted molecular cancer therapy is a type of personalized lung cancer treatment designed to interrupt the unique molecular abnormalities that make cancer grow.

Targeted molecular cancer therapy uses personalized drugs that are designed for each individual through the rigorous analysis of their tumor's unique molecular makeup, or “fingerprint.” These targeted therapies have the potential to cause less impact on normal cells and bring about fewer side effects, while still improving patients’ quality of life.

Every lung cancer is different. So treatment for lung cancer should be tailored to each individual patient.

At Penn's Abramson Cancer Center, patients with lung cancer have access to every treatment option available. Doctors and patients work together to choose the best option for each patient based on their particular situation. Penn's expert care and leading-edge treatments give patients with lung cancer the best chance of an excellent outcome.

Advanced Lung Cancer Therapies at Penn

  • Lung-sparing surgery and other advanced surgical options such as sleeve resection and laser surgery
  • Proton therapy, CyberKnife® and other radiation therapies
  • Chemotherapy and biological therapies, including immunotherapy, vaccine therapy and targeted molecular therapies
  • Clinical trials of the very latest treatments for lung cancer

Lung cancer specialists at Penn Medicine develop personalized treatment plans that often include a combination of therapies designed to meet the specific needs of each patient.

Talk to a Penn Lung Cancer Nurse Navigator
or call 800-789-PENN(7366) today.

Monday, July 29, 2013

Center for Personalized Diagnostic Medicine Brings Next Generation of Sequencing to Melanoma Screening

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus Melanoma and CAN Prevent Skin Cancer Conferences. In this blog, she discusses personalized medicine and melanoma.

Dr. David Elder, MD, a pathologist noted that the newly formed Penn Center for Personalized Diagnostic Medicine will utilize a new gene panel that screens for 41 different gene mutations that can be found in malignant melanomas. This next generation screening can be done with a smaller amount of DNA than the more limited gene screening techniques required in the past. This is significant because it will allow doctors to use new therapies at earlier stages of the disease, focusing on patients who are at high risk for recurrence rather than waiting for the melanoma to metastasize and treating it a more advanced stage.

The Center for Personalized Diagnostics (CPD), a joint initiative by Penn Medicine's Department of Pathology and Laboratory Medicine and the Abramson Cancer Center, integrates Molecular Genetics, Pathology Informatics, and Genomic Pathology for individualized patient diagnoses and to elucidate cancer treatment options for physicians.

The focus of the CPD's initial efforts has been toward developing two cancer gene sequencing panels: a custom hematologic malignancy panel and a solid tumor panel. The primary targets will include leukemia, and solid tumors, beginning with brain, melanoma, and lung tumors. The goal is to identify genomic alterations that allow clinicians to design and implement optimal treatment plans.


Friday, July 26, 2013

A New Treatment for Lymphedema at Penn Medicine {Video}

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus Melanoma and CAN Prevent Skin Cancer Conferences. In this blog, she discusses new treatments for lymphedema.

Melanoma patients who undergo lymph node dissection have a 20 to 30 percent chance of developing lymphedema—a condition in which damaged or missing lymph nodes can no longer move fluid through the tissue. The fluid backs up and causes swelling, pain, decreased movement and increases the risk of infection and cellulitis. While many patients have their lymphedema managed effectively with physical therapy and appropriate pressure garments, others do not respond to these interventions and can suffer from significant functional and cosmetic problems.

Suhail Kanchwala, MD, described an innovative procedure developed in Europe that involves taking lymph nodes from areas of the patient’s own body, such as the groin or abdomen, and transferring them to the damaged area. The team identifies lymph nodes that are surrounded by a blood supply—an artery or vein and then transplants them as a unit to the patient.

The best candidates for this procedure are patients who have:
  • No evidence of any cancer
  • Whose lymphedema was caused by surgery
  • Who have failed other, more conservative treatment for their lymphedema
  • Who have had multiple episodes of cellulitis and severe lymphedema
The technique can be used for both upper and lower extremity lymphedema, and has proven an effective treatment for patients with breast cancer as well as melanoma.

Watch this interview with Dr. Kanchwaala, plastic surgeon and director of the Surgical Lymphedema Program at Penn Medicine, discuss an innovative new surgical treatment for lymphedema after cancer care.


Advances in Personalized Therapies for Melanoma

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus Melanoma and CAN Prevent Skin Cancer Conferences. In this blog, she discusses advances in personalized therapy for melanoma patients.

Anyone who has attended all 10 of the Focus on Melanoma Conferences appreciates how much progress has been made in treating this disease over that span of time.

Paul Chapman, MD
In his keynote address, Paul Chapman, MD, of the Memorial Sloan-Kettering Cancer Center noted that in the 20th century—which somehow seems a long time ago—the five-year survival rate for patients with stage IV melanoma was 10 to 30 percent. That dismal picture began to change at the beginning of this century with the introduction of targeted therapies, notably vemurafenib and other agents that block the over expression of the BRAF gene, a mutation found in approximately 50% of melanoma patients.

The excitement surrounding these new therapies was tempered by the fact that over half of advanced melanoma patients did not benefit from them—and those that did often had responses that lasted an average of seven months as the melanoma became resistant and recurred.

A Change in Direction for Melanoma Research

In the last few years, the goal for researchers has been twofold:
  • To find targeted agents that block other pathways that allow melanoma cells to grow and proliferate. These pathways can be either those that are activated when the tumor becomes resistant to the BRAF inhibitor—or parallel pathways found in patients who do not have the BRAF mutation.
  • To find ways of activating the immune system to identify and fight melanoma cells.

Researchers have known for some time that melanomas are able to disable or even co-opt the body’s immune system to help the abnormal cells grow. One of the major advances in treating melanoma has been the introduction of ipilumimab—a targeted agent that activates T-cells to fight the cancer rather than affecting the tumor directly. For some patients, “ipi” has made an amazing difference.

Approximately 12 to 15 percent of these patients have a complete response to the treatment.

These patients rarely relapse and are considered cured. Others have long term progression free responses, but their disease returns.

The success of “ipi” has led to research to find other drugs that will activate the immune system to seek out and destroy melanomas. Phase I trials of anti-PD-1, an antibody that has been shown to shrink metastatic melanoma tumors are complete, and a phase III randomized trial to compare “ipi” with antiPD-1 or a combination of both agents will start soon.

Chapman summarized by saying:
  • All melanomas should be checked for gene mutations
  • Resistance is the key—but research is yielding new insights into the mechanisms of resistance, and with it, hope for improved therapies to overcome this problem.
  • Several immunotherapy drugs are now in the development pipeline.
  • New drug combinations, and new drug schedules are emerging, promising that the progress against melanoma will continue to be rapid and dramatic.

Penn Medicine's Melanoma and Pigmented Lesion Program was among the first in the country to provide information, evaluation, and genetic counseling for those at increased risk for melanoma and to create a model for melanoma screening. Learn more about Melanoma treatment and care at Penn Medicine.

Thursday, July 25, 2013

Join Penn Medicine’s LIVESTRONG Challenge Team

The Team LIVESTRONG Challenge Philadelphia will once again take to the streets of Blue Bell and the surrounding countryside for what has become one of LIVESTRONG’s most successful fundraising events. This family-friendly event at the Montgomery County Community College offers participation and volunteer options for everyone, regardless of experience.

On Saturday, August 17, join Penn Medicine’s LIVESTRONG Challenge team out on the 5K run/walk course or test your limits with the 10K course. If you prefer to spend your time on two wheels, register for the Sunday ride with distances ranging from 10-100 miles. Our course winds and dips through the rolling and scenic countryside. If you’d like to make a weekend out of it, sign up for both!

The Penn Medicine LIVESTRONG team consists of survivors, patients, families, friends, and people who work at Penn Medicine and The Children's Hospital of Philadelphia. Our team is growing strong but is still missing someone… and that is YOU!!

Come and join us for the day and help us support the many survivors.

Join Us!
Penn Medicine LIVESTRONG Challenge team:
Sign up here

Tuesday, July 23, 2013

What is Roberts Proton Therapy for Lung Cancer?

Proton therapy for lung cancer uses beams of protons that are precisely directed at a lung tumor.

The precision of proton therapy for lung cancer limits the radiation exposure of normal tissues while allowing a higher dose to be delivered to the tumor in the lung. The result is a better chance of curing lung cancer with fewer harmful side effects.

One of the most unique aspects of proton therapy is its ability to treat people with a history of lung cancer.

The Roberts Proton Therapy Center has recently developed re-treatment protocols aimed at treating recurrent lung cancer. Since this therapy is so targeted, it allows a potential lung cancer patient, and those patients with a history of lung cancer to receive multiple treatments and re-treatments – giving hope when other therapies have failed.

Learn more about proton therapy for lung cancer, and other personalized therapies for lung cancer at Penn.

Every lung cancer is different. So treatment for lung cancer should be tailored to each individual patient.

At Penn's Abramson Cancer Center, patients with lung cancer have access to every treatment option available, provided by nationally recognized cancer experts. Doctors and patients work together to choose the best option for each patient based on their particular situation. Penn's expert care and leading-edge treatments give patients with lung cancer the best chance of an excellent outcome.

Advanced Lung Cancer Therapies at Penn

Treatments for lung cancer at Penn's Abramson Cancer Center include:
  • Lung-sparing surgery and other advanced surgical options such as sleeve resection and laser surgery
  • Proton therapy, CyberKnife® and other radiation therapies
  • Chemotherapy and biological therapies, including immunotherapy, vaccine therapy and targeted molecular therapies
  • Clinical trials of the very latest treatments for lung cancer
Lung cancer specialists at Penn Medicine develop personalized treatment plans that often include a combination of therapies designed to meet the specific needs of each patient.
Request a consultation with a
Penn Lung Cancer Nurse Navigator here.

Monday, July 22, 2013

What Happens After Cancer Treatment Ends?

There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Survivorship at Penn Medicine

Survivorship programs at Penn Medicine are a distinct phase of cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

Penn Medicine's Living Well After Cancer™ Program is there to help you make the important transition from cancer patient to cancer survivor. In 2007, the Abramson Cancer Center was invited to join the LIVESTRONG ™ Survivorship Center of Excellence Network. The program focuses on survivorship, a distinct phase of care.

Treatment Summary

Every Abramson Cancer Center patient receives a “Treatment Summary” specific to their individual case upon completing the healing process.

These reports provide patients with a detailed account of their diagnosis, from the specific stage of cancer through to the treatments used in their time at Penn Medicine. The document then highlights any other medical concerns that patients may encounter as the result of the treatments received. Additionally, a copy of the report is sent to primary care providers and other specialists designated by patients.

Follow-Up Schedule

It is important that patients understand and adhere to the follow-up schedule developed personally for them. This individualized schedule helps the team to monitor patients' health and observe any long-term side effects of treatment.

Late Effects

Not all cancer survivors experience late effects, or issues that arise later as a result of treatment or disease. About two-thirds of survivors experience physical or psychosocial effects of chemotherapy or radiation that persist or develop more than five years from the time of diagnosis.

It's important for patients to know about these risks so their health can be appropriately monitored. The cancer care team discusses any pertinent late effects with patients and together develops a plan to monitor and treat late effects.

Read stories from Abramson Cancer Center patients about their experience at Penn Medicine.
Visit the Focus on Cancer Blog here.

Friday, July 19, 2013

“A Firestorm of Progress”—The Road from Bench to Bedside

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus Melanoma and CAN Prevent Skin Cancer Conferences. In this blog, she discusses advances in melanoma research. 


The Wistar Institute is an independent research institution that has made remarkable contributions to science in its long history—especially in the fields of vaccines, cancer, and specifically melanoma. The collaboration between Wistar’s Melanoma Program, directed by Dr. Herlyn and Penn’s outstanding Melanoma Research Progam, along with the clinical team at Penn has lasted more than 25 years and significantly advanced the understanding and treatment of melanoma, and other diseases.
Focus on Melanoma Conference attendees in a session.

Dr. Herlyn’s goal is to understand the exact mechanisms that cause a normal skin cell to become malignant and grow into a melanoma.

“There are still some open questions,” he notes as to which cell in human skin actually undergoes that transformation. Melanomas arise in cells called melanocytes, but there remains some “scientific quirkiness” about which sub-population of these cells produce melanomas, and whether they may be age-related differences in the process. It has recently been demonstrated that older people have populations of pigment producing cells that can revert back to stem cells—or cells that have the potential to differentiate into a completely different kind of cell.

One of Dr. Herlyn’s interests is in understanding how these cells function normally and what their role is in causing melanomas.

What Makes Melanoma Cells Different?

The answers are not easily obtained. Melanoma cells behave very differently than normal cells in many ways.
They can:
  • Grow without aging
  • Control all the normal cells in their environment
  • Invade almost any organ
  • Stay hidden for years without growing, remaining dormant
  • Produce their own hormones and flourish for years on a diet that would kill a normal cell in a day or two.
Each of these factors poses challenges to researchers seeking better approaches to melanoma diagnosis and treatment. Researchers now know that melanomas are heterogeneous, meaning that all not melanomas are the same, and that not all cells within a melanoma are the same. They are also learning much more about what Herlyn calls “the complex rewiring of resistant tumors,” the process by which melanomas evolve so that they are no longer responsive to previously effective treatments.

As difficult as these problems have proved in the past, Herlyn now believes that “we know the strategies, or we think we do,” and that with the rights kinds of teams and partnerships working on the problem, that “his hope and expectation is that there will be a cure for melanoma within five years—because we know so much more now.”

Penn Medicine's Melanoma and Pigmented Lesion
Program was among the first in the country to provide information,
evaluation, and genetic counseling for those at increased risk for melanoma
and to create a model for melanoma screening.
Learn more about melanoma treatment and care at Penn Medicine.

Thursday, July 18, 2013

What You Should Know About Complementary and Alternative Medicine (CAM) and Cancer

If you are undergoing treatment for cancer, you may have heard about complementary and alternative medicine (CAM).

First, it’s important to distinguish the difference between complementary and alternative medicine.

Complementary, or integrative medicine and wellness treatments supplement traditional cancer treatments such as radiation therapy, chemotherapy and surgery.

For example, Reiki, a gentle, completely non-invasive practice that promotes integrated into a patient’s established medical treatment plan. Reiki may minimize or reduce side effects of cancer and cancer treatment, and promote healing and recovery.

Other complementary therapies include:
  • Acupuncture
  • Diet and Nutrition
  • Mindfulness-Based Stress Reduction Therapy
  • Massage
  • Yoga
  • Exercise/Rehabilitation

Alternative medicine may be used in place of traditional cancer treatment. Patients seeking alternative treatments for cancer should know that alternative medicine for cancer may not be research-based.

Complementary and Integrative Medicine Research at Penn

Integrative medicine is a total approach to care that involves the patient's mind, body, and spirit. It combines standard medicine with the CAM practices that have shown the most promise. Research being conducted at Penn Medicine tests the effects and mechanisms of promising health behaviors and integrative therapeutic approaches for symptom management and wellness promotion in cancer.

Additionally, through educational programs at Penn, patients are empowered with the information to make the informed decisions about their cancer care.

Researchers are Penn are exploring ways to best incorporate integrative therapies safely and effectively into the conventional medical therapies to create patient-centered care for optimal health and healing.

Wednesday, July 17, 2013

Basser Quoted on Marie Claire and MedCityNews for BRCA Expertise

The Basser Center for BRCA Research's executive director Susan Domchek, MD and Abramson Cancer Center genetic counselor Jacquelyn Powers made headlines this week as major news outlets turned to Penn Medicine for an expert opinion. Read the headlines and quotes below: 

Marie Claire interviewed Domchek for an article about BRCA and Jolie’s decision:

Angelina Jolie: I had a double mastectomy

"We know from our research that having a prophylactic (preventative) mastectomy is the most effective way to for women who carry BRCA1/2 mutations to reduce their risk of developing breast cancer, but that surgery does come with costs, especially around body image, which is understandably an important factor for women," says Domchek "That's why we're working to develop other ways to prevent cancer in these high-risk women — like vaccines and new medications — so that women someday have new, less invasive options." Read more at Marie Claire here.
Jacquelyn Powers was the go-to source for MedCityNews piece on Angelina Jolie’s decision to follow up her BRCA1 screening with a double mastectomy: Is Angelina Jolie’s Surgery a Logical Response to Genetic Test Results?
“I would say what is our gold standard is what’s in the family’s personal history that sets us down a certain path,” said Powers. “Women are more inclined to choose preventive surgery if they have lost someone close to them — that’s a big factor.” Read more at MedcityNews.com here.


For the latest information on BRCA research, 
screening and clinical trials from 
The Basser Research Center for BRCA,
visit the official webpage.

What Does Skin Cancer Look Like? {and what you need to know about melanoma}

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus Melanoma and CAN Prevent Skin Cancer Conferences. In this blog, she discusses "What Does Skin Cancer Look Like?" and melanoma prevention basics.

For most of the people attending Focus on Melanoma, the most important information pertains to advances in treatment, but for many others, it is critical to know how to prevent skin cancers and detect them early when they do occur.

Emily Chu, MD, PhD, noted that of the three most common types of skin cancer—basal cell,
squamous cell and melanoma—that melanoma is the least frequent but most dangerous. Over 80 percent of all melanomas are detected by either the patients themselves or their partners, which makes awareness of risk factors and warning signs very important.

Who is at risk for melanoma?

  • Certain people are at greater risk for skin cancer and melanoma than others.
  • Individuals who are fair skinned.
  • Anyone with a first degree relative who has had a melanoma
  • Anyone who has a personal history of melanoma
  • People who have multiple moles—often in the hundreds
  • People who have a history of blistering sunburns in childhood
  • People who have a history of chronic sun exposure
While these factors may increase the risk of melanoma, it is also important to remember that anyone can get skin cancer, even dark skinned people of color, and that having a risk factor does not mean that you will get the disease.

What Does Skin Cancer Look Like?

Dr. Chu explained the ABCDE system that doctors commonly use to describe “worrisome” moles.
  • A is for asymmetry. If you could fold the mole over on itself, the two halves would not be the same size or shape.
  • B is for borders. Melanomas often have very irregular borders.
  • C is for color. Melanomas are often darker than other moles and have different colors in different parts of the mole.
  • D is for diameter. Melanomas are often—but not always—larger than other moles.
  • E is for evolving. Melanomas often change their size or appearance.
Dr. Chu urged people, especially those with multiple moles, to “look for the ugly duckling,” the mole that is different or changes or is new.

She also encouraged people with large numbers of moles who might have difficulty detecting “ugly ducklings” to take advantage of whole body photography which can help document the moles that are present and increase the probability of finding new or evolving moles.

Breaking the Habit for Healthy Skin

Neal Nizman followed Dr. Chu’s talk by exploring the reasons why people don’t do the things that they know will reduce their chance of getting skin cancer.

These include:
  • Checking your skin once a month
  • Seeing a dermatologist annually
  • Using sunscreen—enough, the right kind and often enough—to be effective
  • Wearing protective clothing
The answers are relatively simple. Humans are creatures of habit. We are moving too fast, or are too busy to take even simple precautions. We don’t think that bad things will happen to us. When it comes to preventing and detecting melanoma, however, it pays to be a little more mindful and take the extra precautions. The best approach to melanoma is prevention—and the most effective treatment when it does occur is for early disease.

NOTE: To be effective, sunscreens should be broad spectrum, at least SPF 15 and waterproof. It also needs to be applied to all exposed areas of the skin and repeated approximately every two hours or after swimming.

Follow us on Twitter at @PennMedicine and tell us what you’re doing to protect your skin this summer!

Tuesday, July 16, 2013

Chemical Sunscreen vs. Physical Sunscreen – What’s the Difference?

It’s no secret that sunscreen offers the best protection against skin cancer next to staying out of the sun altogether or covering up with sun protective clothing. However, most people don’t realize that the kind of sunscreen we use is also important.

There are two main kinds of sunscreen: chemical sunscreen and physical sunscreen. First, let’s take a look at how sunscreen works.

How Sunscreen Works
chemical vs phyisical sunscreen

A sunscreen is a compound (or lotion) that uses agents to block, deflect or reflect the sun’s rays.

To be effective, it’s recommended that all sunscreens be liberally applied (at least an ounce for the entire body) to all exposed areas of the body.

Chemical Sunscreen vs. Physical Sunscreen

Chemical sunscreens use up to a dozen ingredients that, when applied, are absorbed in the top layer of skin. They react with the skin to absorb UV rays and convert them into energy before they can harm the skin.

Chemical sunscreens aren’t as thick as physical sunscreens, so they are often used in sunscreens specifically made for the face as well as those found in spray bottles. Since chemical sunscreens need to be absorbed into the skin, they must be applied at least 20 to 30 minutes before heading outdoors.

Physical sunscreens, sometimes called “natural” sunscreens, include two ingredients: zinc oxide and titanium dioxide. Together, these ingredients sit on top of the skin and deflect or reflect the sun’s rays. Think of physical sunscreens like a shield, while chemical sunscreens are absorbed into the skin. Both ingredients work well to protect from UVA and UVB (broad spectrum) rays. Since physical sunscreens are thicker, they can leave a white cast on the skin.

Which sunscreen is right for me?

Those with sensitive skin, or are young children, may opt for a physical sunscreen since those ingredients are milder. However, if you are darker skinned, you may opt for a chemical sunscreen, as those do not leave a white cast.

Both types of sunscreen provide adequate protection, however your personal preference may help you decide what type of sunscreen is right for you.

The most important thing to remember is to choose a sunscreen you will use.

For more tips on sun safety,
 read these tips for applying sunscreen.

Tuesday, July 2, 2013

Cancer-Fighting Recipe: Green Goddess Guacamole

Dietitian Carly Roop, RD, shares with us her idea of a beautiful spring wedding . Carly is a registered dietitian at the Joan Karnell Cancer Center (JKCC). She provides nutrition education and support to patients while addressing nutrition-related side effects from chemotherapy and radiation. Dietitians at JKCC provide educational nutrition programs that are open to patients as well as the community.


In the past 5 years, gardening has become downright trendy. Did you know that there are 456 community gardens and over 1,000 flower gardens alive in Philadelphia? If you love to use fresh vegetables and herbs in your summer dishes but hate paying a lot of money for a bunch of mint when you only need a few springs for your mojito then gardening might be the spring activity for you.

Better Homes and Gardens’ website offers great gardening tips and suggestions for getting your hands dirty. They suggest starting with a robust herb such as mint. Mint contains phenolic compounds that have strong antioxidant activities. However, many will warn that mint likes to spread so unless you are looking to cover your lawn in mint, a container may be a good home for this friendly plant.

Vegetables such as leafy greens, kale, and chard add texture to garden beds and roughage to your diet, as well as cancer-fighting phytochemicals. The smallest edible species of alliums, chives, better known as the minced green that accompanies sour cream on your baked potato, grow well in this part of the US. Chives may also serve as great garden guards, planting chives along the borders of flowerbeds may help to keep pests like Japanese Beetles away.

Container gardening allows for more variety by separating plants that may require different soil or light needs, it also minimizes weeds and the time spent on your hands and knees. Perhaps, getting gin the garden is next on your to do list but you just haven’t made it out for the supplies, why not start after dinner. The blackthumbgardener.com provides directions for growing your kitchen scraps, which minimizes waste and saves you money.

If you are looking for a little more support in the garden the Pennsylvania Horticultural Society hosts a variety of programs all over the Philadelphia area. This recipe certainly motivates me to find a sunny spot and grab a packet of seeds.

Green Goddess Guacamole

Recipe from the Tasting Table Test Kitchen
Yield: Serves 2 Cook Time: 5 minutes

Ingredients

  • 2 avocados--halved, pitted and diced
  • 2 tablespoons finely chopped flat-leaf parsley
  • 2 tablespoons finely chopped basil
  • 2 tablespoons finely chopped chives
  • 1 tablespoon finely chopped tarragon
  • 2 tablespoons Greek yogurt
  • Finely grated zest and juice of ½ medium lime
  • 1 small shallot, finely chopped
  • 1¼ teaspoons kosher salt
  • Tortilla chips

Directions

1. In a medium bowl, combine the avocados, parsley, basil, chives, tarragon, Greek yogurt, lime zest and juice, shallot and salt. Use a spatula or fork to mix, breaking down the avocado pieces until a chunky dip forms.
2. Serve with tortilla chips.


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