OBR Daily Commentary

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Cancer's Big Infrastructure Problem

(Forbes) June 15, 2017 - We need to do more than just raise cancer drug prices yet again. We need to invest in the kind of infrastructure that will make it possible to test many of these medicines, and speed up innovation further.

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Thomas Marsland, MD (Posted: June 16, 2017)

quotesSo right patient, right drug, right time. But it is not really that easy. As the author suggest more research is needed but in these tumors with rare targetable mutations collecting enough data is difficult. The prospective randomize trial will always be the gold standard but for rare tumors we may well have to rely on pooled real world data. Agree that the infrastructure is not yet in place but a number of programs such as ASCO's Cancer LinQ are being developed. It is critical that all of us participate in this and like programs to assure that we can accumulate sufficient data to help decide who is the right patient; which is the right drug; and when is the right time.quotes

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New Data Show Durability of Response for Merck’s KEYTRUDA® (pembrolizumab) in Advanced Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient (dMMR) Solid Tumors, Regardless of Tumor Type

(Merck) June 3, 2017 - First-time findings from KEYNOTE-164 and KEYNOTE-158, to be presented at ASCO, further support the utility of MSI-H and dMMR as predictive biomarkers for tumor-agnostic treatment approach with KEYTRUDA.

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Thomas Marsland, MD (Posted: June 08, 2017)

quotesThis release and the recent FDA activity show that the brave new world has arrived. We are now looking at and treating tumors based on biology as opposed to the old system based on anatomy. Clearly that is not going away anytime soon but at least the approach of treating a tumor based on its biology has finally arrived.quotes

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Cancer Drugs Are Getting Better and Dearer

(The Economist) May 4, 2017 - AstraZeneca’s Imfinzi costs $180,000 for a year’s treatment.

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Thomas Marsland, MD (Posted: May 10, 2017)

quotesI have been and on again and off again reader of the Economist for a long time. This article reminded me of the quaint old English expression used by my immigrated English relatives who referred to something too expensive as "dear." The point however is on target. The ever rising cost of cancer drugs is unsustainable. The idea of "value based purchasing" is intriguing. But who and how does one decide "how well they work?" Are we looking at clinical outcomes such as response rate, over all survival, or progression free survival ? Where does the patients point of view come into the equasion ? Should we be looking at the cost for total care not just the cost of the drug? (YES) Do they mean basing cost on the efficacy in a specific clnical senario ? Clearly these are complex and valid issues. To make these choice we obviously need lots of data, including clinical outcomes, patient satisfaction, and claims information. Who and how will these data be collected ?? Hopefully some of the next generation of research tools such as Cancer Linq, Flatiron and other will help us decide the right drug, for the right patient, at the right time.quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...