OBR Daily Commentary

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Opinions: There’s A Miraculous Chance To Cure Cancer. But We’ll Have To Pay For It.

(Washington Post) June 5, 2018 - New treatments are expensive and experimental, but they sure seem worth it.

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Thomas Marsland, MD (Posted: June 06, 2018)

quotesSo back to the grind stone... in clinic today after and exciting ASCO AM. But as this article suggest there is no free lunch. All of these great exciting life prolonging therapies come at a great cost. The theme of the meeting was personalized care and certainly this offers opportunities to help control the costs but even there with the new (FDA approved) next generation testing we still are often left with many expensive choices for a given patient with really no knowledge of success rates. But there is I think hope on the horizon. I had the chance to meet with a group that is developing highly sophisticated computer programs that can actually predict which of the many mutations noted by the ngs testing will really result in a therapy with a high success rate. (and the flip side avoid those that don't.) The data bases are quite sophisticated and developed from true clinical trial materials. When these types of programs become universally available we really will have the idea of "personalized" therapy come to fruition. Then hopefully these costly treatments will be given to those who truly will benefit. quotes

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Most Oncologists Have Discussed Medical Marijuana With Patients

(ASCO) May 10, 2018 - Survey shows patients with cancer initiate conversations about medical marijuana, but knowledge gaps persist.

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Thomas Marsland, MD (Posted: May 17, 2018)

quotesBeing still relatively new to the west coast I can comment that the topic of medical marijuana has certainly come up more here than in Florida (although it did come up for discussion there also). I second the comment about the lack of control data. There really is a dearth of clinical studies to support widespread use. With that said there are great anecdotal stories to support benefit from its use. One other problem is the quality control from the production and distribution. How much of the active cannabinoid are present and in what proportions? I did have the opportunity to attend a pain conference last year and there was a presentation on medical marijuana. Indeed there are a number of cannabinoid receptors within the CNS and it certainly would be interesting to see good scientific research looking at efficacy correlated with markers and outcomes. Hopefully this will come one day but until then we will just have to continue to rely on the anecdotal information. It clearly works for some patients. quotes

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Flatiron Health, Purchased By Roche, Signs Three-Year Deal With Bristol-Myers

(Forbes) May 2, 2018 - This morning, Flatiron and Bristol-Myers Squibb are announcing a new three-year agreement to use Flatiron’s ability to develop so-called real-world evidence – the drug industry jargon for experiments that are not clinical trials, but can still provide useable data – to develop Bristol’s experimental cancer drugs.

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Thomas Marsland, MD (Posted: May 02, 2018)

quotesSo some thoughts to share upon reading this review.....there is one comment on Flatiron and Bristol using real world data to form a "virtual" control on a small study of Opdivo in esophageal cancer. This is at least somewhat troubling, for several reasons. First, the gold standard still needs to be the randomized prospective trial. Secondly, it is bothersome that the folks who control the data are determining what and how the control arm is being selected. I am also worried about industry collecting and controlling the data and how it is used. Rules for transparency and conflict of interests need to be more clearly defined. Finally, where do the patients and physician fit into all of this? Data are collected via flatiron's EMR which is being used in practices; what control over the data accumulated do the doctors and patients have??? In today's world of mergers, as pharma controls data, insurers, drug distributors, and information companies all start to come together. Where is the transparency and who is looking out for the patients interests?quotes

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Prostate Cancer
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Tomasz M. Beer, MD, FACP

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Dean Gesme, MD

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Robert A. Figlin, MD., FACP

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