OBR Daily Commentary

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Merck KGaA, Oncothyreon Lung Cancer Drug Fails Late-Stage Study

(TheStreet) Dec 19, 2012 - Stimuvax, an experimental cancer immunotherapy from Merck KGaA and Oncothyreon, failed to improve survival in a late-stage study of non-small cell lung cancer patients, the companies announced Wednesday.

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H. Jack West, MD (Posted: December 19, 2012)

quotesYet another promising approach based on phase II data fails in the larger phase III experience. We await details on whether there were meaningful overall trends and whether the allusions to benefits in identified subsets will be arguably meaningful. For now, these negative results are a reminder of the gulf between encouraging phase II results and proven phase III benefit. Though this platform has been the subject of some irrational exuberance by many patients, caregivers, and investors, I believe that most oncologists have been more judicious in their optimism, even at the risk of seeming like wet blankets to the rabid crowds who wanted to presume that this treatment would be miraculous even in the absence of actual phase III data. These results provide a sobering reminder of why our hope needs to be tempered by skepticism, even as we become enticed by the promise of various immunotherapies such as BMS-936558 and other novel strategies.quotes

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Putting Twitter to Use Among Oncologists: Shared Note-Taking at National Meetings and Other Stuff

(ASCO Connection) Dec 5, 2012 - “Still having trouble wrapping my head around all the tweets. They say so little…but I’ll keep trying.” This simple statement by a colleague via email is completely understandable.

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H. Jack West, MD (Posted: December 06, 2012)

quotesThis was a terrific, brief piece explaining the value of twitter to disseminate new information. Though many belittle social media and especially twitter as a mechanism to broadcast what you're eating for breakfast or the cute thing your cat is doing, many of the physicians using social media find it to be a very helpful tool to disseminate information to colleagues and/or patients and caregivers, but also to learn more about valuable content they would otherwise miss. If there is one situation where twitter is remarkably helpful, it's for disseminating news, including at a medical meeting. Seeing what others are tweeting about it can help those of us who aren't there (at the meeting or a particular session) learn the highlights. Even if we are there, seeing what others are saying can help us create an aggregate documentation of the key points.quotes

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Study Indicates a Quarter of Lung Cancer Patients Did Not Receive Pharmacogenomic Testing Prior to Start of Treatment

(Yahoo! Finance) Nov 30, 2012 - Nearly a quarter of patients taking erlotinib (Tarceva®) for treatment of advanced non-small cell lung cancer (NSCLC) did not receive the recommended pharmacogenomic (PGx) testing prior to the start of treatment, according to a new study by pharmacy benefit manager Prime Therapeutics (Prime), to be presented December 1, 2012, at the ASCO Quality Care Symposium in San Diego.

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H. Jack West, MD (Posted: November 30, 2012)

quotesIt's misleading to suggest that pharmacogenomic testing is a clear mandate for all patients with advanced NSCLC, as this story would imply. First, NCCN guidelines specify a recommendation for this testing only for patients with non-squamous NSCLC, so the 20-25% with squamous NSCLC wouldn't necessarily pursue testing even if NCCN guidelines are followed. Second, the clear value for EGFR-based molecular testing is to demonstrate an activating EGFR mutation before initiating an EGFR tyrosine kinase inhibitor as first line therapy. But erlotinib is also FDA approved and has a demonstrated survival benefit in a broader population that is not selected by EGFR mutation status or any other pharmacogenomics-based test, as demonstrated in the BR.21 trial (Shepherd, NEJM, 2005). For patients who are being considered for erlotinib in the second or third line setting, there are no data to suggest a clear value in EGFR mutation testing as a discriminator of who should or should not receive erlotinib. Overall, pharmacogenomics-based treatment selection will increasingly help us hone our treatment approaches in advanced NSCLC and many other cancer settings, but it's erroneous to imply that testing should be mandated for all patients, even if there is a financial incentive from diagnostics companies to do just that. And even the NCCN guidelines in this regard are based more on presumptions and biases than any evidence of survival benefit in patients who receive erlotinib in the first line setting vs. later, since the evidence illustrates that advanced NSCLC patients with an EGFR mutation do just as well in terms of overall survival if they receive an EGFR TKI after first line vs. as initial treatment.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...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

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...