OBR Daily Commentary

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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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Editorial: Incredible Prices for Cancer Drugs

(International Herald Tribune/New York Times) Nov 12, 2012 - Sloan-Kettering shows how a refusal to pay and public pressure can force a big drug company to bring down the cost of an overpriced cancer drug.

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H. Jack West, MD (Posted: November 15, 2012)

quotesThis is a topic that is not specific to any one tumor type, and it's a critical development. Over the past few years, costs for many cancer agents have been priced so aggressively that they border on extortionate, presumably based on a premise that oncologists and society can't possibly say no. Several key oncologists at Memorial Sloan-Kettering Cancer Center took a bold stand by critically evaluating the evidence showing a very marginal utility for the agent ziv-aflibercept (Zaltrap), concluding that its true value was minimal enough that the entire institution would not use this agent. Injecting a consideration of clinical value into the equation of oncology drug use is already a very important shot across the bow, but the fact that this led Sanofi to actually lower their infeasible and unjust pricing for this agent makes their effort inestimably helpful in bending the cost curve in cancer.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

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

Distinguished Professor of Medicine, Rutgers Robert Woo...

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...