OBR Daily Commentary

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Gene Test Predicts Leukaemia Survival - UK Study

(NASDAQ/Dow Jones Newswires) May 31, 2011 - Scientists at Britain's Institute of Cancer Research have found that a genetic test can be used to identify patients with the most common type of adult leukaemia who will not respond well to currently available drugs and should instead be considered for experimental treatments.

(Posted: June 01, 2011)

quotesThis article summarizes in a large group of patients with CLL what had previously been published but not looked at so systematically. Patients with p53 mutations have a terrible outcome. It is well known that patients with 17p deletions (which are detected by FISH and can be done on the peripheral blood) have a very poor outcome with any standard therapy and that part of the reason for this is the lack of p53 which is needed for cell kill to chemotherapy. Some data had been published that many patients with the deletion also had a mutation of the other allele. This series looked at 520 samples from patients going on a front-line randomized trial. Mutations were found in 7.6% of patients including 76% of those with a 17p deletion and 3% of those without that deletion. This study clearly showed that those with a mutation who didnt have a deletion did quite poorly. OS at 5 years was only 20% ( versus 59% in the others). Although the authors recommend that "analysis of p53 mutations should be performed in patients with CLL who have progressive disease before starting first-line therapy" this test may not be readily available to most clinicians. However, given the high concordance with 17p mutation I think it would be enough if all physicians would just get a CLL FISH panel (readily available in any commercial lab) at the time of treatment. This is particularly important since there are a number of new molecules in clinical trials, such as the B-cell receptor inhibitors (CAL-101 and PCI32765), that are extremely potent therapies and as of yet, there is no suggestion that patients with 17p deletions do not respond to them. Given the dismal prognosis of patients with 17p deletions/mutations and their failure to respond well to all the currently available treatments, all these patients should be strongly considered for clinical trials and this is the one group where allogeneic transplant in first remission, even if in CR ( albeit unusual), can be considered. quotes

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Drug Shown to Improve Overall Survival in Patients With Metastatic Prostate Cancer

(MSKCC) May 25, 2011 - An international, multi-center study has found that a recently FDA-approved drug called abiraterone acetate significantly improves overall survival in men with metastatic prostate cancer by more than 34 percent.

William Harwin MD (Posted: May 26, 2011)

quotesWe participated in this important clinical trial at FCS and one of our physicians, Dr. Luis Chu, is the fourth author in the NEJM paper. It might be of interest for the readers to know that the FDA as part of their routine regulatory activities closely scrutinized our site as part of their due diligence. I would note that Dr. Mario Eisenberger from John Hopkins (who taught me oncology many years ago at the University of Miami) made an important point in the editorial in the same issue of the NEJM. That is that it would seem reasonable to consider abiraterone not just after docetaxel chemotherapy but also before chemotherapy. For the sake of patients with prostate cancer we can only hope payers don't restrict the drug's use for only patients who have received docetaxel. quotes

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Cancer Costs: Expensive Drugs, Abandoned Prescriptions

(WSJ Health blog) May 20, 2011 - As we gear up for the annual meeting of the American Society of Clinical Oncology — and its flood of studies on drugs and other treatments — let’s take a moment to consider the cost of those often life-saving therapies.

Thomas Marsland, MD (Posted: May 24, 2011)

quotesThe growing use of oral anti cancer therapies raises a number of interesting and complex questions. As demonstrated by the JOP article the cost is a significant factor for the patients. Their out of pocket expense is usually much greated when they take oral medications covered under the pharmacy benefits rather than intravenous therapy covered by medical benefits. We need to do a better job of helping these patients with financial assistance (which often is available through co-pay foundations) and also in actively monitoring for compliance. These types of activities put additional financial stresses on the practice also. We often employ individuals solely to help patients with financial assistance. Oral anti cancer drugs also require close patient monitoring not only for compliance but also for managing toxicities with no real mechanism to capture these costs. Going forward it is critical that the payer community recognize the value that is being provided by the practice and find some novel way to compensate them for the work that is being done. Finally, the cost of the drugs themselves needs to be closely watched. Hopefully many, if not most, of the newer oral oncolytic will be targeted and use of the "right drug for the right patient" will help to control some of these expenses.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

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...