OBR Daily Commentary

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Blood Pressure May Hint at Kidney Cancer Outcome

(U.S. News & World Report) May 5, 2011 - In people with advanced kidney cancer, blood pressure appears to indicate how well their medication is working, with high blood pressure linked to longer survival, new research shows.

Robert A. Figlin, MD., FACP (Posted: May 06, 2011)

quotesAlthough I am a co-author on this publication I wanted to take the opportunity to review the implications found in this retrospective study for practicing physicians and the pharmaceutical industry. We have demonstrated that hypertension as defined in this study may be an on target effect of Sunitinib, and as such may be a biomarker of who is likely to benefit. As in all retrospective analysis such as these it will be important for this observation to be validated prospectively. Studies are underway to do just that. If hypertension is a biomarker of benefit we as physicians and the industry that provides us with these molecules must determine their biology and assist the doctor and patient in their best management.Through further investigation will we be able to offer our patients the greatest chance for clinical benefit. Additionally, we can expect that other on target effects formerly thought as "side effects" of the drug may very well be an important indicator of who might benefit. Strategies to modify on target "side effects" must become part of the strategies for drug development in this era of targeted therapy for cancer.quotes

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Tumors Spotted Between Mammograms Often More Aggressive: Study

(Bloomberg Businessweek) May 3, 2011 - Breast tumors that are detected in between regular screening mammograms tend to be more aggressive and fast-moving than those found during scheduled screenings, indicating that better screening methods are needed, researchers say.

(Posted: May 05, 2011)

quotesThis interesting finding parallels other studies and epidemiologic data demonstrating that tumors detected between screening (regardless of whether screening is done yearly or less frequently) tend to be faster growing. These so-called interval cancers are usually discovered by palpation, are higher grade, and also less likely to be hormone responsive. What are the implications for screening and for patients? Younger women are more likely to get aggressive rapidly growing disease, and have dense breasts, making mammographic detection more difficult. In contrast, older women are more likely to have cancers detected by mammogram. Therefore, women of average risk could have several (one to three) mammograms in their 40's, then start annual screening at age 50. This also assumes regular self-examination. Does this mean that we need better screening methods? I would respond that it is not clear, and that the biology of the cancer dictates the manner in which it is diagnosed. Even the best screening tool cannot and should not be used as frequently as would be required to find a sporadic cancer. So, mammograms are important, they detect cancers earlier for the most part, but are more useful in older women. More aggressive cancers tend to be found by palpation; breast exams are still a useful adjunct.quotes

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Design Dilemma: The Debate Over Using Placebos in Cancer Clinical Trials

(NCI Cancer Bulletin) May 3, 2011 - Ask a clinical researcher in almost any field except cancer for the “gold standard” of assessing the effectiveness of a new therapeutic drug and you will probably get the same answer: a randomized double-blinded placebo-controlled trial.

(Posted: May 04, 2011)

quotesIt is a rare situation where a placebo alone (with no active therapy) would be used in cancer clinical trials against a new therapy in a phase III trial. More commonly the standard of care treatment would be compared to the new therapy in a trial designed to evaluate any additional benefit from the new therapy. One way to evaluate this without bias is to add an inactive drug to the standard of care treatment so that it is blinded against the new therapy in the other arm of the trial. Other optional designs include a cross over design so that the patients in the standard of care arm can cross over to the new drug when the old ones are no longer working. This design is very helpful in helping patients to make the choice to go on the trial. However, if survival is the overall endpoint then this causes some confusion in the end. We owe it to our patients to give them at least the best standard of care for their malignancy.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...