OBR Daily Commentary

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Prolonging Life Carries More Weight Than Enhancing Life For Oncologists

(Sage Publications) May 26, 2011 - Doctors are more apt to recommend a more costly therapy to patients if it were determined to prolong the patient’s life rather than just improve quality, according to a recent study from Medical Decision Making (published by SAGE).

(Posted: June 09, 2011)

quotesThis interesting article quantifies what physicians are thinking about when making treatment choices for our patients. It is logical that considering toxic therapy in exchange for a longer survival might be an option that physicians and patients may choose. However, the cost of therapy is another issue. Here, I think a balanced look at the cost/benefit ratio is the most important evalaution. Sometimes that benefit might be a prolonged survival. However, if the benefit is comfort and improved quality of life then the cost/benefit ratio might also be balanced toward the beneficial side. There are often less costly alternatives or clinical trials that the patient might benefit from and these should always be considered.quotes

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Cancer Costs Put Treatments Out of Reach for Many

(Reuters) June 6, 2011 - The skyrocketing cost of new cancer treatments is putting advances in fighting the deadly disease out of reach for a growing number of Americans.

Thomas Marsland, MD (Posted: June 08, 2011)

quotesTo anyone who was fortunate to attend ASCO's annual meetings it is the best of times and it is the worst of times. One cannot help but be excited about the potential for cancer control that was so obvious at the annual meeting. We currently have over 900 new compounds in clinical development and the meeting presents so many with promise; from the early smaller phase I and II studies to the practice altering phase III presentations. Dr. Sledge in his unique fashion really presented the hope and vision we all share in his presidential address. More than just target therapies, the day of truly personalized cancer care is very close. The worst of times was also an undercurrent present at the meeting. Is a prolongation of median survival of 2 months really worth $100,000? We really are facing some very difficult choices. I think it is really critical that we as a profession and society be actively involved in helping to define what "value" really is. We cannot abdicate our role to advocate for patient access to high quality cancer care. We must not allow the bureaucrats and accountants to usurp that role and determine patient choices solely on the basis of dollars. Value in the long run is best defined by the patients, families and physicians. The payer community needs to be involved in these policy decisions but cannot be the sole entity making these critical choices. ASCO is uniquely positioned and up to the job of being that voice and coordinating discussions between all the stakeholders. We also need all of us to stay involved at all levels: local regional and national. The hope is there, we must not let it slip away. quotes

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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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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...