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Editor’s Note: Can good old-fashioned capitalism solve
the problem? |
One of the most intriguing aspects of my unexpected career as audio co-pilot for medical oncologists as they motor their
way to and from their offices is the number of thoughtful correspondences I receive from listeners. This past week provided
a cornucopia of communication, and excerpts from my three favorites are listed below.
These commentaries are reminders of the potential for bias in continuing oncology education, and our group continuously develops
safeguards to optimize the scientific credibility of our work.
However, as Dr Bonnem suggests, it is the private sector in partnership with “can do” clinical investigators and research groups
that currently drives the war on cancer, particularly with the combination of recent governmental cutbacks in public-sector funding
of cancer research and the glacier-like action of governmental agencies. Consider my proposed top-10 list (page 4) of the most important
recent advances in breast cancer clinical research, and ask yourself the question, “How much of the funding for these advances
came from the private versus the public sector?” (For a snapshot of how these and other research advances are being translated into
clinical practice, consider the results of the enclosed national survey of 150 medical oncologists in private practice and 45 clinical
investigators and practitioners specializing in breast cancer oncology.)
It is interesting that, whereas a great deal of the R&D that led to these important steps forward came from the private sector,
in the long run, our tax dollars pay handsomely for this work as Medicare and other public reimbursement mechanisms ultimately
foot a hefty bill for oncologic products.
Our CME group tries to stick to clinical science, and we generally leave the political discussions to ASCO and other appropriate
entities. However, if this truly is a war on cancer and if our lives are at stake, then we need results now. If incentivizing the private
sector with huge potential profits will lead me, 20 years from now, to being cured of prostate cancer with a nontoxic therapy instead
of being tortured with androgen deprivation, then I say, “Do it!” Back up the trucks to the Treasury and offer multibillion-dollar
awards for results — not promises.
If you have a better way to get it done, shoot me an email.
— Neil Love, MD
NLove@ResearchToPractice.net
Most of your experts are from the world of academia. I
think you are missing an opportunity to access other experts
in the research divisions of various biotech and pharmaceutical
firms. There is, for instance, far more expertise within
Genentech on Avastin and Herceptin than you will find in
any one academician. There is more expertise on Thalidomide
within Celgene than anywhere else and more expertise on
Sutent within Pfizer than in the academic world, etc.
It is probably true that some of the physicians who work
for such organizations may want to keep some things confidential.
But this is no different than Dr Perez playing it close
to the chest before the revelation of the Herceptin data. You
always ask your various experts where they think things will
be in five or 10 years. Some of them speculate and many quite
frankly don’t know. By contrast, the researchers within the
pharmaceutical industry could probably answer that question
with a great deal of robustness, as they often plan out their
trial strategies years in advance and have the multimillion
dollar budgets to actually implement them. In the academic
world, an idea percolates for a year and then it takes another
year for a protocol to be written and get the papal blessing
from the NCI and maybe another three or five years for a
trial to accrue. Thank you for providing the tapes; it is a very
positive service to the community.
— Eric Bonnem, MD
Portsmouth, NH
The new breast cancer think tank program was the best
CD ever. What a group! Arguments are great — that’s what
we listen for. I loved the way you force them to weigh in on
difficult subjects and actually say what they really do in practice.
These eggheads do second opinions all day and with
their fellows, they disparage and pick on the management of
patients by the doctors in “Timbuktu.” I loved hearing Hudis
say he uses Xeloda with Avastin. Imagine if one of the other
docs was seeing the patients for a second opinion and didn’t
know Hudis had been treating her. He’d rip the doc. Great
discussion. I sat in my driveway until it finished — keep up
the good work.
— Scott A Tetreault, MD
Fort Myers, FL
Dr Love, you and your staff deserve a strong “at-a-boy” for
the breast cancer “think tank” just released. The disagreements
that the participants voiced (and their occasional
agreement) reflect reality, and this roundtable format seems
more balanced and less likely to have bias than your oneon-
one interviews. The entire think tank issue was free of
commercial bias in my opinion. Your pharma support should
welcome this type of effort.
In the individual interview programs, when you ask opinion
leaders how they use a specific test or drug, it can sound
like a commercial. Of course we want to know, but this think
tank format of interchange between opinion leaders themselves
with you as moderator preserved your independence. It
worked. Regarding ER assays, I lent my copy to our pathologists.
They actually welcome the information.
— Russell Jones, MD
Chattanooga, TN
Editor’s Top-10 List of Most Significant Recent Advances in Breast Cancer Clinical Research
- Adjuvant trastuzumab
- Adjuvant aromatase inhibitors (AIs)
- Delayed AIs and information on the natural history of
ER-positive and ER-negative breast cancer
- Oncotype DX™ assay; relationship between ER status and
benefit of chemotherapy; quality-control issues in ER, PR
and HER2 assays
- Dose-dense adjuvant chemotherapy and other taxane-based
regimens
- US Oncology TC versus AC study; increased appreciation
for long-term toxicity of anthracyclines
- Capecitabine in metastatic disease; CALGB-49907
(capecitabine versus AC or CMF in “elderly” women)
- Bevacizumab in metastatic disease; emerging data on
mechanisms of action of bevacizumab and other antiangiogenic
agents
- Safety data from large clinical trials that identify unusual
complications such as increased risks for arterial and
venous events and alterations in bone health
- Emergence of novel biologic targets and agents such as
lapatinib
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