Make $$$ [for your doctor] from home!

There’s so much waste in U.S. cancer care that any pet issue represents but a drop in the proverbial bucket, but here’s one of mine: physicians don’t push self-administration of GSCFs like Neulasta because they can bill the in-office delivery of the drug as an outpatient procedure. So instead of faxing a prescription to a specialty pharmacy to have a box of pre-filled syringes delivered to the patient’s house, which would be charged exclusively under the patient’s pharmacy benefits, the physician/center will have the patient return for a separate appointment after chemo to have a simple subcutaneous injection billed as a medical benefit. Even medical staff aren’t consistently aware that home administration is an option; a nurse once asked after a dose of Abraxane if I had an appointment for Neulasta for the next day, and I told her I’d be giving it myself at home. She raised her eyebrows and said, “Do you have someone at your house that can give injections?”

It’s a subcutaneous injection. You cannot do it wrong. Continue reading “Make $$$ [for your doctor] from home!”

EXEL’s trash, Kadmon’s treasure? 10+ years with tesevatinib

Three years ago, I learned of KD-019, an EGFR-inhibiting wonder TKI for which there just happened be a study enrolling, right at the mid-tier academic institution/portal to hell in which I was currently sitting. I nodded along appreciatively to phrases like better than Tykerb! while thinking, Kadmon. Kadmon. Oh, right, the one where the CEO just got out of prison.

Continue reading “EXEL’s trash, Kadmon’s treasure? 10+ years with tesevatinib”

The Puma Panel

I didn’t think neratinib was getting through. As much as I want more flexibility in prescribing and a more moderate drug approval pathway, why does it have to be neratinib?

Despite very modest clinical benefit, a lot of toxicity and a broad label, this morning’s FDA panel voted 12-4 in favor of more options for cancer patients. The panelists did seem to take patient selection seriously, though it’s unclear how that will pan out when Puma is loose in the market. What I’m curious about is whether patients will demand it, whether the patient representatives Puma paid to speak – the what-if-Mommy-dies, I-want-to-do-everything-to-fight-this types – are representative of the overall population. Continue reading “The Puma Panel”

New Threat: “Patient-Dictated” Care

While we’ve been worrying about nuclear war and rising global fascism, a post on KevinMD last week reminded us of a persistent and no less real danger: patients who ask for shit. The blog’s author draws a line between “patient-centered care” and “patient-dictated care”, the latter of which entails the physician sighing mightily yet rolling over at any patient request. What choice does he have, really? He’s just trying to keep the lights on in this crazy world.

The example given is antibiotic abuse, that old workhorse – just as scary and describable as it was in that 60 Minutes episode back in 1998. Can You Believe this Asshole Wants Antibiotics for a Cold?! has been kicking around at least since I was in high school, and despite its wear, it won’t die as the catchall justification for why physicians must remain the keepers of the knowledge. They are the rare, anointed ones, elevated by the combination of intellectual superiority and moral purity; they alone understand the dangers of antibiotic resistance. Continue reading “New Threat: “Patient-Dictated” Care”

Liquid Biopsy Continues to Disappoint

Confession: I have been burned by Guardant twice. Both times were my fault, the first on account of my wide-eyed idealism and the other because I didn’t stick to my guns when it counted, but this has seeded a personal and possibly misdirected venom toward the company.

It helps that the product sucks. Continue reading “Liquid Biopsy Continues to Disappoint”

Puma Post-APHINITY

Puma presented at Cowen today, and I listened to the webcast hoping for a reaction to APHINITY, but alas, they kept Q&A to the breakout session. The tone of the presentation did seem a little grim, but between the crushing of adjuvant dreams and half the slides being devoted to unmanageable diarrhea, I guess it was always going to play grim. Continue reading “Puma Post-APHINITY”

APHINITY!

It worked!

Which is all we know right now, with actual numbers to come later in 2017 (ASCO?), but this morning Roche announced that APHINITY met its primary endpoint of significant improvement in disease-free survival in patients treated with Herceptin, Perjeta and docetaxel in the adjuvant setting.

I can’t wait to see the numbers, but it almost doesn’t matter: Herceptin going off-patent is no longer an issue, and Roche has secured its ownership of the HER2+ patient from date of diagnosis until, well, forever. I’ll be interested to see if Perjeta becomes a co-backbone of HER2+ treatment alongside Herceptin, in the sense that you never really stop Herceptin, regardless of how many times the patient progresses on it; we tend not to even do a lot of biopsies to confirm that HER2 status hasn’t reversed, despite the fact that a flip from HER+ to HER2- does happen in the recurrent and metastatic settings. It’s too soon to consider whether Perjeta will still be the first-line HER2 treatment of choice in recurrent or metastatic disease if the patient has been previously treated with Perjeta, but assessing durability of benefit through multiple courses of treatment is one of the many possible next steps for this agent.