Month: October 2016

“No Cure Yet”, but lots of baseless hype

I asked my friend @Buyersstrike yesterday if anyone took The Motley Fool seriously, and he replied that yeah, some people think it’s real. Whether anyone could take this particular example, entitled No Cure Yet for Breast Cancer, but 3 Big Advances in 2016, seriously is a separate and more concerning question (TL;DR: HOW?), but for entertainment’s sake, let’s pick it apart.

First, the title. No cure “yet”? Are we anticipating a cure? It’s just around the corner? There’s also a promise that said cure will save “millions of lives”, which, given that 40,000 people die annually from breast cancer, is a promise that will take a while to realize. But that’s just the kind of article this is, which you already knew from the happy pink-ribbon-adorned women in the accompanying photo. Continue reading ““No Cure Yet”, but lots of baseless hype” →

My Experience with Liquid Biopsy

We know the narrative: liquid biopsy promises a safe, painless, non-invasive, less-costly method of interrogating tumor DNA to identify targeted therapies for patients who are not amenable to biopsy. Patients will have a real-time view into the resistance patterns of their disease (companies are promoting the idea that patients should have a biopsy after every line of therapy, which was never feasible with tissue biopsy) and be equipped to select treatments that are  more likely to work.

All this from a couple vials of blood? Well. Not so fast. Continue reading “My Experience with Liquid Biopsy” →

Early Detection Doesn’t Save Lives

Breast cancer advocacy has hinged for decades on the idea that early detection – via screening mammography – is the key to breast cancer survival. Mammograms save lives, and questioning the value of that bumper-sticker science is not just raising a hypothesis, but a waging a sexist, classist attack on womankind.

Just look at this screencap from Mammographysaveslives.org:

mammofacts1

Who needs citations? It says right there that these are FACTS.

Some jerk at the Dartmouth Institute for Health Policy and Clinical Practice was not persuaded by FACTS and decided it was time to kill some women. H. Gilbert Welch, M.D., M.P.H. and colleagues reviewed SEER data from 1975-2012 to analyze the impact of screening mammography on the size of breast cancers at diagnosis as well as track mortality trends over the same period. If screening were effective, the villains suggest, we would see a decrease in detection of large cancers over time. Continue reading “Early Detection Doesn’t Save Lives” →

Nivo disappoints, but it didn’t have to be this way

In August, when BMS announced that nivolumab failed to meet its primary endpoint in Checkmate 026, I brushed it off. The flaw was obvious: Checkmate 026 randomized treatment-naive advanced non-small cell lung cancer (NSCLC) subjects with PD-L1 of 1+% to nivo monotherapy or chemo. The competing Merck pembrolizumab study targeted the same previously untreated advanced NSCLC patient population, with the significant difference that Merck’s patients were enrolled based on 50+% PD-L1 expression (note: the studies used different diagnostics/PD-L1 thresholds).

So BMS over-reached. They went head-to-head with Merck for the broader label (not requiring positive PD-L1 expression for treatment, which dramatically increases the patient population), and hubris makes fools of us all. Like a lot of people, I figured the results would improve on subgroup analyses.

As you’ve seen by now, the results did not improve, and Checkmate 026 appears unsalvageable.

Continue reading “Nivo disappoints, but it didn’t have to be this way” →

Oh, Canada. “Limits to Personalized Cancer Care” in the NEJM

The NEJM, despite its habit of publishing every precision medicine milestone in the past 15 years (including the Herceptin and Zelboraf papers cited in the first paragraph of this editorial), elected to give voice to the naysayers: per an opinion from physicians at the Princess Margaret Cancer Centre, treating cancer based on genomic profiling is unproven, expensive, toxic, and requires further investigation in controlled trials before we should consider it as a treatment strategy. No shock that this came out of Canada, that hotbed of medical innovation.

Continue reading “Oh, Canada. “Limits to Personalized Cancer Care” in the NEJM” →

You can enroll in a clinical trial, but that doesn’t mean you should

One of the the core accusations of this blog is that cancer patients are pushed toward clinical trials in spite of alternatives with demonstrated safety and efficacy, which takes advantage of two patient biases: new (if unproven) means better and your physician has your best interests at heart.

Physicians are paid to participate in clinical trials. Let’s get that out of the way. There is nothing objective about recommending trials to patients; you only need to notice how often a physician points a patient toward a trial outside his or her practice to deduce that trial suggestions are not without bias.

Continue reading “You can enroll in a clinical trial, but that doesn’t mean you should” →