Will personalized cancer therapy bankrupt the country?

[pathstudent]

Our lung cancer program has bailed on simply testing for egfr, alk, ros1 and has now voted to perform life technologies next gen sequencing of all primary and recurrent lung cancers.

I agree it sounds intriguing but it seems like we are putting the cart before the horse a little bit as we could be spending money to obtain information that we don't know if it matters.

Moreover, the oncologists says we are just around the corner where we will have targeted therapies for multiple pathways in all cancers and metastatic cancer will be like HIV where you are on a cocktail of targeted therapies that hold your cancer in check while you live your life. Most of these drugs cost 5 figures a month. If all lung cancer and colon cancer patients are living for years on drugs that cost 100,000 a month, how can we afford that as a people? And what does that say about us as a nation where we would be willing to spend trillions of dollars to get keep our septuagenarians and octogenarians alive for a few more years while half the people in the world each live on less than 1000 dollars a year. It seems crazy to me.

In any case next gen sequencing is here and has been marketed well to our surgical and medical oncologists. Every metastatic tumor is going to foundation 1 or caris. Even our neuro oncolonists send every glioma out for foundation 1 even thought here are only two approved drugs for gbm.

I got to figure out how to put the kids college funds in these companies.

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[WEBB PINKERTON]

I agree with James Watson.

"As Watson explained, the effects of most of these new therapies only lasted a few months. That´s because cancer cells are clever. If a drug blocks one of their biochemical pathways for growth and proliferation, they simply activate a different pathway that works just as well, leading to a virtually endless cat-and-mouse game of ever new drugs that lead to ever new pathways."

http://www.redorbit.com/news/health...mes-watson-criticizes-cancer-research-011013/

 

[Cellpathology]

I'm with Pinkerton on this one..........lung cancer mortality rate has been flat-lined for years.......really hasn't improved........As sexy as it sounds to constantly make the claim "we are just around the corner to turning lung cancer into a chronic disease", the reality is it most likely will not happen

 

[pathstudent]

I'm with Pinkerton on this one..........lung cancer mortality rate has been flat-lined for years.......really hasn't improved........As sexy as it sounds to constantly make the claim "we are just around the corner to turning lung cancer into a chronic disease", the reality is it most likely will not happen

Well it seems like we are getting ready to spend the money anyway. I'll be curious to see if we back off if there is not a significant benefit or if we instead decide to double down.

 

[pathstudent]

I agree with James Watson.

"As Watson explained, the effects of most of these new therapies only lasted a few months. That´s because cancer cells are clever. If a drug blocks one of their biochemical pathways for growth and proliferation, they simply activate a different pathway that works just as well, leading to a virtually endless cat-and-mouse game of ever new drugs that lead to ever new pathways."

http://www.redorbit.com/news/health...mes-watson-criticizes-cancer-research-011013/

They are saying that we will know all the known pathways and try to block them all at once. In CML it has been so successful because there is only one pathway.

 

[Cellpathology]

Do you actually believe that they will ever know all the pathways? I doubt it... Nobody is going to be willing to spend 100,000 per month on anyone for any reason....

 

[gbwillner]

hold your horses.

Next-gen platforms are being developed and implemented, yes. Are they being reimbursed? Not really- not to the degree that labs will take up doing this regularly. Reimbursement is only for the actionable genes- so that if you submit a lung case the most you will recover is for ALK, EGFR, etc., and not the other 300+ genes you spent time analyzing.

Cancer is a complex thing. It's not one disease but thousands. I think experts agree there is no doubt therapy will improve with these new approaches, but past experience has taught us that it's utility may be limited to certain conditions/cancer types. Only time and effort will tell what those are.

 

[TMZ2007]

Our lung cancer program has bailed on simply testing for egfr, alk, ros1 and has now voted to perform life technologies next gen sequencing of all primary and recurrent lung cancers.

Who gets the bill for the non-reimbursed portion of this? Or is the difference in price between three mutations by FISH/PCR and the NGS not significant? Is your center in drug trials for the other presumably non-FDA approved mutations/pathways that will be detected? Or is it just a fishing expedition?

Sorry that was a lot of questions. We currently do reflex for EGFR and ALK in lung adenos and our lung people are wanting us to add ROS1 which we are not terribly impressed with because of the low incidence.

 

[Ziehl-Neelsen]

I remember in medical school listening to a medical oncologist tell us that death due to solid tumors was on the verge of extinction thanks to avastin. He went on and on about how one would live in a state of detente with his metastatic cancer: allowing the cancer to remain but starving it of the angiogenesis that it needed to grow and eventually overwhelm the body. Yet here we are 10 years out from avastin's approval and people die every day from widely metastatic carcinomas.

While Michael Crichton doesn't have the "cred" of James Watson, he said it most succinctly and said it best, "Life finds a way."

 

[Thrombus]

No entitlement spending will/has.

 

[Cellpathology]

No entitlement spending will/has.

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