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Rash Predicts Better Outcome With Erbitux; But Will "Rash" Change Patient Care? Probably Not.

November 18, 2008

Analysis of:Merck KGaA: Overall Survival in First-Line NSCLC Reaches 15 Months | www.drugs.com

It is important to use caution when interperting outcomes (in this case survival) in terms of post-treatment  (Erbitux) variables (rash).  It's a little like saying that patients who respond do better. Yes, it may be true that rash is an early indicator of which patients have a higher likelihood of doing well with Erbitux, but the question is how will that change physician's care of patients?  For me, the true importance of this study remains the fact that a EGFR antibody can be combined with chemotherapy differentiating the antibodies from the oral EGFR inhibitors.  Understanding these differences may help in the development of better drugs.  Importantly, Avastin in combination with chemotherapy has been approved in first line NSCLC, so the Erbitux combination needs to be seen as better for patients to be used in this setting.

Avastin Likely To Be Rapidly Adopted for Treatment of Glioblastoma

November 10, 2008

Analysis of:Genentech Submits Application to U.S. Food and Drug Administration for Avastin in the Most Aggressive Form of Brain Cancer | www.gene.com

Glioblastoma (GBM) is a terrible diease with little chance of long term survival and few advancements in over the last few decades. While the recent study of Avastin in GBM was not a definitive study, data presented in the press release suggest that Avastin has clear activity in relapsed GBM patients that would normally have few available options, and it is likely that physicians will quickly begin using Avastin in treatment of this disease. 

Yes, Smaller Populations for Targeted drugs, but Pharma/Biotech AND Patients Win

October 28, 2008

Analysis of:Targeting EGFR in Colorectal Cancer | content.nejm.org

While targeting a drug to the right patients may in fact the decrease the size of the patient population for that drug, but several factors may actually result in benefit not only for patients, but for biotech/pharma companies, insurance companies and society.   When a drug is given to a patient must likely to benefit, the patient obviously has a higher chance of doing better, and this staying on the drug for a longer duration.   Contrast this to a patient who has a very low likelihood of benefiting from a drug, but recieves the drug and quickly progresses.  In this second example, not only does the patient stay on the drug a very limited time, but this "bad outcome" from the drug, may negatively influence the physician's perception of the efficacy of that drug.   Testing for KRAS and eliminating those patients least likely to benefit is probably a good strategy. 

Patient Education Critical Adjunct to Testing for Disease Risk

October 27, 2008

Analysis of:Study to Track How People React to Disease-Risk Data | online.wsj.com

Individual reactions to learning about disease-risk data range the gambit from denial, paranoia, disbelief, as well as relief in knowing, whether the outcome is positive or negative.    One of the most important implications is the need for physicians and other health care givers to be able to accurately convey possible outcomes of a test (including indeterminate) what the actual risk of the disease is, potential treatment or risk reduction options, vs what a true diagnosis might mean one day.  The need for health providers to be able to accurately portray the true likelihood of is critical, and without appropriate patient education this information can be completely misunderstood making the information not only non helpful, but potentially dangerous or misleading. 

Everyone wins when patients get drugs they are most likely to offer a benefit

October 17, 2008

Analysis of:Genetic Research May Help Pick Patients' Best Cancer Drugs | online.wsj.com

Being able to select the right drug for the righ patient benefits everyone, most importantly patients, but also the drug company.  Developing drugs specifically for a small, but targeted population likley means you get a much higher level of efficacy for a smaller population making the risk-benefit ratio of the drug much better.  Ultimately, this benefits pharma/biotech companies by having a drug with superior efficacy, perhaps worthy of a higher price.

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