In theory, immunotherapy is a good thing–a very good thing.
And following news at ASCO about a number of positive advances in the field–including using targeted antibodies and sophisticated drug and immuno combinations to fight everything fro breast cancer to multiple myeloma–excitement was running high in Chicago earlier this month.
I wrote three or four posts about it here, and an even more on our our sister site, HelpWithCancer.org.
For the most part, my reports were positive. And why not? This is an exciting time! But in my second installment of my three part series:
Immunotherapy: The good, the bad and the ugly. Part Two: THE BAD
I closed this way:
The “BAD!” wasn’t hard to find. It wasn’t even buried deep on page two of the story.
There it was, plain as day: “The median progression-free survival (PFS) for patients receiving T-DM1 was 9.6 months, compared with 6.4 months in the control group.” This was considered to be “statistically significant.”
3 months? Media fireworks over 3 months? Sorry, but this is “BAD!” A myeloma drug wouldn’t even get a sniff over a three month improvement in PFS!
And no overall survival data (OS) was available yet. The study is too new. Researcher’s can’t even prove that T-DM1 helps patients live longer. BAD!
As a matter of fact, elotuzumab has produced results three or four times longer than that. And combine elotuzumab–or other exciting new myeloma drugs like pomalidomide–with one or more existing anti-myeloma therapies and this number soars to 15 months or more! Headline news, right? Nope. Not even a whimper from the mainstream media. BAD!
Gene therapies, Dabrafenib and Zelboraf also made big news. But their PFS numbers were also less impressive than elotuzumab or even daratumumab.
BAD!
Why did these two drugs create such a buzz? They’re melanoma drugs.
To be fair, melanoma is far and away the most common cancer. And both metastasized melanoma and breast cancer are incredibly difficult to treat.
It is hard to argue that T-DM1 is achieving amazing results in around 25% of advanced breast cancer patients–the mom featured in the news stories is a prime example of that. And T-DM1 is a technological marvel, no doubt about it.
But a half dozen or more myeloma therapies in the pipeline achieve better results than any of these drugs–and they are working in patients that have relapsed and become refractory to a number of existing therapies, too.
So while there was some good news coming out of ASCO, it wasn’t necessarily what was featured on TV or the Wall Street Journal. Myeloma research continues to lead the industry in every category. The average speed at which new drugs make the market. The low number of side effects experienced when using the new drugs. And the PFS numbers are off the charts, when compared to other cancers being focused on at ASCO.
That isn’t bad, it’s GREAT!
But there truly is an ugly side to all of this as well. I will conclude the third part of my three part series at the end of the week: The UGLY!
And it is very, very ugly…
As you can tell, you can spin a lot of this news several ways. And when I initially composed my outline for this third and final installment: THE UGLY, it all had to do about money.
About how money runs insidiously throughout the process, like heavy marbling you find throughout a juicy, corn fed steak. No matter how hard you try, you can’t get all of the fat out…
But that isn’t what I’m going to write about today. Does too much money corrupt? HECK YES! Do the drug companies wield way too much power and control over what is going to be researched and when? NO DOUBT!
But that’s too easy a target.
No, today I’m going to write about something that I recently learned about after meeting with a researcher at the airport before I boarded my plane headed home from Chicago. Disappointing. Discouraging. And yes, UGLY!
Gary Blau is a researcher at Purdue University. I can’t report specifically yet about his research, because after years of struggle and being dismissed off-hand by the medical community, Gary and his team has finally convinced University officials to consider backing some of their work. OK. So I guess it always does come back to money, doesn’t it!
But that’s not my point. The ugly part of all of this is how easy it would be to improve overall patient quality of life–and possibly improve the effectiveness of a large number of chemotherapy and other important drugs–if a few inexpensive changes were made in the way patients are monitored in their clinics and hospitals.
In other words, the technology exists to improve how well existing drugs work–and how well patients feel RIGHT NOW. TODAY!
The Purdue group calls it individualized medicine. And you may have read Gary’s comments here from time to time as he shares his angst over how multiple myeloma patients are treated–including me!
Gary has convinced me that by using a few, simple and relatively inexpensive tests early-on in the diagnostic process, myeloma patients could be spared the pain and frustration they endure as doctors guess which dose of what drug might help them most.
Imagine if your doctor didn’t have to guess! Imagine if he already knew which chemotherapy drug was most likely to work best–and at what dose–right up front.
The ugly? The technology exists to do this very thing. NOW!
But for some reason, the medical establishment refuses to embrace the idea. Is it resistance to cost. I’m sure it is. But a few thousand dollars up-front could save tens of thousands of dollars down the line.
Like the mutilated test subjects on Dr. Moreau’s Island, many myeloma patients are so beat-down and sick by the time a new drug is made available to them, the effectiveness is reduced significantly.
Just take a look at the test subjects used in the carfilzomib trials that were examined during Wednesday’s FDA hearing. Having already endured an average of five previous lines of treatment, 70% had heart, blood pressure and pulmonary issues coming into the trials. So it was no surprise that 10 of them died from cardiac related causes.
But had these patients been treated more efficiently and given help to stay stronger and healthy up-front, they may well have been able to withstand the rigors of this new experimental chemotherapy drug.
UGLY! Ugly that so many simple, small steps could help us live longer and better lives. No expensive clinical trials are necessary. No expensive, experimental drugs. And I haven’t even touched on how much better we would all feel–and how much better the current drugs we take now would work–if our doctors new what dose would work best for us–and what time of day those doses should be given.
Now doesn’t that sound simple–and make perfect sense? Gary calls that part of the program “individualized dosing.”
I have applied individualized dosing principles to one of my important medications. AND IT WORKS! I am going to write about that part of all of this over the weekend. Fascinating stuff. And so disappointing–SO UGLY–that such a simple change or tweak can help a drug work so much more effectively.
And help patients feel so much better, too!
Immunotherapy: The good, the bad and the ugly. All we can do is hope that these new drugs are going to be administered–not just based on the highest dose our poor bodies can tolerate–but in doses that kill the cancer while helping us live stronger and better lives.
Now THAT would add months and years to our lives, don’t you think? I know that my body feels like it is breaking-down after months and months of RVD therapy…
Should I suffer silently or share the pain?
Maybe Gary’s right. Maybe there is a better way! And if there is, how UGLY that health care professionals aren’t using it to help us NOW!
Feel good and keep smiling! Pat
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