Is this what the future bodes for cancer care? "Oncologists Hold Key to Curbing Cancer Costs"

coloCan

at
medicalxpress.com/news/2011-05-oncologists-key-curbing-cancer.html

I can understand containing costs,eliminating unnecessary procedures,not destroying the person being treated with chemo that's not evincing positive results but who's to say just because two or even three treatments failed that another combo or something new will not succeed? Would these two MDs who authored the article feel differently if they or a loved one was the person with cancer under consideration?

thxmiker

The Insurance Companies are
The Insurance Companies are keeping prices down by negotiating terms with providers.

Lawsuits liabilities are what is making medical costs go up more then any other issue. The medical system needs to able to police bad Doctors out of practice, or certainly to further education before they can practice again.

Drug manufacturer's need to be forced to have a Hospital or University do a blind study for them. Then there will be less bias for pushing drug results through. The Insurance Companies also need to pay their bills on a more timely rate, so doctors do not feel the need to over bill for compensation.

I know for sure that I do not want a government bean counter deciding what kind of insurance I pay for, and what level of care I receive!

Best Always, mike

Buckwirth

thxmiker said:

The Insurance Companies are
The Insurance Companies are keeping prices down by negotiating terms with providers.

Lawsuits liabilities are what is making medical costs go up more then any other issue. The medical system needs to able to police bad Doctors out of practice, or certainly to further education before they can practice again.

Drug manufacturer's need to be forced to have a Hospital or University do a blind study for them. Then there will be less bias for pushing drug results through. The Insurance Companies also need to pay their bills on a more timely rate, so doctors do not feel the need to over bill for compensation.

I know for sure that I do not want a government bean counter deciding what kind of insurance I pay for, and what level of care I receive!

Best Always, mike

Corporate Bean Counters are Better?
Really?

gdpawel

How to Lower Cancer Care's Costs?
It looks like Smith and Hilner have taken up the challenge by creating a top five list of common oncology practices, which if limited to situations where they are truly clinically useful, would sharply lower the cost of cancer care. In many cases, the cost-effectiveness ratios far exceed commonly accepted thresholds, according to Merrill Goozner, of The Fiscal Times. Goozner also wished they had addressed the issue: Why are cancer drugs of marginal efficacy so expensive? Why does a drug that extends life by a month or two cost $5,000 to $10,000 a month for the last year or two of a patient's life, thus adding up to a quarter million dollars to the cost of end-of-life care?

The challenge facing pharmacogenetics – the study of genetically determined variations in responses to drugs in humans – is the number and complexity of interactions a drug has with biological molecules in the body. Variations in many different molecules may influence how someone responds to a medicine. There is a great degree of variation in how people absorb drugs. Individuals have different levels of enzymes in the intestines and liver that breaks down drugs before they even have the chance to get into the bloodstream.

Teasing out the genetic patterns associated with particular drug responses could involve some intricate and time-consuming scientific detective work. Unfortunately, the introduction of these new drugs has not been accompanied by specific predictive tests allowing for a rational and economical use of the drugs. However, there are a number of laboratory tests that are better able to predict the ability of targeted drugs, to produce positive clinical responders (outcomes). To exploit the full potential of targeted anticancer therapies, physicians need laboratory tests that actually match patients to specific drugs.

No pharmaceutical company relishes turning over sizeable pieces of profitable business because a diagnostic test suggests it should. An article in Pharmaceuticalcommerce.com, Drew Fromkin, CEO of Clinical Data warned us that drug makers must drive growth, revenue, and profitability, and personalized medicine runs against their prevailing business model. But many realized that personalized treatments were inevitable and tried to find their way within a new paradigm.

In cancer medicine, that new paradigm established a requirement of a companion diagnostic as a condition for approval of these new targeted therapies. However, it put such great pressure that the companion diagnostics that were approved often had been mostly or totally ineffective at identifying clinical responders to the various therapies. That is because genomics are far too limited in scope to encompass the vagaries and complexities of human cancer biology.

However, Fromkin believed that the impetus for personalized medicine would come from payors, not drug firms. Insurers were paying for drugs that do not provide value, and have been desperate to eliminate the shotgun approach to cancner medicine. But how would drug companies respond when these tests show their drug to be highly effective, but only in 11% of the potential patient population? What can medicine offer patients whose test results suggest no medicine will help?

A $1.5-billion-a-year drug is a blockbuster. Five $300-million drugs, taken together, do not add up. Unless the costs for developing a $300-million new chemical entity can be harmonized with the expected financial return, no one will develop such drugs. Charging significantly more for targeted therapies will work only to a point.

Unfortunately, the introduction of these new drugs has not been accompanied by effective genetic predictive tests allowing for a rational and economical use of the drugs. Pharmacogenetics is not going to transform the market any time soon. However, given the technical and conceptual advantages of Oncologic In Vitro Chemoresponse Assays, together with their performance and the modest efficacy of therapy prediction based on analysis of genome expression, there is reason for a renewal in the interest for these pre-tests for optimized use of medical treatment of malignant disease.

SisterSledge

gdpawel said:

How to Lower Cancer Care's Costs?
It looks like Smith and Hilner have taken up the challenge by creating a top five list of common oncology practices, which if limited to situations where they are truly clinically useful, would sharply lower the cost of cancer care. In many cases, the cost-effectiveness ratios far exceed commonly accepted thresholds, according to Merrill Goozner, of The Fiscal Times. Goozner also wished they had addressed the issue: Why are cancer drugs of marginal efficacy so expensive? Why does a drug that extends life by a month or two cost $5,000 to $10,000 a month for the last year or two of a patient's life, thus adding up to a quarter million dollars to the cost of end-of-life care?

The challenge facing pharmacogenetics – the study of genetically determined variations in responses to drugs in humans – is the number and complexity of interactions a drug has with biological molecules in the body. Variations in many different molecules may influence how someone responds to a medicine. There is a great degree of variation in how people absorb drugs. Individuals have different levels of enzymes in the intestines and liver that breaks down drugs before they even have the chance to get into the bloodstream.

Teasing out the genetic patterns associated with particular drug responses could involve some intricate and time-consuming scientific detective work. Unfortunately, the introduction of these new drugs has not been accompanied by specific predictive tests allowing for a rational and economical use of the drugs. However, there are a number of laboratory tests that are better able to predict the ability of targeted drugs, to produce positive clinical responders (outcomes). To exploit the full potential of targeted anticancer therapies, physicians need laboratory tests that actually match patients to specific drugs.

No pharmaceutical company relishes turning over sizeable pieces of profitable business because a diagnostic test suggests it should. An article in Pharmaceuticalcommerce.com, Drew Fromkin, CEO of Clinical Data warned us that drug makers must drive growth, revenue, and profitability, and personalized medicine runs against their prevailing business model. But many realized that personalized treatments were inevitable and tried to find their way within a new paradigm.

In cancer medicine, that new paradigm established a requirement of a companion diagnostic as a condition for approval of these new targeted therapies. However, it put such great pressure that the companion diagnostics that were approved often had been mostly or totally ineffective at identifying clinical responders to the various therapies. That is because genomics are far too limited in scope to encompass the vagaries and complexities of human cancer biology.

However, Fromkin believed that the impetus for personalized medicine would come from payors, not drug firms. Insurers were paying for drugs that do not provide value, and have been desperate to eliminate the shotgun approach to cancner medicine. But how would drug companies respond when these tests show their drug to be highly effective, but only in 11% of the potential patient population? What can medicine offer patients whose test results suggest no medicine will help?

A $1.5-billion-a-year drug is a blockbuster. Five $300-million drugs, taken together, do not add up. Unless the costs for developing a $300-million new chemical entity can be harmonized with the expected financial return, no one will develop such drugs. Charging significantly more for targeted therapies will work only to a point.

Unfortunately, the introduction of these new drugs has not been accompanied by effective genetic predictive tests allowing for a rational and economical use of the drugs. Pharmacogenetics is not going to transform the market any time soon. However, given the technical and conceptual advantages of Oncologic In Vitro Chemoresponse Assays, together with their performance and the modest efficacy of therapy prediction based on analysis of genome expression, there is reason for a renewal in the interest for these pre-tests for optimized use of medical treatment of malignant disease.

exactly what I'm hoping to access
I'm having a DNA test done with the goal being to identify my primary cancer type...but what I'm most hoping to learn from the test is if I have any specific genes (perhaps mutated) which will be identified and better show which chemo treatment might be best for my needs.

gdpawel

SisterSledge said:

exactly what I'm hoping to access
I'm having a DNA test done with the goal being to identify my primary cancer type...but what I'm most hoping to learn from the test is if I have any specific genes (perhaps mutated) which will be identified and better show which chemo treatment might be best for my needs.

genotype does not equal phenotype
All DNA/RNA-type tests are based on "population" research (not individuals), virtually the same as it is with traditional trial-and-error (guesstimate) treatment protocols. They base their predictions on the fact that a higher percentage of people with similar genetic profiles or specific mutations may "tend" to respond better to certain drugs. This is not really personalized medicine, but a refinement of statistical data. If you are okay with that, go for it!

If not, cell-based functional profiling provides a window on the complexity of cellular biology in real-time, gauging tumor cell response to chemotherapies (conventional and targeted). By examining drug induced cell death, functional analyses measure the cumulative result of all of a cell's mechanisms of resistance and response acting in concert. Functional profiling approximates the cancer of the "individual" not populations.

coloCan

gdpawel said:

genotype does not equal phenotype
All DNA/RNA-type tests are based on "population" research (not individuals), virtually the same as it is with traditional trial-and-error (guesstimate) treatment protocols. They base their predictions on the fact that a higher percentage of people with similar genetic profiles or specific mutations may "tend" to respond better to certain drugs. This is not really personalized medicine, but a refinement of statistical data. If you are okay with that, go for it!

If not, cell-based functional profiling provides a window on the complexity of cellular biology in real-time, gauging tumor cell response to chemotherapies (conventional and targeted). By examining drug induced cell death, functional analyses measure the cumulative result of all of a cell's mechanisms of resistance and response acting in concert. Functional profiling approximates the cancer of the "individual" not populations.

If you're trained in medicine or science/biology (I'm not)
try checking out a site called:sabiosciences.com

Back in Dec i printed off of it a list i still don't understand titled :"Human Colon Cancer DNA Methylation PCR Array, Complete Panel", an enumeration of "gene promoters whose hypermentylation has been reported in the literature the most frequently in a variety of colon tumors", which I'll show onc and radiologist on upcoming appointment.....

I have also read of biomarkers under investigation whose presence may indicate how successful certain chemo may prove or whether mets are likely down the road or if a specific treatment approach will be successful but none of this has been confirmed in reality, as far as I know.....

Again, with ASCO's annual convention next week expect to hear a bit more about cancer research in the general media

steve

tanstaafl

largely a false dilemma
The key is allowing and encouraging cost effective technologies to emerge and be available, then prescribed. Parts of American medical oncology and the FDA process stoutly resist this.

My strong belief is that for advanced colon cancer patients, or those likely to become stage III, IV, there are two cheap treatments that need to be used much earlier. Also the cost of CT, MRI and PET need more competition. Lengthy labs under $25 should be a volume based norm.

First is a targeted cimetidine determination with CSLEX1, CA19-9, and disialyl Lewis markers as companion diagnostics, starting on diagnosis Day Zero for adenocarcinomas, especially colorectal cancer. If strongly positive (~70% for stage III, more stage IV), this cheaply guides all that follows, and averts a likely disaster if otherwise not treated with cimetidine. If negative, that's very good too - likely far less aggressive, just no cimetidine.

Second is preventative vitamin D3. 4000-8000 iu per day on unexposed (most) winter days is looking a lot more reasonable, *especially* in CRC prone individuals or families.
-------------------
We're utilizing beta glucans, PSK right now, for WBC, RBC, platelet stimulus and chemo, instead of expensive genetically engineered shots between cycles. Since we're using continuous chemo, "between cycles" is a nonstarter.

UFT looks like it works best as a continuous antiangiogenic adjuvant tx for many people. Cheap overseas, but it was disapproved by the criminal gang known as FDA management.

Our full chemo bill, 100% self paid, for two years should be under $7,000. Stage IV, about 14 malignant para-aortic nodes were contained 14 months without visible spread by CIM and supplements the first 2.5 months, then PSK-CIM-UFT-LV and large supplements. Two surgeries with surprised surgeons (necrosis, and lack of spread) to complete the initial resection. One year of UFT+ down, at least one year to go, if not forever.

Otherwise, PSK-cimetidine-EPA-lipoic acid with vitamin D3-K2 forever.

gdpawel

coloCan said:

If you're trained in medicine or science/biology (I'm not)
try checking out a site called:sabiosciences.com

Back in Dec i printed off of it a list i still don't understand titled :"Human Colon Cancer DNA Methylation PCR Array, Complete Panel", an enumeration of "gene promoters whose hypermentylation has been reported in the literature the most frequently in a variety of colon tumors", which I'll show onc and radiologist on upcoming appointment.....

I have also read of biomarkers under investigation whose presence may indicate how successful certain chemo may prove or whether mets are likely down the road or if a specific treatment approach will be successful but none of this has been confirmed in reality, as far as I know.....

Again, with ASCO's annual convention next week expect to hear a bit more about cancer research in the general media

steve

Human beings are demonstrably more than the sum of their genes
These gene array methods can be automated and conducted comparatively cheaply, not that they are more accurate. Cancer is more complex than its gene signature. This point is critical to an understanding of what functional analyses are. Both know that contained within the genes of each human is the information to create every protein, every enzyme, every lipid, every carbohydrate and all the organs and systems dependant upon their function. What is not known is how all of those 25,000+ genes are regulated to produce the unique features that constitute us as human entities.

Simply exploring the information contained within the human cell provides you with a blueprint of what may be, but no clear evidence that the outline structure will ever come to be in all of its functional complexity. In this regard, genomic analyses cannot approximate the vagaries and manifold variations that define us as individuals.

We can describe genetic information as permissive, that is it tells you what you may or may not become. Functional information is predictive, it tells you exactly what you are. Genomic analyses provide only a veneer of information. The substance of cancer, its responsiveness to therapeutics and its ultimate cure, require a more definitive analysis. By studying human cellular behavior within the context of vascular, stromal and inflammatory elements, the functional profiling platform provides the closest approximation of human biology possible short of a clinical trial.

Human beings are demonstrably more than the sum of their genes. Cancer biology and the study of cancer therapy are many things, but simple is not one of them. Complex problems require solutions that incorporate all of their complexities, however uncomfortable this may be for genomic investigators.