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PHARMA/QUALITY: Can Cancer Care Get Better? by Greg Pawelski

AP Biotechnology Writer, Paul Elias,  wrote an article this week that described how while the cost of cancer drugs have skyrocketed, the benefits are less apparent. It’s been more than 30 years since we declared a war on cancer and although there have been some real triumphs, and some great advances, the overall picture is not good. Tomorrow one of my closest friends is going into the local oncology center for the removal of what we all hope are some benign breast lumps. This post is dedicated to her, and to all those with cancer or at risk for cancer. Part of the issue is surely environmental, and we have much more to learn about what causes cancer and whether the toxins that we put into the planet are coming back to attack us.  Part of the issue, though, is how we approach cancer care.  THCB contributor Greg Pawelski has written before about the need for more chemosensitivity testing, and now writes on how we can use what we know to more effectively care for patients.


We have produced an entire generation of investigators in clinical oncology who believe that the only valid form of clinical research is to perform well-designed, prospective, randomized trials in which patients are randomized to receive one empiric drug combination versus another empiric drug combination. The problem is not with using the prospective, randomized trial as a research instrument. The problem comes from applying this time and resource-consuming instrument to address hypotheses of trivial importance (i.e. do most cancers prefer Pepsi or Coke?).

There are 60-80 different therapeutic drug regimens out there, any one or in combination can help cancer patients. The system is overloaded with drugs and underloaded with wisdom and expertise for using them. Government and academic clinical investigators have failed to support the individualization of chemotherapy through laboratory testing, in favor of attempts to identify "one size fits all treatments" through trial and error testing which has consumed tens of thousands of human lives. This entire effort has been a colossal failure and a colossal waste of human and financial resources.

One of the main problems in providing effective chemotherapy is the situation that every patient is unique. Tumors grow and spread in different ways and their response to treatment depends on these characteristics. The amount of chemotherapy that each patient can tolerate varies considerably from patient to patient. Therapeutic protocols currently in use are limited in their effectiveness because they are based on the results of clinical trials conducted on a general patient population, yet no two patients are alike. Chemosensitivity testing can help to improve the efficacy of cancer therapies on an individual patient basis.

Without the information provided by chemosensitivity testing, oncologists have the freedom to choose between multiple different drug regimens, all of which have approximately the same probability of working. Some of these regimens are highly profitable to oncologists. Other regimens are much less profitable. Pre-screen testing takes away a lot of this freedom to choose and narrows the selection to those drugs that have the highest probability to be successful but may have lower profitability for the oncologist. This cuts into the oncologist’s bottom line, though it benefits the patient.

The hallmark of the disease is heterogeneity, yet the powers that be insist on trying to homogenize it, rather than tailoring treatment to the individual nature of the disease. If we devoted 10% of the "one-size-fits-all" resources to developing and testing methods to individualize therapy, we’d have actually made some progress at lowering the costs of cancer drugs.

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Susan MannGregory D. PawelskiDawn DelCastilloGregory D. Pawelskihealth care blog Recent comment authors
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Susan Mann
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Susan Mann

Gregory – I read a post by you on some other site that stated that 34% of patients treated with Hereptin got brain metasteses 6 months after the start of Herceptin. Could you direct me to the article from whence these data came?
Thank you very much – Susan Mann

Gregory D. Pawelski
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Gregory D. Pawelski

Cell-based Assay Associated with Survival in Ovarian Cancer Patients
http://cancerfocus.net/forum/showthread.php?t=1114&highlight=Rational+Therapeutics
Targeted Cancer Therapy Improved with Ex-Vivo Chemosensitivity Analysis
http://cancerfocus.net/forum/showthread.php?t=560&highlight=Rational+Therapeutics
Functional profiling with cell culture assays that predicts for patient survival in ovarian cancer
http://cancerfocus.net/forum/showthread.php?t=253&highlight=Weisenthal+Cancer+Group
Functional profiling with cell culture assays for targeted drug therapy
http://cancerfocus.net/forum/showthread.php?t=241&highlight=Weisenthal+Cancer+Group

Dawn DelCastillo
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Cancer and cancer care is a huge topic that weighs on the minds of many Americans. Having someone else determine your standard of care can be a scary experience for the one receiving the treatments. If you are a healthcare manager or case manager you know how hard it is to get consistent and fair external peer reviews and you also know that it is imperative to provide the patient with the best possible care while keeping costs down. Allmed is hosting a webinar on the latest standards of care when it comes to oncology. Sign up for free here… Read more »

Dawn DelCastillo
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Cancer and cancer care is a huge topic that weighs on the minds of many Americans. Having someone else determine your standard of care can be a scary experience for the one receiving the treatments. If you are a healthcare manager or case manager you know how hard it is to get consistent and fair external peer reviews and you also know that it is imperative to provide the patient with the best possible care while keeping costs down. Allmed is hosting a webinar on the latest standards of care when it comes to oncology. Sign up for free here… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Cell Culture Drug Resistance Tests (CCDRTs) are laboratory tests in which fresh specimens of human neoplasms are cultured in the presence and absence of anti-cancer drugs. At the conclusion of the cell culture, measurements are made to determine whether the drugs are effective in either killing the neoplastic cells and in/or preventing their growth. Test results correlate with drug effects in the patient, with respect to both treatment response (tumor reduction) and patient survival. The logic is that if the drug kills tumor cells from an individual patient in a test tube, then the drug is more likely to be… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

An abstract on chemosensitivity testing from the American Society of Clinical Oncologists Annual Conference in 1998, summarized a paper from a National Cancer Institute study which looked at thirteen different studies that searched into assay-directed drug sensitivity testing for patients with cancer. It was noted that there were many different cancers represented in these studies, however, it was seen that the chemotherapy response rates went up using assay-directed therapy, as compared to using physician-directed therapy, and patient survival increased using assay-directed therapy, as compared to using physician-directed therapy. A prospective, randomized clinical trial of physician’s choice chemotherapy versus ATP assay-directed… Read more »

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Gregory Pawelski
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Gregory Pawelski

Here are five studies on the correlation between the results of assay-directed chemotherapy and patient survival in ovarian cancer:
http://weisenthal.org/ov_surv.htm
Other studies of assay-directed chemotherapy in ovarian cancer:
http://weisenthal.org/assay_directed_therapy_in_ovarian_cancer.htm

Harvey S. Frey
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Harvey S. Frey

Can you cite a study showing the correlation between in-vitro cancer cell sensitivity and patient survival?
Can you cite a study showing the correlation between in-vitro normal cell (such as fibroblast) sensitivity and adverse side effects?
It is my impression that such correlations are low, at least using current testing techniques.