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Independent News for the Oncologist and Hematologist/Oncologist CLINICALONCOLOGY.COM • August 2014 • Vol. 9, No. 8
CURRENT PRACTICE Online system helps chemotherapy patients manage symptoms .............
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Cardiac risks are high in childhood cancer survivors ..................................
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HEMATOLOGIC DISEASE Kieron Dunleavy, MD: How I manage adults with Burkitt lymphoma .... 14 Clinical Conundrums .......
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Chicago—Patients with KRAS wildtype metastatic colorectal cancer (mCRC) receiving first-line treatment with a chemotherapy backbone plus bevacizumab or cetuximab survived for a median of 29 months, the longest median survival time reported in a major trial of these severely ill patients. Importantly, survival times were the same, whether patients received the anti–vascular endothelial growth factor bevacizumab (Avastin, Genentech) or the anti–epidermal growth factor receptor (EGFR) cetuximab (Erbitux, Bristol-Myers Squibb), or whether they received FOLFOX or FOLFIRI, see HIGHER BAR, R page 18
SOLID TUMORS Immunotherapy for lung cancer: promising, but combined strategies will likely be needed ..............
IMAGES in ONCOLOGY
Higher Bar Set for Trials in Advanced Colorectal Cancer
INSIDE
EDITORIAL BOARD COMMENTARY
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NOW available! iPad App
Regulations Cause Serious Ethical Issue In Ca Trial Design Calls into question ‘control arms’ of drug approval trials
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his is unfortunately not the first time I have raised the major ethical issue addressed in this column. Regardless of the apparent lack of attention by the clinMaurie ical oncology research Markman, MD community to the matter highlighted in the following paragraphs, a response is required. We begin with a consideration of the Nuremberg Code, arguably the single most important document ever written see ETHICAL ISSUE, E page 5
Dividing breast cancer cell; exemestane with ovarian suppression emerging as new standard for treating premenopausal breast cancer; story on page 20.
What’s an Oncologist’s Role In Containing Health Costs? Chicago—In an era when the rising cost of cancer care has been called a crisis, do oncologists have a duty to society as well as to their patients? In a session during the 2014 annual meeting of the American Society of Clinical Oncology (ASCO), clinicians discussed this ethical dilemma. According to Beverly Moy, MD, MPH, the clinical director of the Breast Oncology Program at Massachusetts General Hospital, in Boston, the professional norm is that the foremost responsibility of oncologists is to do what is best for their patients. But, she said, this norm is eroding under the pressure of escalating costs. Those cost pressures are tremendous. In 2009, the National Institutes of Health estimated overall annual costs of cancer care at $216.6 billion. Data from WellPoint Inc., the largest managed health care company in the Blue Cross Blue Shield Association, show that drugs and technology are the main drivers of those costs (Table). “In 2013, six of the eight drugs approved for cancer therapy were around $10,000 per month, and in 2014, nine of the 12 anticancer therapies approved were or exceeded $10,000 in cost,” Dr. Moy said. “More alarmingly, most of those drugs failed to show a prolongation of survival in clinical trials. For the ones that did, the benefit was modest, ranging from 10 days to a few months.” see VALUE, E page 11
SPECIAL ASCO 2014 COVERAGE Growth Factors Often Given to Low-Risk Patients, Despite Guidelines .......................................................................................................
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Panobinostat Shines in PANORAMA-1 Trial ....................................................
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Checkpoint Inhibitors for Metastatic Renal Cell Carcinoma ...................
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