Independent News on Advances in Hematology/Oncology clinicaloncology.com • April 2013 • Vol. 8, No. 4
INSIDE SOLID TUMORS Brachytherapy: More complications, less conservation than whole breast irradiation ............................... 14 Bevacizumab strikes out in latest breast cancer trials ............................ 15 Should chemotherapy be given routinely after breast cancer recurrence? ............. 24
HEMATOLOGIC DISEASE Ponatinib’s place in the leukemia armamentarium .................... 12 Cutting thromboembolic risk after warfarin ................ 13 By the Numbers: Leukemia risk after breast cancer ........................ 24
CURRENT PRACTICE Maurie Markman, MD: Maximizing novel technologies ........................... 9 Palliative care misunderstandings ‘astonishingly high’ ............. 19 Liability risks in a changing treatment landscape ............................... 26
BCI, Oncotype DX and IHC4 Face Off
Images in Oncology
BCI maintains prognostic performance into late recurrence time period San Antonio—The Breast Cancer Index (BCI, bioTheranostics) outperforms the Oncotype DX Recurrence Score (RS; Genomic Health) and the immunohistochemical (IHC)4 in accurately predicting breast cancer recurrence risk five to 10 years after a disease-free period, according to the TransATAC (Arimidex, Tamoxifen, Alone or in Combination) study, presented by Dennis Sgroi, MD, the director of Breast Pathology at Massachusetts see FACE OFF, page 25
by the
Prostatic intraepithelial neoplasia, a microscopic prostate cancer precursor lesion, exhibiting telomere abnormalities (for more information, see page 8).
numbers Medical Billing
Science in Oncology
I
Drugging the Undruggable
n February, Time ran “Bitter Pill,” a feature story on medical bills in the U.S. that included the following costs for one patient’s care at MD Anderson Cancer Center:
Acetaminophen tablet
Patient’s Bill
Actual Cost
$1.50
$ 0.0149
Chest X-Ray
$283.00
$20.44*
Rituximab, 660 mg injection
$13,702
$4,000
$83,900 Cost of treatment plan and initial chemotherapy doses for a non-Hodgkin lymphoma patient at MD Anderson $2,050,000,000 MD Anderson’s 2010 . revenue, the latest figures available 26% MD Anderson’s 2010 profit margin Source: Brill, S.“Bitter Pill: Why Medical Bills Are Killing Us.” . Time. Feb. 20, 2013.
Liverpool, England—One of the most important avenues for drug discovery in cancer is to target genes considered “undruggable,” according to several experts at the 2012 National Cancer Research Institute (NCRI) Cancer Conference. This line of research is particularly relevant because “only one-quarter of patients derive any benefits from treatment,” said Ultan McDermott, MD, PhD, an oncologist and the career development fellow group leader in the Cancer Genome Project at the Wellcome Trust Sanger Institute in Cambridge, England. Compounding this, as much as 80% of the genome is thought to be “undruggable” and current drugs are only able to target 20% of all proteins, said Martin Drysdale, PhD, of the Beatson Institute for Cancer Research in Glasgow, Scotland. The intracellular molecules—p53, Myc and Ras—have long been deemed unfeasible targets for therapy, but drugging them would be a boon for cancer research and patient care. Aberrations in p53, Myc and Ras represent some of the most common events in human cancer, and experiments show that restoring normal function see UNDRUGGABLE, page 10
* Cost based on amount Medicare routinely reimburses . for procedure.
Clinical Conundrums ......... 29
RE VIE WS & COMMENTAR IES
Expert Insights From Mayo Clinic Cancer Center Curing follicular lymphoma with stem cell transplantation........... 21
Beta-blockers improve survival in patients with NSCLC...........................20 Steven E. Schild, MD
Stephen Ansell, MD, PhD