Independent News on Advances in Hematology/Oncology CLINICALONCOLOGY.COM • December 2013 • Vol. 8, No. 12
INSIDE HEMATOLOGIC DISEASE Bruce Cheson, MD: How I Manage Follicular Lymphoma— Part II ......................................... 20 SOLID TUMORS Tolerability better with weekly paclitaxel ................... 6 MRI use common, but not always evidencebased .......................................... 12 For BRCA mutation carriers, tamoxifen may reduce contralateral breast cancer risk ............................... 17 T-VEC shows efficacy in melanoma trial ...................... 19
IMAGES in ONCOLOGY
Clinical Pathways Reduce Costs Critics contend that pathways are a diversion from real cost issues Chicago—An oncology clinical pathways program led to a 15% reduction in cancer-related claims costs and a 7% reduction in the likelihood of a hospital admission, according to data presented on the program at the 2013 annual meeting of the American Society of Clinical Oncology (ASCO; abstract 6553). A reduction in the number of lines of therapy appeared to be one factor driving down costs. “These results show that payor–provider collaborations through pathways see PATHWAYS, S page 8
Microscopic image of kidney carcinoma. Image courtesy of Science Photo Library
Spotting Spin and Bias Reading clinical trial results critically
CURRENT PRACTICE Top cancer drugs new to market .................................... 4 Maurie Markman, MD: ‘Normal’ screening test results ................................. 5 Balancing ‘rational’ and ‘rationed’ care .............. 13 The Tumor Board: Breast lump following previous augmentation ......................... 14 Clinical Conundrums ........................... 22
Chicago—In recent years, oncologists have adopted standards of care based on clinical trial data that is not always scientifically solid. In some cases, new practice patterns may have caused more harm than good. At the recent annual meeting of the American Society of Clinical Oncology (ASCO), three clinicians discussed how doctors can approach reports of clinical trial data more critically and spot spin and bias. According to Mike Glantz, MD, a professor of neurosurgery and oncology at Penn State College of Medicine in Hershey, Pa., a recent trial that compared memantine with placebo in patients undergoing whole brain radiation therapy (2012 ASTRO annual meeting; abstract 2) is a good example of a lapse in critical appraisal. The study, designed with 80% power and a significance of P<0.025, had a primary end point of cognitive improvement at six months. see SPIN AND BIAS, S page 10
AT A GLANCE | Study Bias In three months of Phase III randomized trials comparing two treatments published in the Journal of Clinical Oncology: • 17 of 28 trials were not only statistically nonsignificant, but had confidence intervals that included the possibility of both clinically meaningful benefit and clinically meaningful harm. • Half of the remaining nine studies afforded a post-study conviction of, at most, 60%. “We are left with less than one in five studies that we have seen in the last three months in the JCO that we can really hang our hats on.” —Michael Glantz, MD Penn State College of Medicine
RE VIE WS & COMMENTAR IES
Expert Insights From Massachusetts General Hospital Cancer Center Dose-dense therapy improves ovarian cancer survival ....................... 16 Michael J. Birrer, MD, PhD
In advanced cancer, dexamethasone helps ease fatigue ...................... 18 Mihir M. Kamdar, MD