Rectal Cancer

We Are Beginning To Realize The Promise Of Cell Free DNA In Cancer Care

Right now, when we want to know everything we can about a tumor, we do surgery: a biopsy to take a sample of it and look at it under a microscope and determine as best we can how to treat it. But what if instead you could get a blood test, and learn even more. That’s the promise of the relatively new science of what is called cell free DNA (cfDNA). It holds the hope of helping us better understand cancer, its behavior in our bodies over time, and even offering clues on how to better treat cancer in ways we would never have imagined even a few short years ago.

It was an important area of discussion at the American Society of Clinical Oncology meeting this week. It’s a meeting where, every year, we get a sense of the future of cancer treatment before it becomes a reality. From genomics, to immunotherapy, to targeted therapies–you name it—promising areas appear on the scene, then either become part of our reality or lose luster as the process unfolds over the course of several ASCO annual meetings. This year, several studies presented on the topic of the so-called “liquid biopsy” illustrate how … Continue reading →

Precision/Personalized Medicine: Can We Afford Our Success?

Here at the at annual meeting of the American Society of Clinical Oncology in Chicago, we are beginning to see the future of cancer therapy—and it raises a provocative question: will precision medicine become so precise, we risk turning off the much-needed investment of human, intellectual and financial capital that keeps progress flowing?

The sheer number of new drugs and new combinations of drugs being reported here at the world’s biggest, and most relevant cancer conference is staggering. Not all of them are ready for prime time, and some may never be successful in the clinic for large numbers of patients, but it is clear the era of old fashioned chemotherapy is diminishing and newer forms of therapies (targeted and immunotherapies among others) are on the rapid ascent.

But with progress, it’s becoming clear that a changing paradigm in cancer care that was predicted a number of years ago is now coming to life.… Continue reading →

The Survivors And Advocates Highlight That Personalized Medicine Is About All Of Us

When it comes to personalized/precision medicine we should never forget it’s all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.

That was the message from a discussion I had the privilege to moderate  on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO),  now wrapping up in Chicago.

There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.

Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually … Continue reading →

Is It Time For Precision/Personalized Medicine?

This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.

++++++++++++

Are we prepared for the genomics revolution?

The President’s proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it’s probably time to get ready for some changes in our daily routines as health professionals.

I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.

And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.

No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It’s not just about cancer, my friends. It will be coming to a primary care practice near … Continue reading →

In New Orleans’ Efforts To Make Bars and Casinos Smoke Free, It’s The Musicians’ Songs That Are the Sweetest.

Let’s call it the Battle of New Orleans, 2015.

As I write this, I am traveling from a meeting of the New Orleans City Council where testimony was heard regarding a new ordinance which would prohibit smoking in the city’s famed bars and the local casino.

As noted by Councilwoman LaToya Cantrell-who is the lead sponsor of the bill and who chaired the meeting–at the end of the hearing, it is a topic which has certainly engendered a lot of discussion among the residents of this iconic American city. Even when sitting in the airport the morning after the meeting I happened to overhear a gentleman near me intensely discussing the merits of the recommendations on the phone with a friend.

But loudest among the many voices were the sweet sounds that came from the musicians who provided testimony to the Council. There was no opposition from the music world: these artists earn their living inhaling the smoke of others, and they came out loud and clear about the need and benefit of being able to provide us entertainment in a healthier, smoke-free environment. As one of them noted a performer doesn’t have to consume a bit of every alcoholic … Continue reading →

CanceRX 2014: We Need Innovative Approaches To Support Cancer Drug Development

What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?

That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn’t want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.

The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much “out of the box” thinking as we can muster. [more]

Let’s assume that we can  continue to accomplish the grand goals … Continue reading →

Breast Cancer Awareness Is About More Than Mammograms: What You Need To Know

It’s October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.

But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! [more]

There’s no doubt NBCAM  is a big deal. In fact it’s probably the biggest cancer care effort for the entire year. It has been enormously successful in bringing attention to breast cancer and creating public focus on a very important issue for women and the men who love them, even as it does crowd out attention to other cancers that also deserve our attention, like lung, childhood cancer, ovarian cancer, and on and on.

And why shouldn’t we highlight mammography’s role? In the bad old days, as a much younger oncologist, I used to dream of a day when we could have not only better treatments for cancer, … Continue reading →

Is It Too Much To Expect More Balance When Discussing Proton Beam Therapy For Cancer Patients?

I had an interesting day this past week. Sadly, it left me wondering why the same “hope and hype” directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.

In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren’t necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.

Not long after, I was informed of an online discussion  on Twitter (called a “tweet chat” at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a “scrum” of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the  limitations of our … Continue reading →

We Need A Sense Of Urgency To Assure The Safety Of Health Information Technology

This was the dream: we would use technology to create a seamless healthcare system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately.

After spending three days at a meeting this past week with some of the top experts in the field, I am not so certain that the dream is going to come true anytime soon. Perhaps more concerning, the problems–including patient safety issues–that are cropping up in so many areas are very troubling. [more]

The meeting was organized by three federal agencies involved in the oversight of medical devices, applications and health information technology including the Food and Drug Administration, the Office of the National Coordinator for Heatlh Information Technology (housed in the Executive Branch) and the Federal Communications Commission. Those three agencies recently released a report describing their vision for regulation of health information technology. The purpose of the meeting was to extend the discussion. (I have listed links to several relevant documents at the end of this blog.)

I came … Continue reading →

The Haunting Memories When Screening Doesn’t Work

I had the opportunity earlier this week to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called “80 by 2018” designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths from this disease.

But I am haunted by two of the comments I tweeted during the session chat that won’t leave my conscience:

“As a doc, you don’t forget the patients you couldn’t help. And you celebrate those you did. #CRCawareness is key #80by2018

“Let’s remember that screening doesn’t help everyone, so don’t forget the need for more research in understanding #CRC #80by2018

While we celebrate the opportunity to save more lives with screening, we cannot ignore or forget those for whom screening for colorectal cancer (or other cancers, for that matter) couldn’t or didn’t make a difference. [more]

Let me share a couple of stories with you. These are obviously people I have remembered over the years and who have had a continued impact for me personally.

The first person … Continue reading →