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New prostate cancer drug set to announce results March 5

There are not too many drugs that improve overall survival in prostate cancer.  Right now, the list is pretty short: Taxotere.

So the announcement that researchers have survival improvement with a new drug, cabazitaxel, is pretty exciting for us oncologists.

It's easy to become discouraged, but once in a while we get something to be happy about.  Today is one of those moments.

At least this time he didn't criticize doctors

dave snowI have to admit it, I took it a little personally when David Snow, the CEO of Medco, took a swipe at doctors in early 2009.  He was quoted in WSJ as saying he has no patience for doctors who think they know better than guidelines.  “I have no patience for a doctor who says, ‘I’m above it all, I don’t want to practice cookboo

REMS Programs place undue burden on clinicians

Dr. Jenkins--

I have seen your recent comments on providing REMS programs for opioids. Since you are the director of OND, I was hoping to give you some feedback on these programs, and to alert you to the adverse effect on patient care that they can have.

I am a clinical hematologist and oncologist. I have to contend with many drugs under these programs, including Promacta, Nplate, Thalomid, Tysabri, and Revlimid. Looks like opioids are next on the list.

Smokers with lung cancer: quit now and live longer, says new study

As an oncologist, I deal with more than my share of tobacco-related cancers. Many patients with these malignancies refuse to quit smoking, and the argument goes, "What's the point? Besides, it's one of the few things I have to look forward to anymore."

Big news for MS sufferers: two new treatments show early effectiveness

Figure 2NEJM has a pair of papers this week about two new drugs for multiple sclerosis: cladribine, which I use as a chemotherapy drug, and fingolimod, which is an immunosuppressive drug affecting lymphocyte function.

Warfarin pharmacogenetic testing not cost effective despite Medco's efforts to dictate care

Today I got a sign-it sheet from Medco asking me to authorize pharmacogenetic testing for a patient on warfarin. Now I know the Medco CEO wants to eat doctors and wants to tell us how to practice but this is crossing the line I think. Does Mr. Snow realize that pharmacogenetic testing for warfarin though trendy at the moment is not cost effective? How about $200 000 per QALY! Usually we have to be less than $50 000 per year to be cost effective like mammography Pap smears etc. It wasn't even that hard to find an analysis--try Google!

What a stay at the Wynn is like in February 2009

Have you ever wanted to stay at the Wynn? Come on it's ok to say yes. It is a very fancy nice-looking hotel. I personally was looking forward for a long time to staying there. To save you having to read a long rant I will summarize the weekend here: a very appealing facility lacking top-notch personalized service. The long story: we are LA people got a great rate for the Valentine's Day weekend. Drove from the San Fernando Valley arrived after dinner. Check in was hit or miss. Our friends got a friendly fresh clerk. We got Jose.

Vitamin C at high doses inhibits cell turnover independent of antioxidant effect

Researchers are calling for clinical trials of high-dose IV vitamin C in cancer treatment since the discovery that the supplement reduces cell proliferation in mice independent of an antioxidant effect. This goes against fifty years of theory dating all the way back to Linus Pauling. Turns out the vitamin turns off gene expression in genes critical to cell growth. Who new? This goes back to the T.S. Kuhn concept of science defined by its tools and techniques. When you had ways of measuring things by their oxidation activity you called them antioxidants.

Genetic testing may help docs dose stroke-blockers better

Looks like clopidogrel/Plavix genetic testing is a reality. A test called 2C19 Genotyping can predict which patients have faulty metabolism of this blood thinner leading to treatment failures and clotting problems. I got a nice review of two recent clinical trials in this area from the testing company Genelex. The testing has never previously been available to us clinicians but looks like it has come to the office setting. In the interest of disclosure I have worked with this company on projects in the past but we have never had a monetary relationship.

Avastin effect confirmed in breast cancer

According to a report by the Reuters Roche Holding AG the world's largest maker of cancer drugs said that Avastin or bevacizumab which the company markets with Genentech Inc. met its prime endpoint in a phase III breast cancer trial when it was disclosed that Avastin is in fact effective for breast cancer sufferers as well. The drug is categorized as a "monoclonal antibody" and "anti-angiogenesis" and is the best-selling drug.

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