'Precision medicine' altering treatment focus

FDA clears pricey oncology therapy drug for multiple cancers with a shared mutation

The federal Food and Drug Administration has approved a drug, Vitrakvi, for a wide range of cancers based on a shared mutation.

According to a recent Washington Post story by Laurie Mcginley that was reprinted in newspapers across the country, the decision shifts treatment focus away from tumor location, apparently "an advance for the sometimes controversial field of 'precision medicine.'"

The FDA action on Vitrakvi (aka larotrectinib) marks the second treatment to receive the agency's "clearance based on a common biomarker found in an array of cancers."

The approval was given simultaneously for adults and children, contrary to the more typical FDA action regarding oncology drugs whereby kids are not considered until much later than adults.

Vitrakvi is intended, Mcginley's story says, "for patients with advanced solid tumors containing what's called an NTRK gene fusion, a hybrid of two genes that can promote uncontrolled cell growth. Cancers of the thyroid, lung and head and neck, among others, can be caused by the defect."

Dr. Scott Gottlieb

According to a story in the online magazine Healio, Dr. Scott Gottlieb, a FDA commissioner, notes that approval of the new site-agnostic oncology therapy "marks another step in an important shift toward treating cancers based on their tumor genetics rather than their site of origin in the body."

The breakthrough drug (that was tested in three clinical trials), the Washington Post piece adds, "is for patients whose cancer has spread or who would experience severe complications by undergoing surgery and have no satisfactory alternatives."

Precision medicine has spawned both enthusiasm and skepticism, partially because both the drugs and the tests can be quite expensive.

The drug's manufacturer, Loxo Oncology, Inc., and its partner, Bayer, announced that "the wholesale acquisition cost will be $32,800 for a 30-day supply of capsules for adults. The cost for the liquid formulation for children…will start at $11,000 per month."

Patient affordability "is one of the big barriers to precision medicine right now," McKinley quotes Carolyn Presley, a geriatric oncologist at Ohio State University Comprehensive Cancer Center, as saying. "Show me the money — how are you going to pay for it?"

Elizabeth Jaffee, Johns Hopkins oncologist, nevertheless predicted that precision medicine "is going to be the way to treat cancer in the future," the Washington Post story reports.

More information on research into cancer can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Dubious ties to cancer industry undercut docs

Sloan Kettering pulls rug out from under its execs after apparent conflicts of interest

Memorial Sloan Kettering Cancer Center, under siege for potential conflicts of interest, has severely tightened the reins on its top executives.

No longer will they be able to serve on corporate boards of drug and health care companies, according to a story by Katie Thomas and Charles Ornstein in The New York Times this week.

The sanctions were imposed following a series of stories by The Times and ProPublica, a nonprofit journalism organization, that exposed questionable exec ties to the industry. 

In some cases, the article indicates, the companies "had paid them hundreds of thousands of dollars a year."

Officials at the facility, one of the world's most prominent, apparently also were informed by officials of their parent hospital that "a series of reforms designed to limit the ways in which its top executives and leading researchers could profit from work developed at Memorial Sloan Kettering, a nonprofit with a broad social mission that admits about 23,500 cancer patients each year," were being made permanent.

The conflicts at the center, the story continues, "have had a rippling effect on other leading cancer institutions across the country."

Dana-Farber Center Institute in Boston and Fred Hutchinson Cancer Center in Seattle, for example, are said to be reconsidering their policies on financial ties.

Dr. Craig B. Thompson

After muck-raking reports were published last fall that included information that Dr. Craig B. Thompson, Sloan Kettering's chief exec, was paid about $300,000 for his services in 2017, Thompson resigned from the board of Merck.

Earlier, The Times and ProPublica had alleged that Dr. José Baselga, Sloan Kettering's chief medical officer, "had failed to disclose millions of dollars in payments from drug and health companies in dozens of articles in medical journals."

Baselga resigned within days of the stories going public — and "stepped down from the boards of the drugmaker Bristol-Myers Squibb and Varian Medical Systems, a radiation equipment manufacturer."

Sloan Kettering employees who represent the hospital on corporate boards now will be barred from "accepting personal compensation, like equity stakes or stock options, from the companies."

The Times story quotes Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, as calling the policy changes a "watershed moment."

More information about research facilities can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Link possible between obesity and cancer

Fat cells can fuel the growth and spread of skin cancer, new Sloan Kettering study finds

Is being fat a potential cause for a surge in cancer?

Possibly.

At least if you believe a story by Matthew Tontonoz a while back on the Memorial Sloan Kettering Cancer Center website.

It says, in short, that cancer cells eat fat to grow and spread.

It cites discoveries at the Sloan Kettering Institute that "melanoma cells in zebrafish use fat from nearby fat cells to fuel their growth and spread," and indicates that a new study finds fat cells, or adipocytes, are filled with fats called lipids that can fuel cancer's aggressiveness.

In humans as well as fish.

Dr. Richard White

The story, sent me by my high school classmate Philip Greenhut, focuses on the words of Richard White, a doctor-scientist in SKI's Cancer Biology and Genetics Program:

"This is the seed-and-soil hypothesis. Tumor cells like to go to places where there is fertile soil. Based on the results of our study, we think that adipose tissue can be very fertile soil for melanoma."

The story notes that "knowing that adipose tissue enables some cancer cells to grow and spread suggests that cutting off their fat supply could be a way to fight the disease."

The findings, it contends, "also add to the growing understanding of the link between obesity and cancer."

White and his colleagues "stumbled onto the connection," Tontonoz's article claims, after using "zebrafish as a model system for studying skin cancer" because those "small freshwater fish get melanomas that are very similar to human melanomas" and because it's easy to see where the fish's cancer cells go as tumors progress since the creatures are transparent.

Ultimately, of course, the researchers examined the connection in human beings by looking at tumor samples from people with melanoma who were treated at Memorial Sloan Kettering.

Details of the findings were published in the journal "Cancer Discovery."

Details about other research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.