HER2 Support Group Forums - View Single Post - Medicare Coverage for Cell Culture Assay Test

gdpawel · 04-24-2007, 08:38 AM

LOL. I am no math whiz either. But again, that doesn't stop people like us grasping concepts. At least for me, it just takes a little longer than others. But in the end, I get the job done. Your graps seems to be pretty good.

Evidence-based medicine is a "trial and error" process of a clinical trial to see what might "appear" to be improving cancer survival. While new regimens "appear" to be improving survival, when these same regimens are tested on a wider range of cancer patients, the results have been very disappointing. In other words, oncologists at a single institution may obtain a 40% to 50% response rate (not cure) in a tightly controlled study, when these same regimens are tested in a real-world setting, the response rates may be 17% to 27%.

There appears to be a number of patients who have had long-term survival after high dose therapy, but there are a number of patients whose tumors are responsive to chemotherapy who have had long-term remissions from standard dose chemotherapy, as well as a number who show no difference in survival when treated with standard-dose or high-dose chemotherapy.

Does chemotherapy shorten survival of some patients, while prolonging the survival of others? You do help some patients, but for every patient helped, there's another one you may hurt. Are you an "average population?" I know I'm not. I am an individual. Take notice the cancer establishment is now using the concept "personalized" cancer treatment. There must be a good reason.

You may want to reserve aggressive therapy for those patients who will derive more benefit than harm, while identifying the most promising treatment regimens for everyone. In patients with tumors very resistant to cytotoxic chemotherapy, the most promising treatments may be angiogenesis inhibitors, growth factor inhibitors, or more integrative medicine approaches.

It may be better not to give more aggressive and toxic, mutagenic and immunosuppressive combinations, but to give targeted single agents, or give least toxic, mutagenic synergistic combinations. One of the most important drug combinations introduced for the treatment of solid tumors in the last 15 years has been the gemcitabine + platinum combination. However, giving this combination to everyone would not be that helpful, because the immunosuppression and mutagenicity of the combination cancels out in many patients, the gains in a few, fortunate patients.

Although an above-average regimen, it is not a highly active regimen in everyone, and it's activity is nicely predicted by cell culture assay results. What is unique about gemcitabine + platinum combination is that, in a subset of patients, it produces responses the likes of which are seldom seen with anything else.

More emphasis should be put on matching treatment to the patient, through the use of individualized genetic and cellular pre-testing, having more respect for minimal partial response or stable disease, when it can be achieved through use of the least toxic and mutagenic drug regimens, and reserve the use of higher dose therapy or aggressive combination chemotherapy to those patients with tumor biologies most amenable to attack and destroy by these aggressive treatments. Sounds good to me.

04-24-2007, 08:38 AM	#5
gdpawel Senior Member Join Date: Aug 2006 Location: Pennsylvania Posts: 1,080	Statistics LOL. I am no math whiz either. But again, that doesn't stop people like us grasping concepts. At least for me, it just takes a little longer than others. But in the end, I get the job done. Your graps seems to be pretty good. Evidence-based medicine is a "trial and error" process of a clinical trial to see what might "appear" to be improving cancer survival. While new regimens "appear" to be improving survival, when these same regimens are tested on a wider range of cancer patients, the results have been very disappointing. In other words, oncologists at a single institution may obtain a 40% to 50% response rate (not cure) in a tightly controlled study, when these same regimens are tested in a real-world setting, the response rates may be 17% to 27%. There appears to be a number of patients who have had long-term survival after high dose therapy, but there are a number of patients whose tumors are responsive to chemotherapy who have had long-term remissions from standard dose chemotherapy, as well as a number who show no difference in survival when treated with standard-dose or high-dose chemotherapy. Does chemotherapy shorten survival of some patients, while prolonging the survival of others? You do help some patients, but for every patient helped, there's another one you may hurt. Are you an "average population?" I know I'm not. I am an individual. Take notice the cancer establishment is now using the concept "personalized" cancer treatment. There must be a good reason. You may want to reserve aggressive therapy for those patients who will derive more benefit than harm, while identifying the most promising treatment regimens for everyone. In patients with tumors very resistant to cytotoxic chemotherapy, the most promising treatments may be angiogenesis inhibitors, growth factor inhibitors, or more integrative medicine approaches. It may be better not to give more aggressive and toxic, mutagenic and immunosuppressive combinations, but to give targeted single agents, or give least toxic, mutagenic synergistic combinations. One of the most important drug combinations introduced for the treatment of solid tumors in the last 15 years has been the gemcitabine + platinum combination. However, giving this combination to everyone would not be that helpful, because the immunosuppression and mutagenicity of the combination cancels out in many patients, the gains in a few, fortunate patients. Although an above-average regimen, it is not a highly active regimen in everyone, and it's activity is nicely predicted by cell culture assay results. What is unique about gemcitabine + platinum combination is that, in a subset of patients, it produces responses the likes of which are seldom seen with anything else. More emphasis should be put on matching treatment to the patient, through the use of individualized genetic and cellular pre-testing, having more respect for minimal partial response or stable disease, when it can be achieved through use of the least toxic and mutagenic drug regimens, and reserve the use of higher dose therapy or aggressive combination chemotherapy to those patients with tumor biologies most amenable to attack and destroy by these aggressive treatments. Sounds good to me.