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Great commentary Sally. I concur with your view and enthusiasm. There is certainly a paradigm shift away from macro targets (i.e. whole tumor) to micro/mutational strategies, aka "genomic therapeutics". The recent ASCO data on improved PFS, PRs, and CRs in non-small cell lung cancer patients treated with the anaplastic lymphoma kinase (ALK) inhibitor, crizotinib, supported the importance of mutation driven interventions. Unfortunately, cancer is a complicated disease process involving a series of pathological changes and it remains to be seen if a single mutation serves as a trigger for disease progression or if disruption of a singular pathway will impair/eradicate the disease. Genomics is a promising direction that will likely lead to improved drugs and enhanced survival times, but may be an incomplete approach for curative expectations. Dr. Dwight Tapp CEO & President ClinicAid Research Management Inc.
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Sally, Interesting commentary and dialogue among your blog respondents. Is there any data on drivers of compliance within cohorts (i.e. does any data indicate if compliance is a problem with physician compliance to either SOC or research protocols or is the issue a greater problem among patients and perhaps supportive care givers)? The problem is likely multifaceted influenced by many variables including stage of disease, age of patient, length of treatment, direct physician involvement in education and support (more and more I see physicians spending less time with patients), etc. Another problem is that much of patient care in cancer is still disease centered rather than patient centered - i.e. researchers and practitioners are focused on disease eradication (which is important) and less on quality of life for the patients. Hopefully genomic medicine will improve in this area, but even at this individualized level, medicine is still focused on the disease rather than providing care for the person as a whole. You've raised a very complex and sensitive issue. DT
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Jul 13, 2010