November/December 2010, Vol 1, No 6

This study compared the safety and efficacy of a new regimen—bortezomib plus dexamethasone and vincristine— compared with vincristine (Oncovin), doxorubicin (Adriamycin), and dexamethasone (VAD) in previously untreated multiple myeloma (MM) (J Clin Oncol. 2010;28:4621-4629).

A discussion of new drug development using the example of acute myeloid leukemia (AML)—but that is applicable to a broad range of diseases— outlines the problems inherent in phase 2 clinical trials that may lead to falsepositive results, and how trial design can be improved and drug development be made more efficient and less costly (Blood. 2010;116:2420-2428).

In patients with multiple myeloma with light chain–induced renal failure, treatment with a combination known as BDD (bortezomib [Velcade], doxorubicin [Adriamycin], and dexamethasone [Decadron]) resulted in a high rate of myeloma and renal responses that was well tolerated by patients (J Clin Oncol. 2010;28:4635-4641).

As the last issue of this first year of publication of Value-Based Cancer Care (VBCC) reaches you, I wanted to take a moment to reflect on where VBCC has been so far and where it will be headed in 2011 and beyond.

Each year, oncologists return to their respective practices after attending the annual American Society of Clinical Oncology or American Society of Hematology meetings armed with knowledge of new drug/biologic combinations, modified regimen dosing, and other novel approaches that may provide incrementally better outcomes for cancer patients.

US and Canadian medical oncologists share similar attitudes on the costs, cost-effectiveness, and health policies concerning new cancer drugs, despite fundamental differences between the 2 countries regarding how these drugs are covered and paid for under their respective healthcare systems.

Concerns about the future of cancer research exist among the spectrum of researchers and regulators, and in remarks prepared for the President’s Cancer Panel: The Future of Cancer Research—Accelerating Scientific Innovation (held September 22, 2010, in Boston), American Society of Clinical Oncology (ASCO) President George W. Sledge, Jr, MD, outlined some of the organization’s concerns regarding new biological therapies and the future of cancer research.

Clinical cancer research is hampered by an overly complex and cautious regulatory system, which slows the development of lifesaving drugs, increases costs, and may be unethical, according to David J. Stewart,MD, of the University of Texas M.D. Anderson Cancer Center and colleagues (Stewart DJ, et al. Equipoise lost: ethics, costs, and the regulation of cancer clinical research. J Clin Oncol. 2010;28:2925-2935).

Some molecularly targeted agents are proving to be less effective, not more so, when administered earlier in the disease course. Researchers say this is counterintuitive, because advanced disease is associated with treatment refractoriness, and cancer agents will typically perform better in the adjuvant treatment setting than in the metastatic treatment setting.

The floodgate has opened for molecularly targeted antitumor agents, and with each novel compound the cost of treating cancer soars ever higher.