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“Pathways Reconsidered: Let’s Not Stop Thinking Outside the Box”

Dr. Stephen Fox of Paoli, PA is well worth quoting without further comment, regarding the increasing pressure on oncologist from insurances and bureaucracies to treat patients with proscribed “pathways” in the name of cost effectiveness :  “… pathway recommendations may work for the majority of patients, but perhaps 20% of patients will be best served by using therapy that is divergent from these accepted pathways… I have been in practice for close to 30 years and have learned the importance of “thinking outside the box.”  I have had major successes with drugs that were not considered to be the standard of care… I understand that reimbursement is a major issue in the current economic environment. I also concede that pathway development is ongoing, evolving, and will generally be a good thing. Nevertheless, I would like to see those of us who attempt to advocate for patients and think outside the box be given some recourse to treat our patients discordant with pathways on occasion, and when and if the physician feels strongly about the need to treat a patient differently… After all, if all we needed were pathways to decide on clinical treatments, we might as well just slip them into a computer with the patient’s records and go dishing” (from ASCO Post Sep 15 2011, p.41). Bravo, Dr. Fox !

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Business, regulatory and legal obstacles to cocktail therapy for cancer

The Institute of Medicine’s National Cancer Policy Forum convened a workshop on developing combination cancer therapies last year to examine and identify barriers that may be preventing the development of combination investigational cancer therapies and to offer potential ways to overcome those barriers. This harbinges the new awareness of the potential of cocktails against cancer, a good start ! (Also see note under Pages on right, referring to p.52 for more details).

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“Triangulation” – a military metaphor for the cocktail approach

A patient recently told me about this, a retired Air Force man who was versed in artillery:

“With respect to artillery, if you fire at a target from one fixed position, then the shells will go in a reasonably straight line and have one of three outcomes – either they will hit the target, will go further beyond the target, or will fall short.  But if you fire at the target from two or more different positions, you triangulate and that permits you to get a more accurate fix on hitting and destroying the target”

Similarly, when we “fire” one drug at a cancer, it could either hit or miss; but if we fire different treatments (from different positions, i.e. using treatments with different mechanisms of actions for example) at the same cancer, we “triangulate” and it will optimize the likelihood of hitting the target head on !

– Thanks Jacob !

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“Functional Cure” for cancer ?

“Cure” may be a hush word in the oncology vocabulary, doctors never say it and sometimes avoid the issue by proclaiming cancer a “chronic disease”.  It reminds me of how “cure” was not in the AIDS doctor’s vocabulary only a few years back and how it was considered overly optimistic to utter, but lately it has been all over the media, on CBS in the summer, as “New Hope for Cure” on the New York Times in Nov, and as a headline article on Dec 1st’s FT Health: ‘Functional cure’  is global target.   Indeed, ‘cure’ is now on the agenda of every scientific meeting on HIV, and the latest focus for AIDS researchers is on finding ways for patients to stop taking drugs and live normally without dependent on medications.  How inspiring!

Of course, by now we all know that ‘cocktail treatment’ is made famous by David Ho’s revolutionary strategy for approaching HIV, and thereafter it became the guiding principle in AIDS therapy. Hopefully cocktail therapy will soon lead to functional cures for cancer as well!

Categories: Uncategorized