Pharmalot... Pharmalittle... Good Morning

FYI...The gilead article is about truvada for prevention...not stribild/quad

Thanks for the note A. After writing about Stribild recently, the name simply stuck in my brain. I appreciate that you pointed out the gaffe.

ed

Stribild, sounds like the sound you try to make with your mouth when you want your infant to smile at you.

In regards to the "Lung Cancer Genomic Mapping Points Toward New Targets," so the major medical centers need to form a consortium. In it, they would direct one or more studies of one mutation and one drug that might home in on the specific mutation. So even if a small percentage of squamous cell cancer patients would have that mutation, patients across the country could be in a clinical trial of a targeted drug. A patient's own doctor could administer the drug and the medical center directing the trial could analyze the data in partnership with the company that made the drug.

This was similarly done with Xalkori (crizotinib), which targets a rearranged gene in some adenocarcinoma lung cancer patients entered clinical trials for lung cancers with the rearrangement. The rearrangement was so rare, about 1,500 patients were tested to find 82 whose cancers had it. They were the ones included in the study.

Xalkori (crizotinib) was originally developed as a clinical therapy for patients who carried the CMET mutation. Serendipity led to the recognition that the responding subpopulation was actually carrying a heretofore-unrecognized ALK gene rearrangement (accidental success). Were it not for the clinical "observation" of response in patients, the investigators conducting this trial would have been unlikely to make the discoveries that today provide such good clinical responses in others. As Dr. Robert Nagourney of Rational Therapeutics puts it, "these patients and their disease entities educated the molecular biologists."

May I ask I naive question. The late author Christopher Hitchens paid to have his entire genome sequenced in the hopes of finding a genetic target for the Stage IV esophageal cancer that eventually killed him. The going rate for this procedure is about $350,000 for a single gene map.

Who is kidding whom here?

So, where did you get your accurate(!) numbers? Did you personally confirm this and what source was used as the "gospel"?

Christopher Hitchens and Steve Jobs experienced unsuccessful efforts to probe their own genomes for effective treatments. Few patients have access to 26 gene-sequencing machines capable of identifying genomic targets. Both entered a realm that one clinician has called "social medicine." Not to be confused with socialized medicine. Social medicine is the process whereby the rich and famous receive care from the "right" doctors. These luminaries, through their channels and connections, are hand carried to the most famous physicians in the country. Their prominent and widely published ivory tower investigators then provide the best care money can buy, whether $350,000 or $250,000 or whatever.

Yet, more often than not, it is exactly the same therapy that they would have received from their home-town oncologists, who read the same journals, attended the same meetings and adhered to the same NCCN or ASCO guidelines as the "best and brightest" academics. Then they conveniently chalk these patient's failures up to the biology of the disease and the patient's drug resistance rather than examining the more discomforting reality that "protocol therapy" doesn't work for famous patients any better than it does for anyone else.

Thanks, Greg. In the case of Hutchens his care was attended by Dr Francis Collins. Famous doctor treating famous patient. Hitch went the cancer immunoscreening route which is just as high stakes since there a only about a five percent chance he had the right antibodies to the tumor antigens for the same tumor that killed his father. Remember also with Jobs that he probably spent about $150K for his liver transplant on top of the other costs.

Hitchens might have improved his chances for survival if he had not smoked or drank alcohol. Likewise epidermoid (squamous cell)carcinoma of the lung us almost 100% caused by cigarette smoking. Lets stop spending money on these really low percentage approaches and get back to basics. Don't smoke cigarettes and it's virtually impossible you will get squamous cell carcinoma of the lung, especially now that generating second hand smoke will get you an audience with the Lord High Executioner, Mayor Bloomberg.