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Who's in It for the Cure?

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Who's in It for the Cure?


Hi, everybody. This is John Marshall for Medscape. I've got my little computer screen here because I want to go through something that I have been thinking about a lot lately in terms of our overall motivation in the world that we live in today. What we are all trying to do is develop new medicines to do a better job of treating patients with metastatic cancer and cancer in general. I have been thinking about the stakeholders in our world and all the different elements that we have to bring together to deliver the cancer care that we do, so I brought up a little slide that I want to go through.

The first one, of course, is the rule setters, and this is the US Food and Drug Administration (FDA). When developing new medicines or approving medicines, they, of course, have safety and efficacy as the primary endpoint. I personally think that this is a terrible endpoint. I think we should switch over to a value endpoint. It has safety in it and it has efficacy in it, but it also must have a value concept: How much is it worth? We need to push towards that. But for now, safety and efficacy get you in.

The Centers for Medicare & Medicaid Services and private payers -- what is their role? They are really about cost control and value. They want to bring it in under budget if they can, and that is their primary motive. The National Cancer Institute (NCI) and Cancer Therapy Evaluation Program (CTEP) -- I like theirs. Theirs is the best. Their role is to cure cancer, and that should be the theme across the board. The NCI's major goal is to cure cancer. I personally think that they are spending too much money on basic science and not enough on clinical research, but, of course, no one is listening to me about that. What is pharma's message? Pharma's primary motivation is markets and return on investment. They are a business and they are a noble business. They are doing good things for humanity and the like, but ultimately they need markets and return on investment. How about community oncologists? The majority of oncology out there is practiced in the community. Theirs is about efficient and quality care, and they do this very well. The majority of patients go to them. They are very happy with the care that they get. It is very efficient and quality care. How about we academic oncologists? My primary metric is clinical trial accrual. I am judged by my boss by the percentage of patients we enroll into clinical trials -- also a good thing, but that is how I am judged in my metric.

Does anybody ask the patients? If you do, their number-one answer is going to be "cure." They want to be cured of their disease, the same as the NCI's motivation. We really haven't embraced that adequately. Of course, we tell them that we are not going to, most of the time, and they don't hear that message. They still believe that one day they will be cured. They have personal benefit and altruism as motivation for participating in clinical trials, but their primary motivation is to be cured of their cancer. So, I think that should be our primary target. If we can bring all of these different motivations of the key stakeholders together around that fundamental point, I think we would change the world of oncology. So, the next time you are over there in clinic, the next time you are talking to a pharma person, or the next time you are thinking about an FDA approval, ask yourself whether you are meeting that primary motivation that our patients are seeking, which is to be cured. This is John Marshall for Medscape.

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