Oncology: July 2010 Archives

A big HT to the WSJ Health Blog for showcasing this intriguing study in Health Affairs. Against the otherwise commonsensical preference for screening colonoscopy (to prevent and detect colorectal cancer), researchers at RTI International showed that yearly testing for fecal occult-blood leads to more life years saved. The result held even when adherence to CRC screening guidelines dropped to 40% and follow-up compliance was only 65%.

The context of the study was a fixed budget for a CRC-screening program ($1 million), and the assumed costs for guaiac testing and colonoscopy were $23 and $699, respectively. (Although the Healthcare Blue Book price for colonoscopy [no biopsy] is much higher, at $1658.) Consequently fecal occult-blood tests allowed the hypothetical program to screen more individuals and lead to a greater number of life-years gained.

The authors warned that the study only assessed life-years gained, not quality-adjusted life years (QALY), and that the test selection was made in the context of a fixed budget. "If there were no budget constraints," they wrote, "a different screening test might be preferable."

But really: When are there no budget constraints?

Addendum: At the WSJ Health Blog, one commenter raised the issue that the authors only assessed a hypothetical population-based screening program. The results do not necessarily indicate that fecal occult-blood tests are preferable screening tools for individuals who are at high risk for CRC (eg, people with Crohn disease or a family history of CRC).

Photo of Olympus standard video colonoscope: price, $3500. (Avoiding Olympus standard video colonoscope: priceless.)

Just as an astronomical white count is not an entity unto itself but a marker of a serious underlying disorder, like leukemia, so a big lie on a CV is an indicator of a grave underlying problem, like sociopathy.

Faculty members at the Duke Institute for Genome Sciences and Policy are learning this lesson the hard way thanks to the failure of someone at Duke to perform the basic HR duty of vetting Anil Potti's curriculum vitae 7 years ago. Potti, who was hired in 2003 as a physician-researcher by Duke, falsely claimed that he was a Rhodes Scholar on scientific grant proposals, according to a recent expose by Paul Goldberg in The Cancer Letter. That's a big lie and one suggesting that other big lies are possible, if not probable. Taking this very cue, Goldberg then questioned the integrity of Potti's research at Duke and found that 2 biostatisticians at M. D. Anderson discovered "a series of errors," including mislabeling errors, in a seminal article by Potti and others.

Consequently the biggest victim of Duke's remote HR lapse: cancer patients who enrolled in clinical trials, which were based on Potti's questionable work. According to the NYT, these trials have now been suspended (after stuttering efforts by Duke officials to reopen them, reported Goldberg). News coverage can also be found at NPR's Shots blog.

For yucks or groans, I performed a quick PubMed search: "A Potti" is the coauthor of 48 articles that were published within the last 5 years. Potti's articles appeared in, for example, PNAS, JAMA, JCO, PLoS One, Lancet Oncology, Nature Medicine, and the NEJM.

Photo of Anil Potti from Duke Institute for Genome Sciences and Policy.

10/24/10 addendum: As the AP reported yesterday, Lancet Oncology editor David Collingridge relayed an "expression of concern" from 15 European investigators who were coauthors with Potti and 3 other Duke researchers on a 2007 article in the journal. (The article validated the use of gene signatures to predict the response of breast cancers to neoadjuvant [perioperative] chemotherapy.) After the damning report from biostatisticians at M. D. Anderson about Potti's alleged errors in another article, the Lancet Oncology coauthors repeatedly attempted to contact their Duke colleagues, but they were ignored, wrote Collingridge.

The editor also revealed that "a large group of scientists" wrote to NCI director Harold Varmus on July 19th, expressing their concerns about the validity of a) Potti's cancer-treatment prediction models and b) 3 clinical trials that were based on these prediction models. Collingridge expressed his own concerns about the Lancet Oncology article given recent developments surrounding Potti. The journal has contacted the Duke coauthors—Anil Potti, Chaitanya Acharya, Sayan Mukherjee, and Joseph Nevins—and awaits their responses. 

Dr. George Lundberg, MedPage's Editor at Large, is really excited about an article that was published in March in the Journal of Clinical Investigation. And he predicts big things for the article's authors, like a Nobel Prize.

The article, by California academicians and an employee at AntiCancer, Inc., describes how vasculogenesis* of irradiated tumors can be inhibited by an already approved drug, AMD3100, in a mouse model of glioblastoma multiforme—the deadliest of brain cancers.

AMD3100 is also known as plerixafor or Mozobil, which is owned by Genzyme. The injectable drug is currently indicated, in combination with G-CSF, to mobilize hematopoietic stem cells for autologous transplantation in patients with non-Hodgkin lymphoma or multiple myeloma. So human trials of the drug and uncontrolled case studies can begin, Lundberg argues, more or less immediately.

G-CSF = granulocyte-colony stimulating factor (eg, filgrastim [Neupogen; Amgen]).

* Which is distinguished from angiogenesis or "the sprouting and proliferation of endothelial cell from local vessels. The authors posit that tumor recurrence after radiation is largely mediated by vasculogenesis, the "colonization of circulating endothelial or other cells primarily from the bone marrow."

Photo of Ted Kennedy, who died last year of glioblastoma: Biographical Directory of the United States Congress.