John L. Marshall, MD; Bruce D. Cheson, MD; David Kerr, CBE, MD, DSc, FRCP, FMedSci


June 10, 2013

In This Article

Retooling the Future

Dr. Marshall: So, we whine about all of this. We have been complaining about it. It's now out in the open. What do we do about it? How can we be leaders in this arena? We think it's our responsibility to do it. How can we change the future?

Dr. Kerr: You have given us our platform, John. The symposium that you host at home in Washington gives us an opportunity to talk about better-value healthcare. ASCO is joining the fight.[10,11] This is an advertisement, plain and blunt: Colleagues and I have written a book called How to Get Better Value Cancer Care.[12] God bless me. If oncologists start to talk about it and understand it -- whether there is a broader coalition and whether we move beyond the group of 100 top hematologists saying this, this, that, and the other... It comes back to a revolution again, but whether there is a wider, broader coalition that we should build, with patient advocates, with industry, whether there are roundtables with politicians to say that this cannot go on... Whether it's under the auspices of professional societies, who knows? But maybe it's time to start to collectively take to the barricades.

Dr. Marshall: I'm always jealous of your lymphoma clinical trials because they are frequently small, enriched, often phase 2 studies that set the standard. I'm jealous of those because I feel like in our big phase 3 randomized studies, we are wasting the standard of treating a bunch of people for nothing. What are some thoughts on how we might further enrich our clinical trial designs to find this value?

Dr. Cheson: We need to identify the important markers and the important therapy. Instead of doing large randomized trials that we are not sure we are going to win, we need to do smaller studies that are hypothesis-generated, biomarker-generated, and things that are really going to work.


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