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


June 10, 2013

In This Article

One Step at a Time

Dr. Cheson: Getting back to what you were saying, we need to lead by example. If we don't do it right, the people in our division won't do it right. The people in the community won't do it right. So we have to be the leaders. The National Comprehensive Cancer Network guidelines or the International Working Group lymphoma criteria -- whatever -- we have to say something because third-party payers pay attention to that. If we say that PET scans shouldn't be done in surveillance, they are not going to pay for it anymore.

So, we have an opportunity in that arena. But with the drug situation, all the sectors have to get together, sit down, and figure out what to do about it because the companies are going to shoot themselves in the foot. They are going to develop these drugs and totally price themselves out of existence.

Dr. Marshall: I like this statistic. There are 6 billion people in the world and only 1 billion have access to cancer care. Is this the right way to go? If we could simply find another 2 billion, could the price be cut in half with the same return on investment? Why have we done such a bad job of embracing our global friends in cancer care? Is it price? Is it efficacy? Has it not been a priority for our countries? David has thought a lot about this.

Dr. Kerr: All that you said is exactly true, John. But I wonder whether there are different research paradigms. We were noodling earlier about continuous low-dose chemotherapy possibly being metronomic. Perhaps we need to direct some of our intellect or drive and energy to designing trials that are appropriate for low-income and emerging nations in reducing toxicity. I'm not saying that we go for the big bang and look for an 80% cure rate; but if it costs $1 a day, a 50% cure rate is a start. And then, often in emerging nations, it's putting the building blocks in place to do something. I would rather do something that is imperfect than wait forever to do something that is perfect.

Dr. Marshall: Are there any closing comments on value in cancer medicine?

Dr. Cheson: It can't stop when they turn the cameras off today. We need to continue this dialogue and figure out a way to bring in the sectors and sit down and convince everybody that it has to be done. We are in a new era in cancer care. We have exciting new drugs. But they are not going to do anybody any good if you can't get them to the people because they can't afford them.

We have to make sure that not only are they really cool, but they are really worth the money. There has to be value in them.

Dr. Marshall: Bruce and David, thank you so much for joining us today. It has been a good and interesting discussion. Change the world step by step.

Thank you for joining us on Medscape Oncology Insights. This is John Marshall, reporting from ASCO 2013.


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