Onc Daily: Center to Pay $100M Penalty, Blood Test Aids Detection

Nick Mulcahy


May 04, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today.

Cancer Center Pays $100 Million Antitrust Penalty

A high-profile oncology practice in Florida has agreed to pay a $100 million penalty related to a criminal antitrust conspiracy charge, says the US Department of Justice (DOJ).

The Florida Cancer Specialists (FCS) & Research Institute had an anticompetitive, "illegal agreement" to divide cancer treatment services with another oncology group in a large swath of southwest Florida. It allocated chemotherapy treatments to itself and radiation treatments to another group, with revenues reaching nearly $1 billion, said the DOJ.

"For almost two decades, FCS and its co-conspirators agreed to cheat by limiting treatment options available to cancer patients in order to line their pockets," said Makan Delrahim, assistant attorney general of the DOJ's Antitrust Division.

Blood Test to Aid Cancer Detection

A multicancer blood test used with standard-of-care screening for breast, lung, and colon cancers is a potentially feasible tool for routine clinical care, say researchers from Johns Hopkins Medicine in Baltimore, Maryland. They presented new results from a study of 10,000 women with no cancer history at the American Association for Cancer Research (AACR) virtual meeting, with simultaneous publication in Science.

The DETECT-A blood test, an early version of the CancerSEEK test currently in development, effectively guided patient management in real time, in some cases leading to diagnosis of early cancer and potentially curative surgery, they note.

The test detected 14 of 45 cancers in seven organs for which no standard screening test is available, the researchers noted.

In addition, 12 cancers in three organs (breast, lung, and colon) were first detected by the blood test rather than by standard screening.

"More important, 65% [of the cancers detected by blood test] were localized or regional, which have higher chance of successful treatment with intent to cure," the team reported.

Harms From Social Distancing

Medscape has already reported how the COVID-19 pandemic has disrupted cancer care, with predictions of excess cancer deaths as a result. But it has affected all aspects of healthcare, and "shutting our clinics and reducing non-COVID care in hospitals threaten the poor more than the wealthy," notes Medscape columnist John Mandrola, MD.

For example, the Kentucky-based cardiologist has had patients stop their medications because of job loss. Interventions have made "the poor poorer," he says.

"We cannot ignore the harms of social distancing," he writes. The coronavirus will continue to "spread, and it will kill people. But so will our interventions."

"COVID-19 is only one cause of death; there will be many more non-COVID deaths over the next 2 years. That is why the endpoint of this experiment is not this summer or next summer, but possibly the summer after that. And at that endpoint, we mustn't count only COVID-19 deaths but all deaths," he concludes.

Molecular Tumor Boards Needed?

One of the most important advances of modern oncology is the transition from choosing the treatment based on an organ to choosing the treatment based on molecular analysis, driving a personalized approach to cancer therapy, say Italian oncologists in a review in Cancers.

Gene mutations, amplifications, and fusions now often guide treatment instead of specific organs in, say, the gut or oral cavity.

But weaknesses in this new approach need to be addressed, the authors say. Cancer cells are complex and have multiple molecular alterations, complicating identification of the driver. Also, tumor heterogeneity may preclude benefit from targeted agents. The authors point to potential multidisciplinary committees or molecular tumor boards to try to address complexity, enhance selection, and increase success.

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