Gene Assays, New Treatments & the Silver Tsunami

Michaela Dinan

Three Questions for Michaela Dinan, PhD, Associate Professor in Population Health Sciences, Member, Duke Cancer Institute and Duke Clinical Research Institute

by Department of Population Health Sciences, Duke University School of Medicine

What was so revolutionary about the Oncotype DX test, and what impact has it had on cost and treatment?

Before Oncotype DX, the vast majority of women with (breast cancer) tumors over a centimeter received cytotoxic chemotherapy because there was no way to systematically identify those who would vs wouldn’t benefit from chemotherapy treatment using clinical or pathologic features. Large studies at that time suggested that, depending on age, the number needed to treat (NNT) with chemotherapy was between 15 to 33 women to save just one life. Because it can be physically draining, has multiple side effects, and is costly, there was significant interest in identifying women who could safely forego the treatment. CONTINUE READING

New treatments may have the potential to lessen heath and treatment disparities, from your research can you say whether this is happening?

As a society, if we are to reduce disparities in care, we have to know all the drivers, be able to intervene at all levels of care, and understand all relevant issues. We know common barriers to cutting-edge care—whether your doctor is up-to-date on the latest technologies, if your hospital is involved in clinical trials and has the latest equipment, or if you’re being treated at a top-level cancer center. We also know patient adherence affects disparities—if medicine is prescribed, and whether or not the patient can afford their co-pay or withstand the side effects. We also know that medical disparities reflect a broader systemic and institutionalized racism that permeates American culture. CONTINUE READING

In your estimation, what has had the greatest impact on cancer care?

Personalized medicine and immune-oncology treatments have been real game-changers in cancer care. Unfortunately, immune-oncology agents, such as checkpoint inhibitors, don’t work on all cancers and are only effective in a small subset, maybe 20% of the population, for most cancer types. But for whom it does work, it can be akin to a cure. CONTINUE READING