Oncology Unscripted With John Marshall: Episode 1: Oncology News, ASCO Plenaries, and RVUs

[00:00:00] John Marshall, MD: Hey, everybody out there. This is John Marshall live from my office at Georgetown University. And this is oncology update for May 22, 2024. We're about one week out from ASCO. There's a lot going on, but first let's talk a little bit about what's going on out there in our business world in oncology today.

Shifts & Shocks: Layoffs, Dose Reductions, and Drug Withdrawals

[00:00:27] There’s been a crazy lot of stuff happening. First, I don't know if you saw this, but Bayer laid off a thousand plus people or will do that over this year. And it's going to be at the management level, pretty high level. They say they need to thin down, become more lean and mean. They got a bit top heavy, but this is not the only company doing it. Biogen and Novartis are also in the process of downsizing their sort of corporate offices. So, look out for, I don't know, people looking for jobs as these folks get laid off and need to move on to something else.  

https://www.fiercepharma.com/pharma/bayer-reduced-1500-roles-new-organization-takes-shape   

[00:01:01] Another fascinating thing that's going on is that there's this recognition around dosing of new medicines; that we're using too high of a dose of medicine. That's the ones that were tested. We didn't want to miss any effect, but that means we're giving too much of a dose. New studies are looking to see if we can we use significantly lower doses of a lot of our cancer medicines and still have our best bang from the buck? And so, this is critically important as we become better physicians. So watch out for that research. 

https://www.washingtonpost.com/health/2024/05/04/cancer-chemo-drug-dosage-fda/

[00:01:32] The next, and I don't know if you saw that just this last couple of days, FDA announced that, infigratinib, now this is one of those fusion molecules for FGFR2 that was seeking to get approval at the FDA level. It got initial approval based on early clinical trial data, but you know why they withdrew the request for approval. They couldn't get it because they couldn't get patients to go on the study. And that means we're not doing good molecular profiling and we're not enrolling patients into clinical trials. This is a shame that this has happened. So, we need to be better about this because now we've lost a drug that could have been useful for our patients with FGFR fusions.

https://www.fda.gov/drugs/resources-information-approved-drugs/withdrawn-fda-grants-accelerated-approval-infigratinib-metastatic-cholangiocarcinoma  

Redefining Cancer Center Operations: Strategic Mergers and Leadership Changes 

[00:02:19] On the big medical corporate front, the news that's out there is that Rush, up in Chicago, has become the seventh internal in the U. S. partner with MD Anderson's network. And this is quite a network. You've got Banner Health in Phoenix, you've got Baptist in Jacksonville, you've got Community Health in Indianapolis, in Camden, New Jersey, a site, Ochsner, Down in New Orleans, Rush in Chicago, and, of course, UT San Antonio, and you think about just the size of this. I happened to be down in Houston to do grand rounds. Actually, only four people showed up live for that. Everybody is virtual. Will grand rounds ever be live again? But nonetheless, I was down at MD Anderson, my wife and I giving grand rounds and lo and behold, it is huge. It's shiny. It's beautiful. And now they've got even more size to go after. 

[00:03:13] So why would you do this? Well, of course, from MD Anderson's perspective, this is a great thing for them. This is connections to cancer centers around the country. They can do more studies, for example. They probably get paid for this brand.

[00:03:26] Why would you want to be this? If you were in New Orleans or in Phoenix? Well, you're trying to compete in the marketplace, and the MD Anderson brand carries a lot of weight for people out there as they're seeking cancer care. So, it seems like it's a win win for both of these groups or all of these groups to get together. But it also means we're getting bigger and bigger conglomerations of cancer care providing, and so, you know, there'll be less variability, less innovation is what I worry about in that space. 

https://www.bizjournals.com/houston/news/2024/04/29/md-anderson-cancer-center-rush-university-chicago.ht