Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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The Survivors And Advocates Highlight That Personalized Medicine Is About All Of Us

by Dr. Len June 02, 2015

When it comes to personalized/precision medicine we should never forget it's all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.

That was the message from a discussion I had the privilege to moderate  on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO),  now wrapping up in Chicago.

There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.

Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually predict who is going to respond better to which medicine. And frequently during the research presentations there was evidence that the more a cancer cell had mutated the more likely it was to respond to these new drugs.

But it was the survivors who touched my heart, my thoughts and my hopes.More...

Is It Time For Precision/Personalized Medicine?

by Dr. Len January 30, 2015

This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.

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Are we prepared for the genomics revolution?

The President's proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals.

I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.

And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.

No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It's not just about cancer, my friends. It will be coming to a primary care practice near you probably sooner than you realize -- but it is coming. More...

CanceRX 2014: We Need Innovative Approaches To Support Cancer Drug Development

by Dr. Len November 06, 2014

What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?

That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn't want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.

The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much "out of the box" thinking as we can muster. More...

Breast Cancer Awareness Is About More Than Mammograms: What You Need To Know

by Dr. Len October 02, 2014

It's October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.

But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! More...

Is It Too Much To Expect More Balance When Discussing Proton Beam Therapy For Cancer Patients?

by Dr. Len September 30, 2014

I had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.

In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren't necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.

Not long after, I was informed of an online discussion  on Twitter (called a "tweet chat" at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a "scrum" of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the  limitations of our knowledge or potential problems with the treatment. It was all about "we can do it, call us and we will tell you how good we are, and insurers won't pay us." Simply stated, the "conversation" seemed to be glancing by some of the inconvenient facts surrounding what has become another poster story for how we develop and promote new treatments in medicine, let alone cancer care. More...

Cancer and the Latino Community: Lessons Learned

by Dr. Len July 24, 2014

I had the privilege this week to serve as the keynote speaker for the 4th Summit sponsored by Latinas Contra Cancer-an organization founded and led by Ysabel Duron, a formidable cancer survivor and news media presence in San Francisco.

Bringing together members of the Latino community, researchers, community health workers, promotores (more on that later) and advocates, the summit focused on the issues facing the Latino community in increasing awareness, access to care, improved treatment and research opportunities among other topics. But what was most impressive was the spirit, engagement and commitment that permeated the room for the two days of the meeting.

I would like to share with you some of what I learned during the preparation for that lecture, as well as some observations that tie together the impact and calls to action that are relevant to the Latino community and many other ethnic and socioeconomic groups in the United States. (You may wish to refer to the American Cancer Society's "Cancer Facts and Figures for Hispanics/Latinos 2012-2014" which contains a wealth of information relative to cancer for this community.) More...

In An Era Of Bold New Cancer Treatments An Older Drug Shows Real Promise For Advanced Prostate Cancer

by Dr. Len June 02, 2014

The annual meeting of the American Society of Clinical Oncology here in Chicago is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But this weekend, a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us asking, "Why did it take so long to find out? More...

The Haunting Memories When Screening Doesn't Work

by Dr. Len March 27, 2014

I had the opportunity earlier this week to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called "80 by 2018" designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths from this disease.

But I am haunted by two of the comments I tweeted during the session chat that won't leave my conscience:

"As a doc, you don't forget the patients you couldn't help. And you celebrate those you did. #CRCawareness is key #80by2018"

"Let's remember that screening doesn't help everyone, so don't forget the need for more research in understanding #CRC #80by2018"

While we celebrate the opportunity to save more lives with screening, we cannot ignore or forget those for whom screening for colorectal cancer (or other cancers, for that matter) couldn't or didn't make a difference. More...

It Helps To Know What Watchful Waiting Really Means In Prostate Cancer Treatment

by Dr. Len March 06, 2014

News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to "watchful waiting" after they were diagnosed.

But guess what? There's a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the "watchful waiting" as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. More...

If PSA Tests Don't Impact Survival, Why Do Insurance Companies Do The Test Without Your Knowledge?

by Dr. Len August 21, 2013

A discussion on Twitter caught the eyes of my colleagues yesterday, and raised a very interesting question: should insurance companies be allowed to do PSA testing to detect prostate cancer on men as a condition of getting insurance?

What started the discussion was a blog post by a well-known and respected medical blogger who goes by the name "Skeptical Scalpel." In his blog he detailed the saga of a 56 year old man who had a pre-employment physical in order to be covered by his new company's health insurance plan. He was not informed that he was going to have a PSA test. It was just done as part of the process. No informed consent, no nothing, just stick out your arm, have blood drawn, and register your surprise that the test was done once the results come back.

The United States Preventive Services Task Force recommends against any man having the test to detect prostate cancer. Even among those who say the test is an option, -including the American Cancer Society-recommend that a man have a full, informed understanding of the pros and cons of PSA testing before getting the test, given the uncertainties of whether it really saves lives and the known frequency of side effects associated with treatment for prostate cancer. None of those recommendations were part of the consideration for this man when he was examined for his insurance plan.

You can imagine what happened: his PSA was slightly elevated at 5.9. He was "rated" by the insurer, charged an extra $200 a month for his health insurance, and may well have to have a number of additional studies. Not to mention that he may have prostate cancer, and may undergo more treatments-as a result of a test that is of uncertain value for most men. And, by the way, the odds are overwhelming that the gentleman in question does not have prostate cancer, but will have to go to considerable lengths (and some risk) to find out. Because he had not discussed the test, he did not have the opportunity to prepare for it correctly, so his reading may have been falsely high; we'll never know. And, if he does have prostate cancer, as reflected in the USPSTF recommendations, he has a significant chance of having long term side effects from the treatment, but little proven benefit in terms of saving his life. More...

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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