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How should we spell success?
Questions of how we define success in cancer research and how costs should factor into that definition have been much in the news.
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The War on Cancer: Raise the bar, or move the goal line?
Plenary Session
SWOG Fall 2009 Group Meeting
Friday, October 23, 12:15 - 2:45 pm
Gold Level, Regency B - D
Hyatt Regency Chicago
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SWOG Spotlight: Comparative effectiveness
NCI GO grant charts comparative effectiveness research course for SWOG
A $4 million National Cancer Institute (NCI) grant will help position the Southwest Oncology Group as a national leader in comparative effectiveness research on cancer.
The Grand Opportunities (GO) award supports the development of the Center for Comparative Effectiveness Research in Cancer Genomics, or CANCERGEN, under the direction of SWOG investigator Scott Ramsey, MD, PhD, of the Fred Hutchinson Cancer Research Center in Seattle. Researchers at the University of Washington, Cancer Research And Biostatistics (CRAB) in Seattle, and the Center for Medical Technology Policy in Baltimore will co-lead the effort.
CANCERGEN will create a comprehensive evaluation, assessment, and design process to identify which emerging cancer genomics technologies are the best candidates for studies by SWOG's clinical trials network.
"CANCERGEN will provide us objective tools to determine which proposed trials are most likely to have a significant clinical benefit for patients," says SWOG Group Chair Laurence H. Baker, D.O., "and we will commit to doing only those trials that meet this new standard."
Comparative effectiveness research, or CER, has gained national attention and a surge of federal stimulus funding because it is seen as a means of slowing the growth of runaway health care costs in the U.S. by moving the system away from expensive but less effective treatments.
A recent Institute of Medicine report on comparative effectiveness research has influenced many of the health care reform packages now wending their way through the U.S Congress.
"Realizing [CANCERGEN's] vision will go a long way to help achieve the health care reform goal of making cancer treatment more effective and less expensive," says Ramsey.
The first SWOG clinical trial to be supported under CANCERGEN will assess whether a genetic test known as the Oncotype DX assay can predict which patients with node-positive breast cancer -- breast cancer that has spread to their lymph nodes -- will benefit from chemotherapy and which patients will not.
The study was one of five comparative effectiveness trial proposals NCI Director John Niederhuber, MD, submitted to the National Institutes of Health in January of 2009 as candidates for federal stimulus funding. It is expected to serve as a model for future comparative effectiveness studies of cancer genomics technologies.
S0930: SWOG & CANCERGEN's first trial?
The Oncotype DX genetic assay is now routinely used to test the tumors of patients whose breast cancer has not spread to their lymph nodes -- node-negative breast cancer. By measuring the expression or activity level of 21 specific genes within the tumor, the assay helps oncologists decide on treatment options by predicting whether a patient is likely to benefit from a course of chemotherapy.
S0930 is a proposed SWOG nationwide phase III clinical trial to determine whether this genetic test has the same predictive value for patients with node-positive breast cancer -- those whose cancer has spread to their lymph nodes. In 2008 about one-third of the 184,000 women diagnosed with breast cancer in the U.S. had cancer that had spread to their lymph nodes.
The genetic assay is expensive, costing about $3,500 per test. Yet the chemotherapy treatment now routinely given to node-positive breast cancer patients costs on the order of $50,000 per year. If the Oncotype DX assay does prove to predict which patients with node-positive breast cancer will see no benefit from this chemotherapy, it could spare thousands of women the grisly effects of a course of chemotherapy that will not help lengthen their life, while at the same time saving hundreds of millions of dollars in health care costs each year.
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