Turner: Challenges to detecting cancer - 12K WES in '14 NEJM https://t.co/5BhjxlY3or Found a bump at the 12%-14% Allele fx #MAPonco16
5:47am September 24th 2016 via Hootsuite
Turner: Fig from '16 Nature Biotech https://t.co/v6Cc1aNPNu with graphical demonstration of reduction of error. 0.01% sens #MAPonco16
5:45am September 24th 2016 via Hootsuite
Turner: Shows illus from '14 Nature Protocols https://t.co/TsjA3ptwjj about how molecular barcoding can reduce seq errors #MAPonco16
5:44am September 24th 2016 via Hootsuite
Turner: Ovarian (S-IV), follicular lymphoma, Hodgkins lymphoma. Clearly not early enough. Fig from paper on how it matched plasma #MAPonco16
5:42am September 24th 2016 via Hootsuite
Turner: Shows this '15 JAMA Oncol https://t.co/XzXwAaZuPG via NIPT detecting cancers - 3 found out of 4,000 NIPT #MAPonco16
5:41am September 24th 2016 via Hootsuite
Turner: Starts with figure from this '14 STM ref https://t.co/Iqp0L4cb3K Theoretically: can be detected prior to symptoms #MAPonco16
5:40am September 24th 2016 via Hootsuite
Turner: (standing in for a GRAIL speaker, continuing on the theme of early detection) #MAPonco16
5:38am September 24th 2016 via Hootsuite
Turner: Model - w/adjuvant, tumor is more homogeneous, no ER mutant clone present. #MAPonco16
5:36am September 24th 2016 via Hootsuite
Turner: Looked at setting of treatment and aromatase inh (AI) - by itself or with adjuvant, found diff in ESR1 mut in ctDNA #MAPonco16
5:35am September 24th 2016 via Hootsuite
Turner: Shows data on ESR1 in ctDNA '15 STM https://t.co/Lsg6w8AGxE #MAPonco16
5:31am September 24th 2016 via Hootsuite
Turner: Example where looks like primary tumor: clonal muts come down together, and come up together. RB1 shows up late post-surg #MAPonco16
5:29am September 24th 2016 via Hootsuite
Turner: Shows genes mutated in primary tumor, and ctDNA at 17mo pre-relapse, 8-mos, then met. PIK3CA clearly progresses in ctDNA #MAPonco16
5:28am September 24th 2016 via Hootsuite
Turner: Can high-coverage seq help to determine micro-mets? 273 gene panel, 460x ave depth: shows an extreme example #MAPonco16
5:27am September 24th 2016 via Hootsuite
Turner: Can ctDNA be used to guide Rx? C-TRAK study: randomized + ctDNA, intervention or observation #MAPonco16
5:26am September 24th 2016 via Hootsuite
Turner: 3 pts with brain-only mets - mutation tracking not detected. Longer followup - >30mos - 100% PPV for relapse (unpubl) #MAPonco16
5:24am September 24th 2016 via Hootsuite
Turner: Lead-time - Median lead time over clinical relapse was 7.9mos. Shows a case where it was 13 mos. #MAPonco16
5:22am September 24th 2016 via Hootsuite
Turner: 69% found in baseline plasma. Showed chart and P-values; post-surgery 19% ctDNA detected had poor DFS. #MAPonco16
5:20am September 24th 2016 via Hootsuite
Turner: Showed PIK3CA, baseline, post-surgery with 7 copies/mL 6mos later to 198, pt relapsed. Other: no relapse, no ctDNA det. #MAPonco16
5:18am September 24th 2016 via Hootsuite
Turner: Study - collected samples prior to neoadjuvant Rx, during and post. Seq of primary br ca, used dPCR for ctDNA to 0.1% #MAPonco16
Turner: #MAPonco16 Starts w/ ctDNA Dawson '14 NEJM https://t.co/G0x8KPlPqQ Shows increased incidence of br ca since '85, but lower mortality
5:15am September 24th 2016 via Hootsuite
Nicolas Turner (ICR) Predicting relapse using ctDNA in breast cancer #MAPonco16
5:13am September 24th 2016 via Hootsuite
Sullivan: One part of the problem is advertising, how PM is presented; journalism, press releases from org's, public view #MAPonco16
5:07am September 24th 2016 via Hootsuite
Sullivan: #MAPonco16 Ref '14 paper, 'War on cancer and the influence of the medical-industrial complex' https://t.co/8WaN3gOVcw
5:01am September 24th 2016 via Hootsuite
Sullivan: Strong countries negotiate price; weak political coherence in public policy doesn't recognize need for HTA mechanisms #MAPonco16
5:00am September 24th 2016 via Hootsuite
Sullivan: PM is adding on costs to systems and societies 'in an unaffordable, unsustainable manner' #MAPonco16
4:57am September 24th 2016 via Hootsuite
Sullivan: Can emerging heath systems afford PM? Fig from BMC Med ref https://t.co/usetgiP1st Cancer dx is potentially disastrous #MAPonco16
4:56am September 24th 2016 via Hootsuite
Sullivan: Shows a Mumbai storefront sign: "House of Diagnostics" and says "I went in, and they are nice people" #MAPonco16
4:54am September 24th 2016 via Hootsuite
Sullivan: Chart per-capita spend against mortality to incidence; there are 'seriously weak health systems in EU' #MAPonco16
4:53am September 24th 2016 via Hootsuite
Sullivan: CAGR of medicines are 11%; but hitting saturation (direct is only 1%) #MAPonco16
4:52am September 24th 2016 via Hootsuite
Sullivan: Chart by country and by type of cancer, it is obvious some countries are 'massively undertreating' #MAPonco16
4:51am September 24th 2016 via Hootsuite
Sullivan: Says CEOs say stock buybacks is a problem as well. Onto cost burden: Lancet https://t.co/89dxl1we8K Many data charts #MAPonco16
4:50am September 24th 2016 via Hootsuite
Sullivan: 19 pharma in S&P500, spent $226B buying-back. HBR "Profits w/o Prosperity' Lazonick https://t.co/m4Tkn1FTYm #MAPonco16
4:46am September 24th 2016 via Hootsuite
Sullivan: Drug revenues - only rising line is Oncology, from $55B to over $80B. "The Big Short" movie: stock buybacks #MAPonco16
Sullivan: Following the money - lack of competitive pressure. Shows CAGR bubble plot. PM is 'THE major driver of ROI' #MAPonco16
4:44am September 24th 2016 via Hootsuite
Sullivan: 'In pure economic terms, value is crashing'. No way to rationally look at non-economic aspects. #MAPonco16
Sullivan: Shows chart, price per life year gained vs drug approval date. Trend line? Rising. #MAPonco16
4:42am September 24th 2016 via Hootsuite
Sullivan: #MAPonco16 Upcoming publication: "Failing patients, failing society: Critical examination of the UK's cancer drugs fund"
failing patients failing society critical examination of the uk's cancer drugs fund
4:41am September 24th 2016 via Hootsuite
Sullivan: 'natural experiment' the Cancer Drugs Fund: 16.2% pts had appropriate use; of these, 14.4% had improvement in outcomes #MAPonco16
4:40am September 24th 2016 via Hootsuite
Sullivan: In 5y, 277 randomized clinical trials: 31% designed to meet MCB ESMO threshold; only 15% actually met them #MAPonco16
4:38am September 24th 2016 via Hootsuite
Sullivan: Cancer 'exposes all the problems' since it is so expensive. 28 oncology drugs between '14 and '16. PFS 6.1 mos #MAPonco16
4:37am September 24th 2016 via Hootsuite
Comment: Non-linearity may not be a bad thing; it's the nature of discovery. #MAPonco16
4:36am September 24th 2016 via Hootsuite
Sullivan: Raising quality of research - 'it all went in to expensive kit, not one blind bit of improvement in research' #MAPonco16
4:28am September 24th 2016 via Hootsuite
Sullivan: There's a gap in policy between the baseline 'good quality' and the high-end expensive, latest tech. #MAPonco16
4:27am September 24th 2016 via Hootsuite
Comment: other cheaper tools may need to be exploited before more expensive ones implemented. Sullivan: Where's the baseline? #MAPonco16
4:26am September 24th 2016 via Hootsuite
Swanton comment: Feels money still should be spent on it; NHS Pathologist: Sees inequality w/in the NHS, sees 'massive gaps' #MAPonco16
4:25am September 24th 2016 via Hootsuite
Sullivan: Q: Should precision cancer medicine be this dominant? A: What should we spend money on then? #MAPonco16
4:21am September 24th 2016 via Hootsuite
Sullivan: Context: a mosaic of cultures, politics, demographics, economics. It 'shapes the dynamics of cancer tectonics' #MAPonco16
Sullivan: Shows slides of global inequality. OECD 2015 Health Spending (as a map). https://t.co/tRzJwM9GFb #MAPonco16
4:20am September 24th 2016 via Hootsuite
Sullivan: Siglitz - the larger the group, the less it will further its common interest. It is a narrow focus. #MAPonco16
4:18am September 24th 2016 via Hootsuite
