publication date: Dec. 28, 2018

The 25 most-read stories in The Cancer Letter in 2018

We thought you might want to see what your colleagues in oncology have been reading. So, we went through our analytics to bring you a list of 25 of The Cancer Letter’s most-read stories of 2018.

Our stories routinely run for 5,000 words or longer, and it’s heartening that in an era that tends to favor abbreviation, you want us to dig deep.

In 2018, we enhanced our coverage of clinical issues, adding the Trials and Tribulations column and wrapping The Clinical Cancer Letter into The Cancer Letter.

We invited opinion pieces, often giving them prominent play:

  • Steven Rosenberg, chief of the NCI Surgery Branch, wrote an editorial on obstacles to development of immunotherapy.

  • A Trials and Tribulations piece by Mark Ratain et al. (No. 2 on the list) focused on proposed changes in marketing of ibrutinib. The editorial had gravitas–and its impact was immediate.

  • Kadija Ferryman’s and Robert A. Winn’s editorial warned about the dystopian potential of artificial intelligence to exacerbate disparities.

  • Mark Burkard’s Trials and Tribulations column about studying “extreme survivors” in breast cancer, too, was an eye-opener.

Fame, infamy and social media matter. To wit, stories about Sacha Baron Cohen and Memorial Sloan Kettering Cancer Center’s ousted Chief Medical Officer José Baselga are on the list.

Twitter star Vinay Prasad appears three times. A Sept. 28 cover story about an attempt to deny Medicaid coverage for next-generation sequencing in Oregon also resulted in the highest number of PDF downloads in 2018.

We note with humility that our readers turn to The Cancer Letter to celebrate the lives of leaders in oncology. The list includes appreciations of patient advocates—Marlene McCarthy and Amy Reed. Geriatric oncologist Arti Hurria and radiation therapy pioneer James D. Cox are also on the list.

Conversations with The Cancer Letter that made the top-25 list include sit-downs with:

  • Gary Reedy, CEO of the American Cancer Society, who walked us through his plans to end the decline in the society’s revenues,

  • Daniel O’Day, CEO of Roche Pharmaceuticals, who told us about his company’s rationale for buying Flatiron Health for $2.1 billion, and

  • Peter Pisters, president of MD Anderson Cancer Center, who described his vision and leadership strategy.

Reportage by our staff makes up the largest category—17 pieces in all. It’s great to see that our investigative coverage of the hazards of minimally invasive surgery, including morcellation, continues to figure prominently.

Some stories have become classics, appearing on this list year after year. One of those stories—about a courageous medical school student at Duke University—has been on the list for four years. The story about Ronald DePinho’s resignation as president of MD Anderson is also on the list, getting clicks almost two years later.

Some newsmakers—Baselga, chief among them—would surely have preferred not to be on this roster. He appears three times.

Here is our Top 25 list:

1. Gynecology’s deadly surprise: Cancers are frequently missed prior to routine procedures

By Matthew Bin Han Ong

As they reach for surgical tools, gynecologists vastly underestimate the probability that their patients have undiagnosed uterine cancers, a study by Yale University researchers found.

Their paper, published in Obstetrics & Gynecology last month, is immediately relevant in the clinic, because a suspicion that cancer may be present dictates the choice of surgical techniques employed in gynecological procedures that are performed in about 650,000 women every year in the United States.

The newly calculated prevalence rates, based on analysis of data from 26,444 cases in the 2014-2015 American College of Surgeons National Surgical Quality Improvement Program, are staggering.

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2. Trials and Tribulations: Sales Revenues at the Potential Expense of Patient Safety: The Example of You & i

By Mark J. Ratain, Lisa S. Chen, Allen S. Lichter, R. Donald Harvey, Sonali M. Smith, Leonard B. Saltz, William G. Wierda, Varsha V. Gandhi, Michael J. Keating

Ibrutinib is a selective and irreversible inhibitor of Bruton’s tyrosine kinase (BTK) that entered phase 1 clinical trials in 2009 based on preclinical efficacy in models of B-cell malignancy and autoimmune disease.

The initial phase 1 trial showed clear efficacy in a number of lymphoid malignancies at doses as low as 1.25 mg/kg/d. Furthermore, full receptor occupancy was demonstrated at 2.5 mg/kg/d. Despite these pharmacological and early clinical findings, development of ibrutinib continued at doses of 420 mg qd and 560 mg qd, levels 3-4 fold higher than suggested by the pharmacological data. In addition, the absorption of ibrutinib is enhanced by administration of food, which may explain why even the lowest dose showed efficacy in some patients.

Ibrutinib is unique in having received four Breakthrough designations on the basis of its efficacy data. It was first approved in November 2013 for the treatment of mantle cell lymphoma at a dose of 560 mg qd, administered as four 140 mg capsules. Three months later, ibrutinib was approved for chronic lymphocytic leukemia (CLL) at a dose of 420 mg qd, again administered as multiple 140 mg capsules. Between July 2014 and August 2017, ibrutinib was approved for five addition indications, but it was not until December 2017 that its 70 mg capsule, necessary to permit safe administration of 70 mg qd in patients with B-cell malignancies receiving posoconazole or patients with moderate hepatic impairment, was approved.

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3. Guest Editorial: A unique drug for each patient: a paradigm shift in cancer therapy

By Steven A. Rosenberg

The recent FDA approvals of a cell/gene therapy for patients with advanced B cell malignancies provide a glimpse into a paradigm shift in the treatment of hematologic and solid cancers, the creation of a new drug unique to each cancer patient.

In 2010, the Surgery Branch at the National Cancer Institute first reported the regression of advanced lymphoma in a patient infused in 2009 with his own lymphocytes genetically engineered to express a chimeric antigen receptor (CAR) that recognized CD19, a cell surface molecule expressed on B cell malignancies and normal B cells.

This patient experienced a complete cancer regression that has lasted over 8 years. Other groups at Memorial Sloan Kettering Cancer Center, the University of Pennsylvania and other academic medical centers demonstrated similarly impressive results with CD19-CAR T cells in patients with B-cell malignancies leading to multi-institutional trials sponsored by Kite Pharma and Novartis. The CD19-CAR T cell approach became the first cell and gene therapy approved by the FDA for patients with cancer.

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4. José Baselga: “I take responsibility for failing to make appropriate disclosures”

By Matthew Bin Han Ong and Paul Goldberg

José Baselga, physician-in-chief and chief medical officer of Memorial Sloan Kettering Cancer Center, has apologized to his executive team for “failing to make appropriate disclosures in scientific and medical journals and at professional meetings.”

Baselga’s email comes on the heels of a Sept. 9 article by The New York Times and ProPublica, which details Baselga’s failure to report millions of dollars in consulting fees and ownership interests in health care companies.

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5. Conversation with The Cancer Letter: Gary Reedy describes plan for turning around the American Cancer Society

In addition to being one of the oldest charities and having one of the most recognized health organizations in the US, ACS is the largest continuous private funder of cancer research. While other organizations are more focused on specific diseases and treatment modalities, ACS, is big—the biggest.

If it can be reengineered, i.e. if it can find new urgency and new ways to raise money, ACS might be positioned to stand up for the needs of cancer patients and the future of cancer research as it is being threatened by the Trump administration’s budgetary priorities.

The society has been around since 1913. Its critics say it has grown stodgy, bureaucratic, not sufficiently focused on research, reliant in fundraising practices of a different era, a big political and economic structure in search of urgency. ACS has been trying to streamline its organization for decades, and in 2011, it took fiduciary control from its 12 autonomous divisions, creating a single structure (The Cancer Letter, Nov. 18, 2011).

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6. Vinay Prasad, oncologist and Twitter star, locked in debate over precision medicine

By Paul Goldberg

In recent years, Vinay Prasad, a young hematologist–oncologist at Oregon Health and Science University, has emerged as a premier critic of new directions in cancer medicine.

In his view, cancer drugs are aimed at miniscule populations, approved way too easily, and priced too high.

With nearly 21,300 Twitter followers, over 30,000 tweets, a book, and multiple op-eds, Prasad can turn an academic paper into a bestseller—and an obscure point into a rallying cry.

Vinay Prasad is the guy to call.

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7. An Appreciation: Amy Reed, physician and patient who “moved mountains” to end widespread use of power morcellation, dies at 44

By Matthew Bin Han Ong

When Amy Reed enrolled at the University of Pennsylvania medical school in 2001, she could not have possibly imagined that she would save more lives as a patient than as a physician.

The final phase of her medical education began on Oct. 17, 2013, when Reed, then 41, checked in at Brigham & Women’s Hospital—her husband’s workplace at that time—to undergo a common gynecological procedure that would fundamentally redefine her career, and, ultimately, consume her life.

Reed, a Pennsylvania native, died May 24 from complications stemming from disseminated uterine cancer. She was 44.

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8. An Appreciation: Marlene McCarthy, formidable National Breast Cancer Coalition advocate, dies at 74

By Fran Visco

There are so few individuals who are willing to challenge authority in the world of cancer advocacy. Marlene McCarthy was one of the best at that. Marlene died on July 17; she was 74.

Marlene was a fighter. Over the years I have seen so many women and men shy away from questioning the approach of a member of Congress and from speaking out when a policy was watered down to the point of being meaningless.

Not Marlene. She had this wonderful way of establishing great relationships with her senators and representatives in Rhode Island, earning their respect and friendship, and at the same time never hesitating to make demands and tell them when they were wrong. They still loved her and took her calls.

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9. New data prompts CDC to examine adequacy of pre-op workup by gynecologists

By Matthew Bin Han Ong

In response to a congressional letter and a new study on the prevalence of undiagnosed hidden uterine cancers, officials at the Centers for Disease Control and Prevention are considering launching a review of whether gynecologists are sufficiently thorough in evaluating patients in the preoperative setting, according to insiders with knowledge of the agency’s plans.

CDC has the authority to set screening guidelines—for instance, by recommending that gynecologists perform biopsies on women undergoing removal of fibroids to preserve fertility—and may do so if it determines that gynecologists aren’t evaluating patients as rigorously as oncologists in a setting where there is a high risk of encountering unsuspected malignancies.

CDC’s new director, Robert Redfield, appears to be interested in convening an advisory panel of surgical specialists to discuss potential CDC action on this matter, said Larry Kaiser, president and CEO of the Temple University Health System, the Lewis Katz Dean at the School of Medicine, and a professor of thoracic medicine and surgery.

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10. Trials and Tribulations: Searching for Breast Cancer’s “Extreme Survivors”

By Mark Burkard

I remember the day I met Margaret “Peg” Geisler, who has now been living with breast cancer for 40 years, and with metastatic disease for 36 of those years.

She had long outlived her original oncologist, pioneering breast cancer researcher Dr. Paul P. Carbone, for whom our cancer center is named. I saw her for a colleague, her third oncologist, who was out on maternity leave.

Peg’s records showed she originally had breast cancer in 1978, it recurred in the 1980s, and she had a biopsy-proven pelvic metastasis that had been treated with radiation, but had never disappeared. She had received multiple medical treatments over the decades, including hormonal therapies and a few chemotherapies. The mass had grown slowly over the years and the most recent scan again showed a slight growth. What treatment did I recommend? I could select a number of possibilities, but, in the end, I recommended observation. Four years later, at age 82, her health is good. She attributes her survival to her “cantankerous” attitude, but everyone else describes her as charming, so I suspect another cause.

How many extreme survivors with metastatic cancer are there and what makes them tick?

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11. Conversation with The Cancer Letter: It took an elaborate ruse to get NIH Director Francis Collins on Sacha Baron Cohen’s “Who Is America?”

Intricate deception went into luring NIH Director Francis Collins onto Sacha Baron Cohen’s television show.

A production company called Here and Now Television was created, as was its website. The show’s working title was priceless, in an Orwellian sort of way: AGE OF REASON. It turned out to be Showtime’s “Who is America?”

The production company staff members—presumably actors all—did considerable advance work, and did it well. Their letters were good enough to convince a seasoned professional, NIH Associate Director for Communications John Burklow, that the show is worth doing.

“Even though we were tricked into the interview, Francis really wasn’t pranked, so to speak,” Burklow said to The Cancer Letter. 

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12. A color-coded document Baselga created to explain himself instead illustrated the extent of his confusion and exposure

By Paul Goldberg

The discussions that took place in the executive offices of Memorial Sloan Kettering Cancer Center over the past week aren’t publicly known. Ditto conversations at top-tier medical journals and professional societies, which are assessing the aftermath of José Baselga’s systematic failure to disclose his conflicts of interest.

However, the extent of the disclosure problem created by Baselga, who stepped down as physician-in-chief and chief medical officer Sept. 13, can be assessed publicly—even in the comfort of one’s own office—thanks to a document Baselga himself created in order to explain his rationale for disclosing some competing interests while remaining mum on others.

If the document he created in response to questions from reporters from The New York Times and ProPublica is an indication, Baselga was guided by a highly unconventional interpretation of disclosure requirements and was inconsistent in applying even his own version of these standards.

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13. An Appreciation: Arti Hurria, geriatric oncologist at City of Hope, dies in traffic accident

By Michael Easterling

Arti Hurria, a pioneer of geriatric cancer care at City of Hope, died Nov. 7 in a traffic accident. She was 48.

Hurria was the George Tsai Family Chair in Geriatric Oncology, director of the Center on Cancer and Aging, co-lead of the Cancer Control and Population Sciences Program, vice provost of clinical faculty, a professor in the Department of Medical Oncology & Therapeutics Research, and a medical oncologist at City of Hope.

“Arti Hurria was special,” said Robert Stone, president and CEO of City of Hope. “She was a visionary, a groundbreaking innovator, and the kind of doctor who earned the trust of her patients with her humanity and her compassion. We were incredibly fortunate to know her, to work with her, and to learn from her for more than a decade and we will sorely miss her.”

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14. An Appreciation: James D. Cox, former RTOG chair, dies at 80

By Walter Curran

Jim Cox, professor emeritus in radiation oncology at the University of Texas MD Anderson Cancer Center, passed away on Aug. 14.  He was 80.

Anative of Ohio, Jim graduated with honors from Kenyon College and University of Rochester School of Medicine and Dentistry and completed his oncology training at Penrose Cancer Hospital of Colorado Springs, University of Chicago, and Institute Gustav Roussy Institute in France.

Jim served during his long and illustrious career as professor and founding chairman of the departments of radiation oncology at Medical College of Wisconsin and Columbia University College of Physicians and Surgeons and as professor, physician-in-chief, and division of radiation oncology head at UTMDACC.

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15. Duke Officials Silenced Med Student Who Reported Trouble in Anil Potti’s Lab

By Paul Goldberg

Duke University would have avoided embarrassment, a misconduct investigation and a lawsuit, had its top administrators paid closer attention to a thoughtful report by a medical student who saw problems in the lab of the disgraced scientist Anil Potti.

Documents obtained by The Cancer Letter show that Duke’s deans were warned about Potti’s misconduct in late March and early April 2008, at the time when clinical trials of the now discredited Duke genomic technology were getting started.

The three-page document was penned by Bradford Perez, then a third-year medical student and a Howard Hughes Medical Institute scholar.

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16. Artificial intelligence can entrench disparities—here’s what we must do

By Kadija Ferryman and Robert A. Winn

Heinz Von Foerster, the renowned Austrian-American physicist and cybernetics scholar, declared that “information can be considered as order wrenched from disorder.” Ever-increasing amounts of digital data and new computational tools promise that technological developments such as artificial intelligence (AI) will bring order, clarity, and new solutions in multiple areas—from transportation to criminal justice.

Solutions are clearly needed in healthcare, particularly in the U.S., where high expenditures have not led to corresponding improvements in health outcomes.

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17. José Baselga resigns as physician-in-chief at Memorial Sloan Kettering

By Paul Goldberg and Matthew Bin Han Ong

José Baselga has resigned from his position as physician-in-chief and chief medical officer of Memorial Sloan Kettering Cancer Center less than a week after The New York Times and ProPublica reported that he had failed to disclose his conflicts of interest in scientific and medical journals and at professional meetings.

After the conflicts—involving millions of dollars—were enumerated in an article published Sept. 9, Baselga attempted a mea culpa strategy while MSK pointed out that disclosure rules are vague and inconsistent.

The Cancer Letter’s analysis of documents that emerged during this imbroglio demonstrates that Baselga didn’t apply standard rules for disclosure, apparently believing, for example, that, in papers dealing with basic and translational research, conflicts are not subject to disclosure. Similarly, he seemed to believe that no disclosure was needed in papers on compounds that are no longer viable.

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18. Twitter star Vinay Prasad retires @VinayPrasadMD

By Matthew Bin Han Ong

Vinay Prasad, a cyber-iconoclast for all things cancer, appears to have closed the Twitter account that made him a brand in oncology.

At first glance, Prasad appears to have erased his personal presence on Twitter—his 30,000 tweets are gone, along with all recognizable traces of his account, which had about 21,300 followers as of late June.

It’s unclear whether Prasad has deleted his Twitter account, @VinayPrasadMD and all tweets, deactivated the account and made them private—or, more likely, switched his Twitter handles.

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19. Conversation with The Cancer Letter: Roche CEO O’Day: Our investment in Flatiron will accelerate their mission

Roche’s purchase of Flatiron Health will accelerate the development of real-world data suitable for supporting regulatory decisions, said Daniel O’Day, CEO of Roche Pharmaceuticals.

“They have very good coverage of cancer lives in the United States, but it’s roughly 30 percent, so they have the scale in terms of the number,” O’Day said. “As we know, in electronic medical records systems, up to 50 percent of the data is unstructured and uninterpretable in a digital format. The wealth of information that exists in that unstructured data is exceptionally important.

“So, they’ve been able to structure that data, make sense of it, and they’ve done it at scale and uniquely compared to other companies in the field.”

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20. Roche to acquire Flatiron Health for $2.1 billion, with focus on real-world data

By Matthew Bin Han Ong

Roche has signed an agreement to acquire all shares of Flatiron Health, a health care technology and services company headquartered in New York City, for $1.9 billion.

The deal, which would raise Roche’s stake from 12.6 percent to outright ownership, is subject to regulatory approval and is expected to close in the first half of 2018. The total price tag is closer to $2.1 billion, including about $200 million in cash balances.

Flatiron will retain autonomy in its operations and continue to be able to share data with collaborators beyond Roche, officials said.

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21. Oregon flirts with—and quickly abandons—plan to deny Medicaid payment for next-generation sequencing

By Matthew Bin Han Ong

The Oregon Health Authority did a considerable amount of work to prepare a plan that would deny Medicaid coverage for next-generation sequencing tests in the state.

A review of medical literature it conducted resolved that “direct evidence of clinical utility is not available” for NGS. Then, a guidance was drafted, approved unanimously by an advisory panel, and brought forth to a public hearing Sept. 27.

But there, the proposal encountered stiff opposition from Oregonians, who argued that it would create a massive health disparity in the state. The younger Oregonians eligible for Medicaid would be denied access to precision oncology, while the elderly would continue to get access under Medicare.

“I want to thank everyone who spoke up to make sure that NGS for patients with cancer is covered by Oregon Medicaid,” Brian Druker, director of the Knight Cancer Institute at the Oregon Health & Science University, said to The Cancer Letter. “Your voices were clearly heard and I applaud the committee for ensuring that our most vulnerable patients have access to this cutting edge technology.”

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22. DePinho resigns as MD Anderson president, acknowledges shortcomings as administrator

By Paul Goldberg

Ronald DePinho announced on March 8 that he will be stepping down as president of MD Anderson Cancer Center.

DePinho’s five-and-a-half years at the helm of the world’s largest cancer center were marked by unprecedented turbulence, questions of conflicts of interest, and unhappiness on the part of the faculty.

MD Anderson, once a highly profitable operation, lost $405 million over the past 11 months. Indeed, January marked the first month since last March that the hospital completed with positive operating margins.

Also, in recent weeks, control over MD Anderson’s day-to-day operations was transferred to Stephen Hahn, chief operating officer, deputy to the president, and director of the Department of Radiation Oncology, who is described as being well-liked by the faculty (The Cancer Letter, March 3).

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23. Letter to the Editor: Noorchashm: Uterine cancers are not “occult” if gynecologists don’t bother to look

By Hooman Noorchashm

Dear Editor,

As you know, a team of gynecological researchers from Yale University recently reported that the incidence of “missed” cancers in women undergoing general gynecological operations of the uterus approaches 2%. Even more staggering is the reported 10% incidence in such women, over the age of 55.

Despite reporting such a staggering frequency of “missed” gynecological cancer, it is concerning that the Yale authors, like most gynecologists, appear quite relaxed about this level of risk in their paper’s discussion—foremost because this level of oncological risk in women undergoing non-oncological operations is an iatrogenic mortality risk.

In fact, the Yale authors seem quite comfortable labeling these cancers as being “occult”—as though a best effort was made to pinpoint the cause of symptoms where the cancer was truly hidden.

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24. As José Baselga clears his desk, MSK forms task force on conflicts; meanwhile, new allegations emerge over center’s role in AI start-up

By Paul Goldberg

José Baselga, who has resigned from his positions as physician-in-chief and chief medical officer at Memorial Sloan Kettering Cancer Center, is winding down his research and clinical activities at that institution, officials said.

After Baselga’s resignation, two publicly traded companies—Bristol-Myers Squibb Co. and Varian Medical Systems Inc.—announced Baselga’s departure from their boards of directors, and MSK has convened a task force physicians, scientists, and external experts to review and update the cancer center’s relevant policies and processes involving conflicts of interest.

The fallout from The New York Times and ProPublica Sept. 8 story about Baselga’s years-long failure to disclose conflicts of interest continued last week as the Times editorial board on Sept. 16 published an editorial about conflicts of interest at the cancer center.

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25. Conversation with The Cancer Letter: Six months at MD Anderson: Pisters announces organizational change

After six months of listening and observing the functioning of MD Anderson Cancer Center, Peter Pisters announced changes in the cancer center’s organizational chart.

The center’s structure will continue to flatten out, continuing along the path that first emerged during a reorganization last June (The Cancer Letter. June 30, 2017)

The box diagram that flashed on the screen above Pisters as he described his plans to the faculty and staff on May 22 featured many blank boxes that arguably denote some of the most sought-after jobs in oncology.

“I inherited a structure, looked at that structure, and operated through that structure for six months,” said Pisters, who took over as MD Anderson president on Dec. 1, 2017. “As I did so, I saw opportunities to improve that.”

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