Answers for DCIS are coming

Great news for those confused about Ductal Carcinoma In Situ (DCIS). That includes just about everyone, from doctors and researchers, to patients and their families!

Four new projects and resources are available: COMET logo

  1. A new study called COMET just opened that will look at whether women with low-risk DCIS will do just as well with active monitoring (also called Active Surveillance) as those who choose surgery, radiation and/or hormonal therapy. Watch the video.

    “The aim of this work is not to try and determine what’s ‘better,’ but rather to quantify the tradeoffs associated with these two approaches to DCIS treatment.”
    – Dr. Shelley Hwang, Principal Investigator

  2. A new website for DCIS also opened this week to help the over 50,000 women per year who are diagnosed with DCIS each year in the U.S. Of course, the site is also available for women worldwide.
  3. SHARE is sponsoring a webinar called “DCIS: What You Need to Know” that features
    SHARE DCIS webinaryours truly on March 22 at noon Eastern Time (US). We’ll explain what DCIS is, how to think about it, and what is needed to make rational decisions when faced with a diagnosis.
  4.  A new international research project called “Preventing Unnecessary Breast Cancer Treatment” was recently announced to learn how to find DCIS that will not turn into breast cancer so women won’t have to deal with treatment issues.CRUK DCIS graphic

Together, these projects can tell us how to deal with DCIS, what risk factors may cause approximately 1 in 10 women to develop a later invasive breast cancer, and hopefully, that Active Surveillance works just as well as invasive treatments.

By the way, about 90% of women with DCIS won’t get invasive breast cancer!

If you can’t wait to find out more about DCIS, check out this post or get the DCIS Dilemmas ebook. Stay tuned for more about these projects and other findings about DCIS!

COMET study team

Some members of the COMET Study team

A Place to Teach Old Drugs New Tricks

Due to popular demand, former blog guests Bruce Bloom, and Clare Thibodeaux from Cures Within Reach have returned with another post. This time, they explain how they bring researchers, older drugs, and new funders together to come up with new solutions for patients. Disclosure: I am a member of their Advisory Board, and think this concept is brilliant!
Continue reading

Patients Want Their Data Shared

Patients also want to be:

  • Respected for their contributions to science and medical advances. Those contributions include samples from their bodies (biospecimens), information (data), experiences (input), and sometimes their very lives.
  • Protected from harm and misuse of sensitive data about themselves, their family, and/or their culture or ethnicity.

As long as we are respected and protected, we will participate in clinical research and learning healthcare systems so researchers can find better ways to treat and prevent diseases and medical conditions.

What & Who

This post focuses on data from past “legacy” cancer clinical trials. The Patient AdvocateProtectionCommittee in the Alliance for Clinical Trials in Oncology drafted a resolution to add the patient voice to the groundswell of support for data sharing.

Why?

  1. People who join cancer clinical trials are often asked to donate their tissue and data for future research.
  2. When patients give consent for research, they expect their information to be shared.
  3. Unfortunately, many hospitals, clinics, academic centers, or research groups will not release information to other researchers, even though patients gave their consent.
  4. This does not honor or respect patients who want to contribute to research.

Your Call to Action

  • Please read the resolution, sign on, and share it with your networks and organizations. While this resolution deals with cancer, its intent is to help all medical conditions.
  • Include patients in data sharing activities.

“Today, oncologists and cancer researchers realize that they can’t [advance cancer progress] alone… What’s required today extends beyond any individual or any individual discipline, beyond medicine itself… It requires somewhat of a change in mindset. It requires a lot more openness – open data, open collaboration and above all, open minds.

– Vice President Joe Biden, ASCO Speech

Thank you!

How to Solve Diseases with Existing Drugs

My blog guests this week are Amy Conn, Bruce Bloom, and Clare Thibodeaux from Cures Within Reach. Disclosure: I am a member of their Advisory Board, and think that testing older drugs for rare diseases is brilliant!

The power of repurposing

What if the latest treatment for cancer, diabetes or thousands of other unsolved diseases was already available?

Although this might sound too good to be true, “repurposing” existing drugs could make this a reality. Repurposing takes any drug, device or nutriceutical, already approved in one disease, and tests it in a different disease to quickly and affordably improve more patients’ lives.

cures within reach infographicCurrently more than 500 million people worldwide suffer from diseases that lack effective treatments. As a result, global health care costs are growing and patients are suffering. Yet new drug discovery can take 10-15 years and can cost over $2 billion. This process is too long and costly for many patients who needs a solution today.

Instead, repurposing leverages prior investments by finding new uses for “old” drugs. This means repurposed treatments can reach patients in about 3 years and for less than $500,000.

Testing for repurposing sometimes means they are first tested in tissue samples or animal models in laboratories to find accurate dosing. If this pre-clinical research is done, the drug can quickly move into human trials. In some cases, it moves into human trials immediately.

How do repurposing ideas happen?

Repurposing is not a new concept. Doctors often prescribe medications ‘off-label’ when they think the patient may benefit. This happens when there is no approved treatment for a specific medical condition.

  • In fact, 1 in 5 prescriptions (21.3%) written in the United States are for off-label use. The range varies widely, based on the medical condition or patient group. For instance off-label use can be as high as 7 in 10 children for pediatric illnesses, because sponsors don’t typically focus on them. Here is a table with common off-label prescriptions.

Repurposing research can take off-label prescribing a step further by confirming clinical observations through a clinical trial. The data from these trials can then be published in scientific journals, and shared with other doctors to become part of standard treatment.

Other sources

  • Patients also contribute insights when they describe how a drug or supplement that they are taking for one issue impacts a different disease or diagnosis (i.e. “my asthma drug seems to be helping my eczema”).
  • Ideas also come from laboratory scientists, who connect the dots between newly discovered disease information and existing compounds.
  • And in our emerging world of big data, informatics engines can comb through scientific literature to find existing ideas and generate new ideas suitable for immediate testing.

Who pays for repurposing research?

Sometimes, pharmaceutical companies finance repurposing projects.

A case in point: ViagraViagra_in_Pack

Originally tested as a drug for angina, sildenafil failed. Instead, it was repositioned into the Pfizer blockbuster Viagra for erectile dysfunction after patients mentioned this side effect. Sildenafil was still under patent protection and the market was huge, making it a lucrative endeavor. This drug was later repurposed by Pfizer a second time in a different dosage under the name Revatio for pulmonary arterial hypertension.

Too many are orphans

Many repurposed opportunities are based on generic drugs that are often inexpensive and widely available. These characteristics make them ideal candidates for repurposing for patients, but industry doesn’t often pursue them, since there is no clear path to profit. This is where philanthropy plays an important role.

Cures Within Reach (CWR) is a global non-profit dedicated to repurposing research

CWR focuses on improving patient outcomes in any disease with repurposed treatments, while addressing larger needs around global collaboration, and the creation of alternative financial incentives for repurposing.

Successful repurposing

Key In Lock Showing Forbidden Information And Privacy

Since 2010, 13 repurposing projects that Cures Within Reach supported have made a clinical impact. One such project involved repurposing sirolimus, a generic drug originally used to reduce organ transplant rejection, to treat a rare and deadly childhood disease called autoimmune lymphoproliferative syndrome (ALPS).

Children with ALPS carry a genetic mutation that causes some of their white blood cells to multiply and crowd out other types of blood cells. They suffer from enlarged lymph nodes and spleens, increased infections and anemia. Some patients can spend up to 10 days a month in the hospital receiving treatment, placing physical, emotional and financial burdens on patients and their family.

CWR funded research that helped prove that sirolimus produced a lasting positive response in patients, leading to fewer hospitalizations, greatly lowered medical costs and improved quality of life. This result happened in 3 years for about $250,000. Sirolimus has since been repurposed in 5 more childhood autoimmune diseases with similar results.

Ready for more successes with CureAcceleratorTM

Philanthropic funding was critical to this high-impact repurposing research. There are many more opportunities like this one, in which a small “investment” can create a life-saving repurposed treatment.

To find important repurposing opportunities CWR asks:cure accelerator logo

  • How can we help repurposing researchers connect with strong funding streams?
  • Are there financial models other than traditional philanthropy that can help scale this research?

To answer these questions, CWR created an online crowd-sourced platform in 2015 called CureAccelerator.™ Check us out, and watch for another post soon about CureAccelerator.

Repurposing is an important healthcare strategy, both in terms of patient impact and cost savings. As scientists and clinicians learn more about the mechanisms and molecular targets of diseases, repurposing will play an even larger role. The key stakeholders in repurposing, from funders to researchers to patient advocates to industry, all need to work together to drive new “old” treatments to patients.

Learn more about repurposing drugs here.

Oops! Don’t Buy Chocolate Milk for Concussions

No, really. This is a real thing, created by money. Oops, I meant to say, created by researchers and institutions with MAJOR conflicts of interest. Why post it? Well, while this is the most blatant example we’ve seen in a long time, it happens every day, even to well-meaning researchers.

silhouette arrow to dollar signFACT: research is a money game. If your proposal piques the interest of a funder (e.g.  government (public), private foundations, commercial companies), you get to do your research. Researchers are eternally grateful because, otherwise, they have to find a new career. Many proposals are worthwhile and survive rigorous grant review (including serious peer review) to qualify as “good science.” This one didn’t…

Note: always be wary of overly-enthusiastic researchers

The chocolate milk story shows how urban legends are founded, and never die. This story came to light because it was PUBLICIZED without the necessary data from the Public Relations or Press Release (PR) office, not PUBLISHED (as in a scientific journal).

While I always hope for the best in research, skepticism is a good thing. Why are good scientists inherently skeptical? Because researchers can quickly lose their objectivity and tout success based on hope, not on facts. In the worst cases like this one, their ‘hope’ can turn to hype, fame and/or fortune. It takes constant vigilance by each scientist, and the whole research system, to make sure facts lead to relevant conclusions instead of ego.

Unfortunately, news aggregators, like prnewswire.com, also spread false hype without question. By the way, University of Maryland (U MD) has since removed the press release since the ‘scandal’ began.

“There are real consequences to PR spin of health research.”

Andrew Holtz, Yoni Freedhoff, & Kathlyn Stone, HealthNewsReview.org reviewers

In this case, consequences for people included mass purchases of this particular chocolate milk by school athletic departments, as reported by Quartz and others. Unfortunately, the sugar content is very high, leading to other issues involved in dietary studies (see the post Quality Diet Research Needed for more on this). Consequences for U MD aren’t done yet.

Concussion/milk study: fact or fiction? Cow - dairy

But I digress – let’s get back to the study. HealthNewsReview.org first commented on a U MD press release (PR), giving it a 1 out of 5 rating on January 5th, 2016 (that’s bad). They couldn’t get any study information (data) because it had not been published.

This was picked up by other news sites later in January, such as Stat News and NYMagazine Science of Us, claiming more bizarre issues with the study. The only reason Retraction Watch wasn’t involved – the study was never published.

“…a scandal that touches on vital issues of scientific ethics, the collision of money and research, and the lightning-quick pace at which pseudoscience can lead vulnerable people astray. And it all boils down to a simple question: How the hell could the University of Maryland have allowed this to happen?”

Jessie Singal, Science of Us

Then, on April 1st (no joke), CBS News reported that U MD “disavowed” the study and would give back the $228,910 to the company who sells the milk and sponsored the study. I learned about it from this Huffington Post sketch.

All of this adds to other examples of concussion research conflicts in which the National Football League (N.F.L.) is embroiled, as reported by The New York Times.

But Deb, You Don’t Do Concussions!

Web research

True, I usually cover research in cancers and infectious diseases. So? This deals with a universal research issue that impacts millions of patients and people. Seriously!

Research is often done well, by researchers who care and follow ethical principles. Even the good ones with whom I’ve served on countless committees and review panels, however, can let ego, opportunity, and fame trump true objectivity. Many are also led down conflicted paths by their institutions who smell money, and are willing to give undue influence to sponsors in return.

Frankly, we need set Standard Operating Procedures (SOPs) for these kinds of conflicts for ALL academic research institutions (after all, that’s what standard actually implies). For instance, don’t do it in the first place. But, when a conflict is discovered:

  1. Give the money back (in process).
  2. Recall the erroneous information (check).
  3. Fire the researchers involved (not yet).
  4. Publicize the error and steps taken to resolve the problem through the SAME CHANNELS + others (not yet).
  5. Share the data so others can learn from it (not yet). Doesn’t matter if it’s bogus or not – everyone can learn and take steps to make sure it doesn’t happen again.

Health/medical researchers and their institutions/companies HAVE to understand that their work impacts lives. They MUST start policing their own, or others will do it for them.Important Stamp Shows Critical Information Or Documents

The references I listed in this article aren’t hard to find. It takes some effort, but it should represent the least amount of effort we all put into study results to make sure the claims match the data. So, thanks HealthNewsReview.org and others!

Got research? Do it right, or suffer the consequences.

All content © 2016 by Deborah Collyar unless otherwise specified. All rights reserved. Permission is granted to use short quotes provided a link back to this page and proper attribution is given to me as the original author.