Important aspect of recent lung cancer screening discussion prompted by the new JAMA Open article: even if we were to keep pack-year criteria, current cutoffs are inadequate & disproportionately rule-out Black patients. From 2019 analysis: ~30% sensitivity, 80% specificity

Sorry @erictopol.bsky.social it doesn't. All participants were normal coffee drinkers. Therefore, the coffee-drinker arm is the Control arm. The intervention of going cold turkey increased the hazard of AF by 64% (100/0.61). The whole report is written from the wrong perspective.

When patients with metastatic cancer are admitted to the hospital, many people optimistically say "you'll go to rehab and get stronger and we'll see you back!" IMO this data suggests we need 1) better care coord with SNF & 2) more honest discussion of what outcomes may be after.

Wow. Data from @n8pennell.bsky.social & team #JCOOP confirming the care fragmentation many of us see in real life. Patients with metastatic NSCLC whose docs felt it was reasonable for them to restart treatment after rehabbing at a SNF: - Only 54% saw outpt onc again - 31% restarted tx

"our report highlights the need for our professional societies and abstract reviewers to cultivate greater awareness and adherence to patient-respectful language" Original research from @narjustflorezmd.bsky.social @jco-asco.bsky.social @ascocancer.bsky.social ascopubs.org/doi/10.1200/...

free study idea! i’ve found myself avoiding the mychart app this year because it immediately showers me with notices about my medical debt, including when i try to schedule appointments. can’t help but wonder whether this is adversely affecting care and/or outcomes for vulnerable patients

Woah! 41% of stage I/IIA dMMR colon cancers could be overstaged by CT imaging. May need better ways to upfront stage (MRI, ctDNA?) in the neoadjuvant ICI era. #GIOnc #OncSky #MedSky #JCOOP ascopubs.org/doi/10.1200/...

We also need to know *which* subsidies are in play. As I understand it: Paragon has proposed converting CSRs to HSA contributions Cassidy has proposed converting ePTCs to HSA contributions Trump has proposed (I think? this is least clear) converting *all* subsidies to HSA contributions.

If you or your caregiver are working at time of cancer diagnosis, it almost seems unfathomable how people can make it financially work. Often “good” insurance doesn’t correlate with coverage, and while there are some good support programs out there it can be a full time job in itself to set up.

In Sept, Bishal Gyawali published in #JCOOP on the high cost of some 'more convenient' Rx formulations (peg-GCSF, oral GNRH instead of SQ/IM, combo pills) Out now, European perspective on how to operationalize this: ascopubs.org/doi/10.1200/...

I often hear "I wish we didn't have to waste these expensive meds every time a patient stops & has extra left over." Here's what the state of Michigan did to combat this: - Statewide cancer drug repository, 105 sites - $26 million value/>100K pills donated to >1K pts ascopubs.org/doi/10.1200/...

Exciting end to #CTOS2025 with final presentation from Erica Pimenta. Could PPARγ-2 or GLP1 agonists restore differentiation in dedifferentiated liposarcoma?

Can adding aromatase inhibitor (+/-LHRHa) rescue patients with #PEComa who progress after responding to mTOR inhibitor? #CTOS2025 - n=23 women - 26% PR, 35% SD - Time to progression generally shorter than initial mTORi response - Some exceptions in patients with TSC1/TSC2/PTEN

.@RobinL_Jones @royalmarsden presenting ChonDRAgon PhII registrational study of Ozekibart in conventional #chondrosarcoma #CTOS2025. - No approved systemic therapies - mPFS 5.5 mo, with 21.7% w/o prog @ 12 mo - Activity in both IDH-WT & mut - TRAE incl ~13% fatigue, ~6% hepatitis

#CTOS2025 Need options for pts w/ angiosarcoma who are refractory to ICI. In PhI, injected oncolytic virus w/ TGF-B trap (AdAPT-001) shows some efficacy! Notably heavily pre-tx group.

More data on TCRs in synovial sarcoma/MRCLS! In pooled analysis, Lete-cel (NY-ESO-1), w/ similar ORR to afami-cel (MAGEA4) & median OS 20.5 mo w/ small subset long-term responders. Exciting to have multiple cell therapy options, need further studies to know how to seq & cross-sensitivity. #CTOS25

Larotrectinib for TRK-fusion sarcomas: when it works, it works. - 38% long-term (2 year) responders - In responders, 73% remain without progression at 6 years, 98% OS #CTOS2025 Next questions: When to stop? How to predict responders?

Wisdom from #JCO assoc editor Bob Maki at #CTOS25: “There are many ways to lose your shirt. Las Vegas, Crypto, and [bad] statistical design.”

Starting with this article on ICI pricing from @thewonkologist.bsky.social and colleagues! Do more approved drugs with the same mechanism reduce prices? ascopubs.org/doi/10.1200/...

Happy to say it's masthead official, I am joining JCO OP as a consultant editor for social media! Our goal is to generate real conversations on the journal's work with the #OncSky #HealthPolicy experts here. I'll be sharing some of what's published in the journal & would love to hear your opinions!

New at Can We Still Govern? New Medicaid work requirements will see an estimated 5 million lose coverage. Small investments in in-house tech capacity could allow states to start preparing now to expand automatic renewal of clients. Here is the evidence 🧵 donmoynihan.substack.com/p/how-a-van-...

🚲⚠️ Look out, CAR T, there's another transportation-named cancer treatment class in town! ⚠️🚲 First-in-human trial of bicycle-drug conjugates (BDCs) hit JCO this week. So what are they, and how are they different than antibody-drug conjugates (ADCs)? #OncSky #MedSky

🚲⚠️ Look out, CAR T, there's another transportation-named cancer treatment class in town! ⚠️🚲 First-in-human trial of bicycle-drug conjugates (BDCs) hit JCO this week. So what are they, and how are they different than antibody-drug conjugates (ADCs)? #OncSky #MedSky

Interesting article out this week from Dr. Bishal Gyawali, arguing that we should use more superiority designs for treatment de-escalation studies in cancer. "The burden of proof in medicine lies on more treatment." academic.oup.com/jnci/advance...

Among many great talks today at @fredhutch.org HICOR Value in Cancer Care Summit, one that' I'm still thinking about on is this one re: trust in oncology, from Dr. Tony Back. His points (1/5):

Cool new study from @pamherd.bsky.social, @giannella.bsky.social, @jbarofsky.bsky.social, @lukef.bsky.social, & @donmoyn.bsky.social finds technical assistance & capacity improvements from USDS significantly improved Medicaid renewal outcomes during unwinding www.healthaffairs.org/doi/10.1377/...

Woah! @majorajay.bsky.social thinking through just about every hematology/oncology vascular access question possible (1422 scenarios, to be exact) to guide access choice. #medsky #oncsky #nursesky Just a few examples below:

Love to see an implementation win in @ascocancer.bsky.social/ #JCOOP ⬇️ In a mix of community/academic practices in NE, low overall inappropriate use of denosumab/zolendronic acid for mHSPC compared to prior national studies. ascopubs.org/doi/10.1200/...

Why do eligible patients choose not to enter a clinical trial? New in JCO OP: - >90% cite time/travel - Many concerned about being taken advantage of, receiving a placebo - Fear of unknown/side effects also major contributors Anything you would add, #oncsky #cansky? ascopubs.org/doi/10.1200/...

With diffusion of #medsky #healthpolicy across platforms, at times miss hearing about work posted by people on other media. Want to share this post & study from Justin Berk @brownmedicine.bsky.social on discrimination in post acute care re: incarceration: www.nature.com/articles/s41...

#FDA's first list of 9 drugs for Commissioner's National Priority Voucher (CNPV): "We're asking reviewers, are you seeing anything that's amazing? And if we do, we're calling them up." 9 Pilot meds will get 1-2mo FDA review instead of 10-12mo. Who are the first chosen? My #HealthPolicy takeaways:

I've seen a lot of discussion about this NEJM article finding ~2% of people with dx of MS, IBD, or atopic dermatitis actually had a rare genetic condition. 1. Rare disease isn't (in aggregate) rare! Will never forget this early lesson from @cpsolvers.bsky.social.

Medicare Telehealth Flexibilities and CMS Operations During Government Shutdown @ascocancer.bsky.social www.asco.org/news-initiat...

What if every comprehensive cancer center were required to show they have a comprehensive AYA pathway? Here's a thoughtful and patient-led list from the EU. #AYACSM anything you might add from the US setting? Via @winettevandergraaf.bsky.social

The indomitable @fumikochino.bsky.social highlighting Financial Toxicity: From Data to Practice and Policy Change in Plenary Session 1. Calling out practical solutions to a huge issue (like free patient parking, streamlined visits and appropriate telemedicine that limit time off from work) #MASCC25

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%! Practice changing investigator-initiated RCT. #ISTH2025

Dr. Elizabeth Loggers of Fred Hutch presents Phase II and interim phase III trial analyses of peri-transplant supportive and palliative care and/or comorbidity management for older, medically infirm and/or frail recipients of Allo-HCT. #ASCO25 www.asco.org/abstracts-pr...

Made me think of @adrianna.bsky.social 2024 study in Health Affairs www.ncbi.nlm.nih.gov/pubmed/38190...

Finishing up some coding of interview transcripts, and I'm struck by a participant / cancer survivor who experienced a lapse in their health insurance coverage because their ACA marketplace plan no longer had a $0 premium, & in that time, incurred out-of-pocket costs for surgery.

Dr. Natalie Miller presents results final results from the proof-of-concept investigator-initiated study of combination therapy with anti–PD-1, anti–LAG-3, and anti–TIM-3 in participants with advanced or metastatic PD-(L)1 refractory #MCC. #ASCO25 meetings.asco.org/abstracts-pr...

#ctDNA after neoadjuvant therapy may serve as an independent prognostic marker for #breastcancer recurrence, per results from the TBCRC 040 PREDICT-DNA trial presented by Dr. Natasha Hunter of Fred Hutch. #ASCO25

#ASCO25 Q&A stat: 20 years ago, time to first competitor (“me too drug”) in oncology was 4-5 years. Now, it’s under 9 months. Huge pressure on companies to pick endpoints that will turn around quickly, another pressure making it harder to get industry sponsored studies with OS primary endpoints.

Presenting at #ASCO25 today! I was expecting to find evidence that oncologists prefer more-lucrative treatments, and was surprised by our results! Clinical benefit matters, drug profit did not. Cc @dusetzinas.bsky.social

Excited to share our findings re: caregiver requirements for HCT and CAR T with the National Alliance for Caregiving in 2 hours! To join us, listen here: us06web.zoom.us/webinar/regi... #OncSky #CanSky #Caregivers

Excited to share new work in @jama.com on launch prices for cancer drugs in Medicare Part D. Prices are going up, but no trend change post-IRA. Mean monthly launch prices increased from $10,954 in 2012-2014 to $27,891 in 2023-2025. Many thanks to @arnoldventures.bsky.social for funding this work!

In case anyone else was impressed, like me, at early separation of survival curves based on medication fills (ie., what group of medications is this life-saving on this short a timescale??): 6 more patients per 1000 are dead within 9 months if they don't have access to ART for HIV. #medsky

Wow: bench -> regulatory approval -> bedside in 7 months. Editorial from Peter Marks @nejm.org highlights that the "platform technology" designation was key to rapid approval. Hope to see this concept develop & pipeline/safety assessment formalize under Dr. Prasad. #medsky

But, once the early Medicaid loss group began losing LIS, these folks started filling fewer prescriptions than those who still had LIS. Around this time, mortality rates diverged for these two groups. After both groups lost LIS, prescription fills converged; so did death rates. (9/11)

"I would not have dared to dream that metastatic melanoma would become a treatable disease in my lifetime. Yet here we are today, with 43% of people diagnosed with metastatic melanoma living 10 years or more, due to treatments that we broadly refer to as cancer immunotherapy." Barry P. Sleckman, UAB