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    1. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Lots of discussion about today's announcement that cancer death rates (in age-standardized population) are on the decline. The big question seems to be where should the credit go? Smoking cessation or new game-changer medications? Do you want my take? [THREAD]pic.twitter.com/gs9jiHvsmk

      19 replies 212 proslijeđenih tweetova 426 korisnika označava da im se sviđa
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    2. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      The fact that is getting the most play (from authors of the report) is that while we are used to seeing a 1.5% decline, from 2016-17 we got a a 2.2% decline!!!pic.twitter.com/urw9RrwsVd

      2 proslijeđena tweeta 31 korisnik označava da mu se sviđa
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    3. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      20 years of education has led to me to agree that 2.2% is bigger than 1.5%, but my first point is that it is really a nice, longer, consistent time trend. Epi-stats folks, who wants to spline their regression at 2016? Are you with me?pic.twitter.com/jU5YDwal4Y

      0 proslijeđenih tweetova 37 korisnika označava da im se sviđa
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    4. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Next, I think I should also mention that @OHSUIMRes J Chapa took a deep dive on the methods used by ACS, and raised a number of provocative Qs about how fine we can slice this population data in this 2019 MCP article! Worth a read. https://drive.google.com/file/d/1g9Ugql7fYgP8Y6Snw3fc-_hraEfw8B36/view …pic.twitter.com/pbfaUdQtsO

      4 proslijeđena tweeta 40 korisnika označava da im se sviđa
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    5. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      But, to play along, let's just focus on lung ca, since the authors credit gains there with driving the overall trend. Let's note that all the drug approvals in lung ca have been in the advanced or metastatic space, and not chemo-prevention So...

      1 reply 0 proslijeđenih tweetova 21 korisnik označava da mu se sviđa
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    6. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      So all the changes in incidence, And in so far as lower mortality is due to lower incidence, must be from smoking and other environmental/ lifestyle changes (pic)pic.twitter.com/lvr26j6eQZ

      6 proslijeđenih tweetova 40 korisnika označava da im se sviđa
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    7. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Next, lets consider the maximal role new cancer drugs might play. There are 2 classes to consider here All the genome targeted drugs EGFR, ROS1, ALK, BRAF, (and in years since) TRK and RET and (in future) maybe MET and who knows! And immunotherapy

      2 proslijeđena tweeta 20 korisnika označava da im se sviđa
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    8. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Lets consider the genome drugs All those genome drugs in all tumors in humans could max be given to 8% of patients and shrink tumors in 4% max in our JAMA Onc paper led by John Marquart https://drive.google.com/file/d/1CjvpM-wTYuYgZDUxcEluL2P_K9Vd8SAF/view …pic.twitter.com/igjm0AsnPg

      4 proslijeđena tweeta 34 korisnika označavaju da im se sviđa
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    9. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Moreover, if you plot eligibility and maximal % responding over time for genome drugs it is a slow linear trend; so not the sort of phenomenon that could explain a single year jump, if one existspic.twitter.com/SokTUQ31lI

      1 reply 1 proslijeđeni tweet 17 korisnika označava da im se sviđa
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    10. Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Finally, these drugs still offer modest benefits overall; median survival from genome drugs have been associated I think with an upper bound of 7 months survival gain in real world data setshttps://pubmed.ncbi.nlm.nih.gov/30964529-association-of-patient-characteristics-and-tumor-genomics-with-clinical-outcomes-among-patients-with-non-small-cell-lung-cancer-using-a-clinicogenomic-database/ …

      1 proslijeđeni tweet 26 korisnika označava da im se sviđa
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      Vinay Prasad‏ @VPrasadMDMPH 9. sij
      • Prijavi Tweet

      Take one comparison This is what imatinib in CML does to close the life expectancy gap of the disease https://pubmed.ncbi.nlm.nih.gov/27325849-life-expectancy-of-patients-with-chronic-myeloid-leukemia-approaches-the-life-expectancy-of-the-general-population/ …pic.twitter.com/kdjdco4OB5

      17:23 - 8. sij 2020.
      • 9 proslijeđenih tweetova
      • 52 oznake „sviđa mi se”
      • Robert Corty HoodRadStuff Manju George DVM PhD, Rectal cancer survivor Gail Eidman, CFP Victor Tatarskii Adam Forman, MD Joel Boggan Kevin Lee jharveylewis
      9 proslijeđenih tweetova 52 korisnika označavaju da im se sviđa
        1. Novi razgovor
        2. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          And here are all the ALK drugs in a row do.... For these reasons, I think precision cancer drugs are unlikely to be responsible for a single 1 year change beyond time trendspic.twitter.com/2Irh26mOI5

          5 proslijeđenih tweetova 36 korisnika označava da im se sviđa
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        3. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          Now lets consider immunotherapy In our recent paper in @JAMANetworkOpen Alyson Haslam set out to estimate the upper bound of utilization from these drugshttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2732329 …

          2 proslijeđena tweeta 17 korisnika označava da im se sviđa
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        4. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          Bottom line is that indeed in 2015 they got the lung cancer approval (time fits), and indeed a sizable chunk of cancer pts are eligible, so it is possible that some of the improvement may be due to PD-1 blockade Here it is plotted over time w/ genome Rx https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2732329 …pic.twitter.com/8jwGQRCsCu

          1 reply 2 proslijeđena tweeta 20 korisnika označava da im se sviđa
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        5. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          But, that analysis assumes immediate real world uptake. That the drugs are free and doctors changed practice right away. Both open qs. Yet, I will concede that it is possible that immunotherapy has had some modest effect here.

          2 proslijeđena tweeta 25 korisnika označava da im se sviđa
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        6. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          So, although I do not like to play the game of attributing causality to population stats And Dr. Chapa will be mad at me (link) I would be incredulous if Genome Rx did much here I suspect lifestyle/smoking is big driver(incidence) Maybe a tiny bit IOhttps://drive.google.com/file/d/1g9Ugql7fYgP8Y6Snw3fc-_hraEfw8B36/view …

          5 proslijeđenih tweetova 51 korisnik označava da mu se sviđa
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        7. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          If you liked this, then you will really like Malignant In Malignant, I tell you a 300 page story of cancer medicine that is satisfying and can be fully supported by available data.https://www.amazon.com/Malignant-Policy-Evidence-People-Cancer/dp/1421437635/ …

          2 proslijeđena tweeta 63 korisnika označavaju da im se sviđa
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        8. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          Vinay Prasad je proslijedio/a tweet korisnika/ceCBS Evening News

          ... oh dear, why is this the headline? @adamcifuhttps://twitter.com/CBSEveningNews/status/1214976451642044421?s=20 …

          Vinay Prasad je dodan/na,

          CBS Evening NewsOvjeren akaunt @CBSEveningNews
          Cancer death rate in the U.S. dropped 2.2 percent from 2016 to 2017 -- the largest ever single-year decline, according to new report from American Cancer Society; the increased survival rate was mainly due to advances in treatment of lung cancer https://cbsn.ws/304FLpn  pic.twitter.com/w0f9UjyKJl
          6 replies 4 proslijeđena tweeta 45 korisnika označava da im se sviđa
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        9. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          Last thought. I did not even entertain CT screening for lung CA & for good reason. It has had v. v. low uptake and cannot explain much I won't get into the whole does it work at all/ false positives on this thread. Still no Nelson trial!https://www.ajpmonline.org/article/S0749-3797(18)32163-9/fulltext …

          9 replies 5 proslijeđenih tweetova 38 korisnika označava da im se sviđa
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        10. Vinay Prasad‏ @VPrasadMDMPH 9. sij
          • Prijavi Tweet

          Update: @rdienstmann linked me to a nice @JAMAOnc paper that shows that IO uptake was brisk, which is compatible with my final conclusions; (had uptake been slow, another story...)https://jamanetwork.com/journals/jamaoncology/fullarticle/2680749 …

          3 proslijeđena tweeta 13 korisnika označava da im se sviđa
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        11. Vinay Prasad‏ @VPrasadMDMPH 21. sij
          • Prijavi Tweet

          New, 100k drugs; but more environmental carcinogens Cancer mortality better, but life expectancy worse 1 step forward, 10 steps back only make sense in a system that prioritizes profits over human health Just 2cents https://www.nature.com/articles/d41586-020-00116-2 …pic.twitter.com/a1l4rxUrGH

          5 replies 33 proslijeđena tweeta 62 korisnika označavaju da im se sviđa
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