KRAS mutation responds to anti-folate therapy

While there is still a way to go in designing personalized medicines, increasingly some interesting (and surprising) findings are unfolding. Indeed, it is becoming increasingly evident that gene mutations, changes in protein expression, or changes in the location of proteins in the cell can alter how the response to treatment. A recent study, presented at the American Association for Cancer Research Annual meeting, demonstrated that a mutation in KRAS, a gene commonly mutated in some cancer patients, reduces the responses to chemotherapy. This is, in and of itself, not welcomed news -- however, this study found that such KRAS mutations improve the response to anti-folate drugs (drugs not commonly used to treat lung cancer). Therefore, depending on the mutation present and the number of copies of that mutant protein that exist in the cell, anti-folate treatment may help stop cancer growth. The bigger picture that emerges from this study is that a mutation that is detrimental when common chemotherapies are employed, in fact, be quite beneficial when other therapies are considered.

http://www.aacr.org/home/public--media/aacr-in-the-news.aspx?d=2739

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Is the increased spending on cancer care in the US "worth it"?

This was the question asked by health economy scientists at the University of Chicago, the University of Southern California, Precision Health Economics, and Bristol-Myers Squibb in a recent publication in Health Affairs (April 2012, 31:667-675). Spending on cancer care in the US is almost double the amount that is spent in Europe ($70,000 vs $44,000 per cancer patient). Many have debated if this increased spending is evidence of waste and unnecessary excess of the US health care system or if it equates to improved survival for patients. In this paper, Tomas Philipson and colleagues evaluated the financial cost and gain from increased spending on cancer care. Interestingly, they found that the increased spending in the US averted cancer-related deaths as seen in decreased mortality and led to improved survival rates. According to their calculations, the authors estimate that an increase of $20,000 in cancer spending per patient results in a 1 year increase in survival. This may be due to improvements in technology, more targeted therapy that is incorporated into therapeutic care faster, and/or increased screening procedures. While they cannot dismiss other factors that are not related to care delivery, such as improved diet and increased exercise, the evidence presented suggests that a correlation between spending on cancer care and survival does exist. It cannot be argued that excesses and inefficiencies in the US health care system do still exist, however this analysis suggests that improvements in detection, prevention and treatment - while costly - produce favorable outcomes.

http://content.healthaffairs.org/content/31/4/667.abstract

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