Miguel Bronchud: Too many different treatments options for some cancer patients? Or not enough?

Miguel Bronchud, Co-Founder of Regenerative Medicine Solutions, shared on LinkedIn:

“Too many different treatments options for some cancer patients? Or not enough?

Going from one standard classic option (usually cytotoxic chemotherapy) to several in sequence or combination (be it radiotherapy or immune therapies or targeted small molecules by oral route) requires an ordered and contextual approach that implies many clinical trials, good designs (including quality of life measurements) and robust statistical analyses, choosing the right selection criteria for patients, the correct order and sequence of therapies and an accurate learning path to choose widely, besides a variety of cancer coaching methods to explain adequately the different treatment options to patients and family (so that they are not vulnerable to unwanted paternalistic approaches).

Last but not least- Increasingly, oncologists need to understand and explain cost effective comparative treatment approaches to avoid excessive financial toxicity to patients and families? and to their own institutions or insurance companies?

Cancer of the bladder (infiltrating and loco regional or metastatic) is an example. It is a nasty disease, often difficult to detect very easily or early. And for the sake of simplicity here I avoid entering important surgical variables such as radical surgery (cystectomies) or new modes of radiotherapy.

A recently published multi center retrospective study in the USA:

JAMA Netw Open. 2024;7(5):e249417,  doi:10.1001/jamanetworkopen.2024.9417.

It is illustrative of the complexity and just how difficult it can be to develop in-house or standard procedures and treatments protocols that on the one hand are truly personalized or tailored to individual patients and on the other hand respecting collective guidelines (like NCCN or ASCO or ESMO) and cost effective care.

Treatment Patterns and Attrition With Lines of Therapy for Advanced Urothelial Carcinoma in the US:

Vinay Mathew Thomas, Yeonjung Jo, Nishita Tripathi et al.

This retrospective cohort study used patient-level data from the nationwide deidentified electronic health record database Flatiron Health, originating from approximately 280 oncology clinics across the US. Patients receiving treatment for 2 or more different types of cancer or participating in clinical trials were excluded from the analysis on balance, from approximately 280 oncology clinics across the US.

Patients included in the analysis received treatment for metastatic or local diseases.

Concluded:

‘The findings of this cohort study suggest that approximately two-thirds of patients with aUC did not receive second-line treatment.

Most first-line treatments do not include cisplatin-based regimens and instead incorporate carboplatin– or PD-1/PD-L1 inhibitor–based therapies. These data warrant the provision of more effective and tolerable first-line treatments for patients with aUC.’

Progress is made step by step…”

Source: Miguel Bronchud/LinkedIn