Comparative Effectiveness Pre-Holiday Contest....

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  • 11/21/2006
This is my next to last post from Israel....

Since everyone who supports the government getting into the business of compraing the effectiveness of drugs have assured me that the methodological issues are quite easy to address I am announcing a pre-Thanksgiving comparative effectiveness contest to come up a way of establishing the comparative effectiveness of using different cancer drugs with the technological advance described in this article:

Toward Reducing The Toxic Side Effects Of Cancer Chemotherapy
An advance that may speed the use of "prodrug chemotherapy" -- one of the most promising new strategies for reducing the side effects of anti-cancer drugs -- is being reported by scientists from Johns Hopkins University's In Vivo Cellular and

This two-part chemotherapy involves giving patients the inactive form of an anti-cancer drug (the "prodrug") and an enzyme that changes the prodrug into an active, cancer fighting form. Patients first get the enzyme, which is gradually eliminated from normal tissue but builds up and remains in the tumor. Then patients get the prodrug, which changes into its active and toxic form only upon encountering the enzyme in the tumor.

"Determining the optimal time-window for prodrug injection is therefore of utmost importance for success of these strategies," Zaver M. Bhujwalla, lead author Cong Li and their colleagues note in a report scheduled for the Nov. 29 issue of the weekly Journal of the American Chemical Society.

If the prodrug were injected before all the enzyme cleared from normal tissue, it could damage normal tissue and cause body-wide side effects, they say.
The report describes the synthesis and early laboratory testing of the first prodrug-activating enzyme that can be imaged in tissue to time administration of the prodrug. The enzyme produces the active form of the common anti-cancer drug 5-fluorouracil. Its elimination from normal tissue can be monitored with magnetic resonance imaging (MRI) or optical imaging, according to the researchers."

Anyone want to come up with a method of comparing the effectiveness of delivering 5-F with side effects and without that a) does not delay access to new technologie, b) captures individual response to pro-drug injection since that will be key to optimal treatment and c) determine whether alternative drugs delivered in pro-drug or non-pro-drug fashion are the best for a particular cancer at a particular state? And extra credit for figuring out a way to continually add new drugs and new approaches in real time as opposed to when it is convenient for bureaucrats and politiciians

The comparative effectiveness crowd wants to spend a billion a year on this approach as a cure all for drug costs and a filter for setting up drug formularies AND it will be proposed as a way to set government prices for breakthrough drugs.. A Dunkin Donuts coupon for the winner of contest....We promise to post the results and responses...

Bonus question

Come up with a comparative effectiveness method for evaluatng the folowing advance:

Nanoparticle-Arsenic Combination Makes for More Potent Anticancer Agent
Arsenic trioxide, one of most promising drugs for treating acute
promyelocytic leukemia, encapsulated in lipid-based nanoparticles
designed to release their cargo inside tumor cells.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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