"One of the dominant themes emerging is this notion that all cancers are becoming rare cancers."
Pharmaceutical companies also stand to profit from a strategy that targets increasingly small subsets of cancer patients. Although there are a little more than 4,000 new cases of Philadelphia chromosome–positive CML each year, the tyrosine kinase inhibitor imatinib (Gleevec) is making a fortune for the company that developed it, Dr. Mendelsohn said.
"It’s expensive, but on the other hand it works, and the five-year survival rate has just rocketed up as a result," he said. "If it’s a good drug and it really will change outcomes, our society is willing to pay for it and it can make a profit."
Dr. Link pointed out that the efficacy of some drugs crosses tumor types, with imatinib also approved for several malignancies including Kit-positive gastrointestinal stromal tumors.
The recently approved anaplastic lymphoma kinase (ALK) inhibitor crizotinib (Xalkori) was also cited as proof that smaller trials in very select patient populations can pay off. Crizotinib pushed response rates to 61% in patients with ALK-positive non–small cell lung cancer (NSCLC), a subset that represents just 1%-7% of NSCLC patients, and may bring Pfizer annual sales of $755 million by 2015, according to analysts surveyed by Bloomberg.
Making Medical Records Do More. Part of ASCO’s vision for the next decade is that advances in health information technology would deliver up-to-the-minute personalized information and save patients from repeating their medical history every time they see a new doctor, Dr. Link said. The data would be linked to national treatment guidelines that would prompt physicians on what national experts view as the appropriate course of treatment.
At the same time, linkage to clinical trial databases would trigger notification of suitable clinical trials based on available data about the patient’s clinical condition and course. On the back end, patient data would be fed into registries that could be analyzed by researchers for clues, not just for clinical trials but for routine care, he said.
The authors did not disclose any conflicts of interest.