Profile picture
Ade Adamson, MD @AdeAdamson
, 11 tweets, 4 min read Read on Twitter
New @JAMADerm cost-effectiveness study on use of combination Talmogene Laherparepvec (Tvec) + ipilimumab (ipi) vs ipi alone. Cost of 1 year of life w/o tumor growth was $2.2 million!!! Blistering editorial by Zeke Emanuel and @sarah_dimagno thread👇🏾
jamanetwork.com/journals/jamad…
This cost effectiveness analysis was based on a 2018 Phase II study of stage III/IV unresectable melanoma patients randomized to ipi alone or ipi + Tvec
here: ncbi.nlm.nih.gov/pmc/articles/P…
In case you were wondering how to pronounce it: Tal-i-mo-gene La-herp-arep-vec. Thankfully there is a video showing you how to say it on youtube!
here:
Tvec is a genetically modified herpes virus that expresses GM-CSF. Tvec increases tumor specific immune activation so the idea is that it has complementary action with ipi, hence the trial.
Tvec is a medication injected directly into melanoma lesions. Its supposed to work by revving up the immune system to attack melanoma elsewhere in the body.
In the trial the primary endpoint was objective response rate (ORR). Pause! 🤔

This is a quickly lethal and devastating condition, why on earth isn’t OS the primary endpoint?
The study showed ORR benefit of 39% in ipi+Tvec vs 18% in ipi alone. There was NO PFS or OS benefit!!!
In a cost effectiveness analysis using this trial data, Almutairi and colleagues not only show that cost was >$2 million for 1 year of PFS but also $1.6 million for 1 additional patient to get ORR!!!
How can a drug combo at this price ever be justified, especially without even a PFS benefit not to mention no OS benefit?
I interviewed corresponding author Dr. Ivo Abraham about this study on the @JAMADerm podcast. Have a listen to our discussion:
edhub.ama-assn.org/jn-learning/au…
Also, check out the biting editorial about the implications of this paper and cancer drug costs in general from Zeke Emanuel and co-author @sarah_dimagno
link: jamanetwork.com/journals/jamad…
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Ade Adamson, MD
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

More from @AdeAdamson see all

Profile picture
I’m glad that this article was written, it makes a LOT of great points about sun exposure and melanoma, but I think a few things need further discussion.

My final #tweetorial of 2018! 👇🏾👇🏾👇🏾
In order to appreciate the complexity of this relationship (i.e. sun exposure and melanoma), one must remember that measuring sun exposure over time is HARD.
The sun is all around us making it difficult to measure exposure levels and thus draw conclusions with absolute certainty.
Read 21 tweets
Profile picture
This study is yet another one in a growing list demonstrating that dysplastic nevi are NOT obligate precursor lesions for melanoma. Let me give you a brief history/discussion of the 40 year old controversy.

A thread/#Tweetorial 👇🏾👇🏾👇🏾
Dysplastic nevi are atypical looking moles that appear on the skin that can look like melanoma.
The term clinically atypical nevus (CAN) describes the clinical appearance of a mole on visual examination, while dysplastic nevus (DN) refers to the histopathological features of the lesion.
Read 26 tweets
Profile picture
Study: African Americans Are More Burdened by Atopic Dermatitis Severity mdmag.com/medical-news/s… the conclusions of this study are deeply problematic and show the authors don't quite understand how to think about race.

A thread 👇🏾👇🏾👇🏾
The first flag for me was this statement:
I was unaware that there is a paucity of safe and effective treatments for African Americans with atopic dermatitis. 🤔
Read 20 tweets

Related threads

Profile picture
Outrageous: 16 y/o sex slave. A survivor. Terrified. Killed her last purchaser. Ineligible for release for 51 years.
For those asking: This was the Tennessee Supreme Court’s decision *on appeal.* She’s been incarcerated since 2004 when she was 16. She’s now in her 30s. Will have to serve 37 more years.
What about those Supreme Court decisions overruling life w/o parole sentences for juveniles? Her lawyers argued in 2012 that her sentence was “de facto life w/o parole.” Court disagreed. Bc she was technically eligible for release (even though a lifetime later) that was that.
Read 5 tweets
Profile picture
@jblaque @aspiringinvntor Shocker...leftists making assumptions, when in reality I’m undoubtedly far more of an actual, classical “liberal” than you’re likely to be. Current 2018’s self-identified “liberals” are actually collectivists, who see the entire world thru the distorted lens of postmodernism plus
@jblaque @aspiringinvntor the “oppressor vs oppressed” power hierarchy view of life that is inherently marxist, not to mention incredibly divisive, flawed and a large contributing reason to why so many under age 40 or so, across the entire western world (🇺🇸🇬🇧🇦🇺🇨🇦🇪🇺🇳🇿, among other nations) have
@jblaque @aspiringinvntor bought into the trappings of this dangerous ideology, such as the renewed interest in socialism+communism (an ideology that murdered more than 20x as many people as the Nazis did during the 20th century alone). It’s also why people such as yourself will refuse to ever admit their
Read 26 tweets
Profile picture
We need to pay attention to--and work to end--the use of solitary confinement. It is there, in the long-term lockdowns & sensory deprivation conditions that daily house upwards of 100,000 people in US, where the cruel endgame of American punishment is made clear. 1/
Solitary has always been a part of American prisons. It was central to the Quaker notion of "penitentiaries," only instead of penitence isolation led people to mental & physical decay. As well as rebellion & romance. See @activisthistory upenn.edu/pennpress/book… 2/
Isolation has long been the weapon of abuse prison systems use to punish dissidents, from people engaged in political protest to those who violate prison rules of segregation and compulsory (but institutionally prohibited) heterosexuality. E.g. press.uchicago.edu/ucp/books/book…
Read 29 tweets
Profile picture
There is a concept called 'living off the grid'. Off-the-grid life refers to living in a self-sufficient manner without reliance on one or more public utilities like electricity connection, piped water supply, gas connection, underground drainage connection, etc.
1/8
One may be able to live daily life without these hardware infrastructure in India easily. If you are in a village, burning firewood, lighting oil lamps, drawing water from well, and peeing/defecating in open, you may be able to live off-the-grid.
2/8
Indian social life needs an analogous 'grid' of castes. Life events like marriage, death, etc. are carried out through rituals that necessitate the support of people from different castes. Typical traditional TN marriage/death makes use of people from many castes such as...
3/8
Read 8 tweets
Profile picture
@SurvivorsnetBtn @RASASC_London @survivorstrust @Danvers07943910 @ObjectUK @BrightonSurvivorsNET “In the light of a highly disturbing increase of #transphobia locally & nationally…” IF everything anybody says or does is #transphobia, of course you can say it is rising. Any reputable statistics?
@SurvivorsnetBtn @RASASC_London @survivorstrust @Danvers07943910 @ObjectUK “…so the date @Womans_Place_UK event feels like a concerted effort to make #trans ppl, & particularly #transwomen, feel #intimidated and #invalidated” Is it the position of SN that the sensitivities of #transwomen mean that #democracy should be suspended any time they say so?
@SurvivorsnetBtn @RASASC_London @survivorstrust @Danvers07943910 @ObjectUK @Womans_Place_UK #Transwomen do face special challenges but they remain #bio #logical #males but it is fine for them #Gender express as ‘women’ but with the best will in the world, they remain #bio #logically #male @WomenEqualities @Commonswomequ @PennyMordaunt @MariaMillerUK @LesleySemmens
Read 51 tweets
Profile picture
So I'm now reading "On Tyranny: Twenty Lessons from the Twentieth Century" by Timothy Snyder. #OnTyranny goodreads.com/book/show/3391…
"Aristotle warned that inequality brought instability, while Plato believed that demagogues exploited free speech to install themselves as tyrants." #OnTyranny p9
"Both fascism and communism were responses to globalization: to the real and perceived inequalities it created, and the apparent helplessness of the democracies in addressing them." #OnTyranny p12
Read 36 tweets

Trending hashtags

#ItsnotOK #WeThePeople #ElectionFraud #Winning #SaturdayMorning #transgender #CAP #women #FistPump #WelcomeToTheFall #TheCalmBeforeTheStorm #Female #Pennsylvania #YouCantDeleteTheTruth #PanicInDC #Freedom #WeStandTogether #potus #FutureProvesPast #TruthBelongsWithThePeople #NotALarp #DarkToLight #Abused #FedRestructure #RapeCrisis

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member and get exclusive features!

Premium member ($30.00/year)

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!