Thread by @VPrasadMDMPH

Our new paper is now out in European Journal of Cancer

We analyze 55 cancer drugs that target genomic abnormalities & assess the evidence

Only 24% reported an improvement in survival 👇

A seductive mechanism of action apparently means low levels of evidence

[thread]

Modern oncology has several classes of drugs
Cytotoxic drugs
Checkpoint inhibitors
CAR-T therapies
General targeted drugs &
Drugs that target specific cancer genomic abnormalities
(Genome drugs!)

Genome drugs get outsized attention; Previously we found that (best case scenario) 13% of US cancer patients were eligible for these drugs; leaving 87% not eligible

pubmed.ncbi.nlm.nih.gov/33862157/

In our new analysis, we dive into the evidence base of these drugs.

We study 53 drugs approved for 92 unique indications between 2006–2020

We find only a fraction of these drugs improve overall survival!

Even PFS is lack luster!

See figure (Blue is good)

Heme malignancy tolerates more uncertainty than solid cancers (we can speculate why)

Evidence varies by cancer type: NSCLC drugs have only ~10% of drugs showing OS gains while Melanoma does much better with 70+%

When drugs improve survival the median gain is 4.7 months, with some as low as 1.5 months

Our patients deserve better!

FLT3 is the highest, but we all know why that is a distortion (PSST look the at the KM plot)

I am particularly worried by targets that have never established that ANY drug can improve OS

(below)

Overall, we find that, likely b/c these drugs have exciting mechanisms of action and b/c they generate often good responses, we have largely forgiven them from showing robust clinical benefit

But we lower regulatory standards to our detriment, and large uncertainty remains

Check out the paper here, and for more updates on research, follow our lab @vkprasadlab

ejcancer.com/article/S0959-…