Vincent Rajkumar Profile picture
Editor-in-Chief, Blood Cancer Journal; Giants of Cancer Care Award; Professor, Mayo Clinic; Opinions are personal views; @CovidThreads;
Ross Grayson, MPH, CIH Profile picture No One You Know ♥️ Profile picture Stan Kerr 🍊Fringe Minority Profile picture BeTweet Profile picture favs3 Profile picture 36 added to My Authors
Sep 27 10 tweets 2 min read
After seeing vorinostat, panobinostat, elotuzumab, belantamab, venetoclax, melflufen, selinexor, ixazomib falter in myeloma, my thoughts on cancer drug development for investigators and Pharma. Simple. But simple is hard.
1/ #MedTwitter Make sure as a company or investigator you are convinced of the single agent efficacy of your drug in phase II trials. If a drug is weak, needs steroids or something else to take it over the hump, even if it is approved, its likely to be a marginal drug that’s marginally used.
Sep 24 9 tweets 7 min read
Sept 25. 2 years since India lost one of the greatest singers ever: SPB

What can you do in 2 mins to highlight the divine talent of a man who recorded >40,000 songs? I made this video collage in memory of the legend. A dear friend. #SPBLivesOn @rameshlaus @PSampathkumarMD I’ll link some rare videos and some videos of him that I have made over the years in this thread. Here is Nilave Vaa. @charanproducer @ThisIsDSP @singersrinivas @_ShwetaMohan_ @HaricharanMusic
Sep 23 6 tweets 2 min read
Prolonged PFS doesn’t mean a thing if overall survival is worse.

In myeloma we have 3 instances in which drugs that prolonged PFS showed worse overall survival in the same trial.

Here is 6 more: with P13K inhibitors in other cancers.…
@ZacharyBrennan I am happy @US_FDA lets us use PFS as a surrogate. It helps us get drugs to patients early.

But they make sure that response rate, DOR, TTP all go in same direction. That there is no major safety concern. And most importantly overall survival curves don’t go the other direction
Sep 22 8 tweets 2 min read
Breaking: ODAC votes No on melflufen for myeloma.

Given the data provided, this is the right decision. The vote was 14 against and 2 in favor of melflufen.
Sep 22 5 tweets 2 min read
A killer slide in the FDA presentation on the ODAC hearing for melfluen. Highly important for #MedTwitter

It shows the limitation of subgroup analysis.

Survival difference seen in subgroup analysis based on month of randomization!! Shows how subgroup analysis can mislead. In the hearing Sponsor states an overall survival benefit is seen with melflufen in subgroup who didn’t get transplant.

FDA counters now that sub group analysis can mislead showing that survival also varies by month of randomization.
Sep 22 6 tweets 3 min read
Whats unfortunate about prescription drug prices in America is that most doctors dont know the cost of the meds they prescribe. But you cant blame them: price can vary for the same drug 10 fold depending on the pharmacy

Not seen with any other commodity on earth @ConsumerReports Or a 100 fold.
Sep 20 4 tweets 2 min read
COVID deaths are deaths caused by COVID.

Excess deaths in the US from all causes mirrors reported COVID deaths. @OurWorldInData 👇 Although it’s easy to say a lot of COVID deaths are “with” not “of”, that’s not true.

This pandemic is real. And we have lost over 1 million lives. Excess mortality from all causes tracks reported COVID deaths.
Sep 19 5 tweets 1 min read
40,000 deaths in the last 3 months. 400 deaths a day. No. Covid is not over. We can do a lot to prevent a bigger wave in the fall which doesn’t require mandates or lockdowns. But it requires us to be clear to the public on the daily losses, and the simple steps people can take to reduce risk.
Sep 13 10 tweets 3 min read
Whats in the Inflation Prevention Act for Medicare recipients?

Lower cost of prescription drugs

1) Annual copay capped at $2000.
2) Medicare will start negotiating prices for the first time
3) Drug price increases cannot exceed inflation
4) Insulin cost per month capped to $35 This is a great start.

But a lot more can be done if there is more support to lower prices. The public should make their voice heard.
Sep 13 4 tweets 2 min read
In the last 6 months countries that controlled COVID so well for 2 years have had huge waves.

1. Due to variants, waning immunity, & relaxation of preventive measures, COVID infections did occur.

2. Lives saved by controlling Covid till the public was well vaccinated stay saved Image 3. The idea that we are all going to get COVID and we can do nothing about it is wrong.

There is a disconnect between number of cases and deaths that occurs because of vaccines. Individually or as a country waiting till fully vaccinated to relax precautions has huge benefits. ImageImage
Sep 9 12 tweets 4 min read
What’s new in myeloma?

1/ Frontline treatment: We are recommending quadruplets as initial therapy for more patients, especially as pre transplant induction for high risk myeloma.
My preferred quadruplet is Dara-VRd. 2/ Refractory myeloma: We have two approved CAR T-cell products, ide cel and cilta cel. They are approved for relapsed refractory myeloma, in patients who have had 5 or more prior treatment regimens. Cost is high. Availability is limited. Refer early.
Sep 9 4 tweets 2 min read
Since an old tweet of mine about COVID and Florida resurfaced, I looked again at Florida.

New York was among the first to be hit by COVID. Paid a big price before we recognized importance of masks. Before they knew what hit them. Before vaccines.

Florida has surpassed it. List of states with higher death toll than New York.

Note: PA and NJ got hit around the same time as New York. Most others had time, and could have done way better.
Sep 6 4 tweets 2 min read
New bivalent Covid booster vaccines target both the original virus and omicron variants. You can now make appointments to get them in the US. Get them.

As I have stated since the original vaccines rolled out, I expect them to offer high level of protection against severe disease Pharmacies and healthcare centers have started accepting appointments.…
Sep 5 10 tweets 7 min read
Just out: Current Treatment Algorithms: Smoldering Myeloma. Great to co author this article with @mvmateos @SagarLonialMD @myelomaMD @BloodCancerJnl

Bonus: a section on frequently asked questions. @WinshipAtEmory @usal @MayoCancerCare… Our approach to smoldering myeloma is based on data from current trials and our best collective judgment after taking into account all the pros and cons.
Sep 1 4 tweets 2 min read
Lenalidomide cost per month

$100 in India
$1000 in Europe
$18,000 in USA

No wonder lenalidomide is the #2 drug Medicare spends the most money on. #CostVR @DavidP4AD @policydeb

17-20 generics in Europe and India bringing down the cost.

2-3 in USA but they are prevented from getting full market share.
Aug 31 5 tweets 2 min read
Average life expectancy in America fell by 3 years due to Covid in 2020 and 2021.

Other developed countries did not see a hit in 2021 like the US did.… Life Expectancy fell by 6.5 years in Native Americans bringing their life expectancy to levels seen in America in 1944.

Life expectancy fell more in Black people and Hispanics in 2020.
Aug 27 4 tweets 1 min read
Bispecifics for myeloma are promising. As I said earlier, I’d like them all get accelerated approval.

But as clinicians we must swiftly adjust dosing schedule & be watchful to risk of severe infections & other cancers that can occur with prolonged T cell suppression. #IMS2022 Overall survival is a composite endpoint. It not only depends on efficacy but also safety.

At this meeting talking to colleagues, I am increasingly aware of the risk of serious infections with these agents.
Aug 26 6 tweets 3 min read
Dr. Thierry Facon making a compelling argument for autologous stem cell transplant for newly diagnosed myeloma. @Myeloma_Society #IMS2022 For high risk myeloma, its important to consider early transplant in the frontline setting.

For standard risk myeloma, we continue to prefer early transplant but in certain circumstance can delay transplant until first relapse accommodating patients’ wishes & life circumstances
Aug 26 4 tweets 1 min read
This is the kind of lawsuit that makes people lose even more faith in the Pharmaceutical industry.

We have a pandemic costing millions of lives. And this is what their concern is?… When so many including me were thanking Moderna, Pfizer, Astra Zeneca for rapidly producing vaccines, we were also defending you from those who alleged you were solely doing this for profit.

I cannot defend you any more.
Aug 24 10 tweets 3 min read
Although we have multiple options to treat myeloma, the number of highly effective drug classes are few and just not enough.

We continue to have an unmet need for relapsed myeloma. We continue to need accelerated approval by the FDA. @Rfonsi1 @NorthTxMSG #IMS2022 #IMS2022VR
1/ Image We also need accelerated approval of multiple drugs of the same class because patients tolerate one better than the other, and sometimes one works better than the other. It is also important to have competition to foster more innovation and to have some effect on price.

Aug 24 4 tweets 2 min read
I will get the updated COVID vaccine boosters as soon as they are available.… COVID vaccines have saved countless lives. I’m glad to see vaccines modified to target new variants.…