NEJM Highlights July 2015: a first in class drug for cancer, Sovaldi cures renal failure too (sometimes), convenient primary care

Palbociclib – first to target cyclin dependent kinases – breast cancer

As all biology majors know, cyclin dependent kinases are critical elements controlling the machinery of cell proliferation.  They have proved difficult targets due to their ubiquitous activity in both normal and abnormal tissue – until now. In a phase 3 study, about 500 patients with metastatic hormone positive, Her2 negative breast cancer were treated with palbociclib (Ibrance, Pfizer, recently FDA approved) vs. placebo.  The median disease progression time for patients on drug was 5 months longer than for placebo (9 vs. 4 months, survival data was pending).  Adverse effects of treatment were common, as one would expect from such a target.  As oncology transitions to highly personalized algorithms there is tremendous potential for such a drug hitting a new pathway to emerge as a key tool in the chemotherapeutic armamentarium. Palbociclib in Hormone-Receptor–Positive Advanced Breast Cancer (subscription access)


A side effect of Sovaldi – more kidneys

In the US, the waiting time for a cadaveric kidney transplant by patients with kidney failure is about 5 years. In the meantime they are on dialysis, with a severely impaired quality of life, and a high rate of death. An interesting perspective points out that over the past decade, approximately 4,000 kidneys coming from deceased potential donors who had hepatitis C were discarded because of the perceived risk to the recipient. With new highly effective and well tolerated treatments for Hepatitis C, the authors believe the conditions are right for these kidneys to be used, saving lives, and possibly costs even though treatment is expensive because dialysis is even more so.  Transplanting Hepatitis C–Positive Kidneys (subscription access)


Convenient ambulatory care

Medical appointments are hard to get on short notice, and unless you have a good book, the local emergency department is a painful place to sit – not to say anything about expense. Out of this gap has grown what some have called Convenient Ambulatory Care in the form of urgent care centers and retail clinics. With a just-in-time philosophy, a greater level of pricing transparency, a highly scripted / algorithmic process to care pathways, and a generous use of mid-level practitioners (NPs and PAs), these are the harbingers of a commoditization of primary care that could represent a major evolution in the current office-centered model. Some physician constituencies are clearly worried about this encroachment, they emphasize the risk to continuity of care from systems that focus on bite-size patient encounters and as made clear in the articles below, some of the next stages of this struggle are likely to take place in the arena of public regulation.  Convenient Ambulatory Care — Promise, Pitfalls, and Policy; The Expansion of Retail Clinics — Corporate Titans vs. Organized Medicine (subscription access)


The New England Journal of Medicine is a premier weekly medical journal covering many topics of interest to the health sector. In this monthly series we offer a brief overview of highlights that might be of interest to our clients and others.