Lessons in Good and Bad

Several years ago, country comedians Archie Campbell and Roy Clark made famous a sketch based on the phrases “that’s good” and “that’s bad”.  Archie:  My uncle died.

Roy: That’s bad.

Archie: No, that’s good.

Roy:  How come?

Archie:  He left me $50,000!

Roy:  Oh, that’s good.

Archie: No, that’s bad.

Roy:  How come?

Archie:  The IRS took half of it!

The sketch goes on and on, but you get the idea:  the same circumstance could be viewed as good or bad, depending on your perspective.

I received a call from a reporter who covers pharma news, asking what I think about the data from a new study of Abraxane in melanoma.  Abraxane is a chemotherapy drug used in breast cancer, and the company is now testing it for other cancers.

The headlines make it seem like a slam-dunk:  “…drug shows significant improvement”; “Abraxane performs well.”  As I think about talking with the reporter, however, I recall that sketch with Archie and Roy:

Me:  Abraxane doubles progression free survival!

Reporter:  That’s good!

Me:  Yes, but it’s bad too. 

Reporter:  How come?

Me:  It only extends it to 4.8 months!

Reporter:  Oh, that’s bad!

Me:  Yes, but it’s good too.

Reporter:  How come?

Me:  That is as long as the two newest drugs on the market—Yervoy and Zelboraf, which means there’s one more tool in the toolbox!

And on it goes.  So here is the good and the bad:

About half of melanoma patients cannot take one of the new drugs because they don’t have the genetic mutation, called BRAF, that matches the drug’s treatment pathway.  Abraxane may be a significant improvement over what is currently available for these patients. 

Yet, Abraxane by itself is unlikely to cure melanoma, or to offer a long-lasting effect to very many patients.  It highlights just how far we still have to go in meeting the needs of people with melanoma.

We also know that some doctors—most likely those who see few melanomas—are not using either of the two newest drugs.  The conjecture is that they are unfamiliar with, and so uncomfortable with, the mechanism of action of these drugs.  That’s just shameful and every treating physician has the obligation to treat patients according to their best available options, not their comfort zone.  But, one asset for Abraxane is that it  is very familiar to doctors and may help move them away from advising the use of the rather ineffective dacarbazine. 

Abraxane only extends progression free survival to 4.8 months.  That’s bad.

As a currently approved drug, Abraxane can be moved into the clinical setting rather quickly, and can also be used in a variety of combinations with other drugs.  This data is also the latest in a long series of improvements, demonstrating that the treatment landscape for melanoma is improving very quickly.  That, end the end, is very good indeed.