Hi Dr. Olivier - if only 38% of the experimental arm went on to receive CDK4/6 whereas 57% of the control arm did, wouldn’t that bias survival in benefit of the control arm?
Good question: it’s normal to be lower in the experimental group, with patients recurring under therapy (which by definition will not occur in the control arm). Have a close look at the late relapse data which is very interesting. The overall point is that a limited access to any subsequent therapy in both arms (and even beyond CDK4/6 inhibitors) will potentially affect survival by limiting the desired “dilution” of first iDFS gain.
Like that you noticed words matter... I react to the standard history taking, where patients are reported as having denied pain, denied SOB, denied smoking etc... as if we've accused them of doing something wrong... There seems to be implicit a suggestion we don't believe them
Words absolutely matter!.. ‘decided’ I believe, is more accurate .. as much data and evidence and information the medical community has it has to only have value when it is within the much grander context of the whole person.. I still shudder from insensitive and inaccurate comments made by my oncologist.. my distrust and wariness of her continued through out my treatment.
That is the problem, the oncologists refuse any shared décision making! For instance they decide to invent that the dose effect relation With adjuvant abemaciclib is positive, to enforce thé full 2 years of poisonning, against goetz 2024 data showing a significantly worst outcome in thé patients poisoned for at least 22 months, as compared to thé group who dropped very early!
According MonarchE, the NNT for OS benefit equals 55, so 54 patients are 'bored' to save ONE other. Is it really acceptable, both in clinical AND financial terms?
Example of the impact of different access to standard treatments in thé control group And in subsequent lines: the OS benefit is driven by countries outside of the US, Canada And Europe, while the OS data are actually detrimental in the US, Canada And Europe!
Yet, they concluded that the drug has an OS benefit in our countries, against the data!
Whatever you do, these oncologists Will always falsify their data or conclusions, One way or another.
Same for adaptcycle trial: the Germans did Find significantly more fréquent hepatic toxicities, and neutropenia after the first 6 months of ribociclib as compared to standard chemo, since september 2023 (end of neoadjuvant phase), And Yet, they decided to pursue this phase 2 Safety trial towards several years of uninformed exposure, And they keep claiming that they found that ribociclib is more safe than standard chemo!
In our country where the patient who will afford the treatment , I can’t consider this for them according to this results .
Hi Dr. Olivier - if only 38% of the experimental arm went on to receive CDK4/6 whereas 57% of the control arm did, wouldn’t that bias survival in benefit of the control arm?
Good question: it’s normal to be lower in the experimental group, with patients recurring under therapy (which by definition will not occur in the control arm). Have a close look at the late relapse data which is very interesting. The overall point is that a limited access to any subsequent therapy in both arms (and even beyond CDK4/6 inhibitors) will potentially affect survival by limiting the desired “dilution” of first iDFS gain.
Like that you noticed words matter... I react to the standard history taking, where patients are reported as having denied pain, denied SOB, denied smoking etc... as if we've accused them of doing something wrong... There seems to be implicit a suggestion we don't believe them
I agree, it is really a bizarre way of reporting, yet almost a convention. This should change in my opinion.
Words absolutely matter!.. ‘decided’ I believe, is more accurate .. as much data and evidence and information the medical community has it has to only have value when it is within the much grander context of the whole person.. I still shudder from insensitive and inaccurate comments made by my oncologist.. my distrust and wariness of her continued through out my treatment.
I agree. When shared decision-making happens with your oncologist, the words “declined” or “refused” should not be used.
That is the problem, the oncologists refuse any shared décision making! For instance they decide to invent that the dose effect relation With adjuvant abemaciclib is positive, to enforce thé full 2 years of poisonning, against goetz 2024 data showing a significantly worst outcome in thé patients poisoned for at least 22 months, as compared to thé group who dropped very early!
According MonarchE, the NNT for OS benefit equals 55, so 54 patients are 'bored' to save ONE other. Is it really acceptable, both in clinical AND financial terms?
Example of the impact of different access to standard treatments in thé control group And in subsequent lines: the OS benefit is driven by countries outside of the US, Canada And Europe, while the OS data are actually detrimental in the US, Canada And Europe!
Yet, they concluded that the drug has an OS benefit in our countries, against the data!
Whatever you do, these oncologists Will always falsify their data or conclusions, One way or another.
Same for adaptcycle trial: the Germans did Find significantly more fréquent hepatic toxicities, and neutropenia after the first 6 months of ribociclib as compared to standard chemo, since september 2023 (end of neoadjuvant phase), And Yet, they decided to pursue this phase 2 Safety trial towards several years of uninformed exposure, And they keep claiming that they found that ribociclib is more safe than standard chemo!