ACNE VULGARIS

Acne vulgaris is a highly prevalent inflammatory skin condition associated with substantial morbidity that affects people of all ages, but is most prevalent among teenagers. According to some estimates, 95% to 100% of teenage boys and up to 82% of teenage girls suffer some degree of acne. In total, acne may affect as many as 50 million people in the United States.

The pathophysiology of acne is multifactorial and involves a combination of increased sebum production, follicular hyperkeratinization, inflammation, and follicle colonization by Propionibacterium acnes. Treatment strategies and options are based on targeting different aspects of these pathophysiologic mechanisms. However, pathophysiologic mechanisms alone are an insufficient basis for selecting treatments. Encouraging patient acceptance of treatment—which may vary by patient age—is also an important consideration. The goals of treatment are to control the acne and to achieve a clear or almost clear status, especially on the patient's face.

Given these considerations, topical combination products that target multiple disease mechanisms (while minimizing the number of products and frequency of application) are of great appeal to clinicians and patients. A variety of products that combine topical antibiotics, such as clindamycin with benzoyl peroxide, are available and have demonstrated efficacy superior to that obtainable with either product alone. Acanya® (clindamycin phosphate and benzoyl peroxide) Gel 1.2%/2.5%, offers effective once daily treatment of acne with a favorable cutaneous profile.

HEROIN OVERDOSES

CDC says deaths due to heroin overdoses doubled over two-year period.

Bloomberg News (10/3, Cortez) reports that the number of Americans “dying from heroin overdoses doubled across 28 states in 2012 from 2010,” citing the CDC. The shift has mainly been due to ready access “and rising rates of opioid addiction,” the piece adds. Bloomberg notes that the “unusual analysis” unveiled today by the CDC’s weekly bulletin came in the wake of the agency’s effort to find out “if reports from some states about spikes in heroin use and related deaths since 2010 were part of a larger nationwide trend.” In sheer numbers, there were 3,635 heroin deaths in 2012, compared with 1,779 two years earlier, the piece adds.

        The Washington Times (10/3, Pace) highlights that death rates from heroin rose “in every age cohort, ethnic group (except American Indians/Alaskan Natives) and region of the country.” According to the paper, “men were nearly four times as likely to overdose from heroin as women, and 25- to 34-year-olds had the highest heroin-overdose death rate.” The piece notes that from 2010 to 2012, “the death rate from heroin overdose increased from 1.0 to 2.1 people per 100,000 in the population.”

        According to the AP (10/3, Stobbe), officials have been most concerned about “powerful prescription ‘opioid’ painkillers” such as Vicodin (hydrocodone bitartrate and acetaminophen) and OxyContin (oxycodone). The piece notes that “deaths involving such painkillers continue to be much more common than heroin-related deaths.” However, “while those deaths are leveling off or declining in many parts of the country, heroin-related deaths” jumped between 2010 and 2012 in the 28 states, the AP adds.

        Reuters (10/3) highlights that the shift in the drug use pattern, from prescription painkillers to heroin, raises potentially new problems for public health officials because it suggests more people are resorting to intravenous drug use, which raises the risk of spread of diseases.

ORGAN TRANSPLANT PATIENTS FACE HIGHER RISK OF SKIN CANCER

The San Francisco Chronicle (10/1, Colliver) reports organ transplant patients have higher risks of skin cancer because of the anti-rejection drugs they take. Dr. Sarah Arron, director of UCSF’s High Risk Skin Cancer Clinic, said, “It’s really devastating for transplant patients, given a new lease on life from their transplant, to discover they’re struggling with skin cancer.” The Chronicle adds UCSF researchers “are also involved in a National Cancer Institute study on melanoma in organ transplant patients, which includes examining how safe it would be for a patient already diagnosed with melanoma to have a transplant.” The Chronicle notes, “UCSF will serve as the lead among 20 centers in an American Academy of Dermatology study looking at the incidence and death rates of skin cancer in transplant patients.”

YOUR TAX DOLLARS AT WORK

Analysis: Healthcare.gov has cost $2.1 billion so far.

Bloomberg News (9/24, Wayne) reports on a Bloomberg Government analysis of contracts related to healthcare.gov finds the project “has cost about $2.1 billion so far.” According to the analysis, the spending exceeds the most recently-provided government estimate (9/25) (pdf) of cost, which was $834 million. Bloomberg Government, which shares an owner with Bloomberg News but is editorially independent, included several factors that the government’s estimates of ACA costs have not included: “$387 million in spending for healthcare.gov by the IRS and other agencies outside the health department; a $300 million contract to process paper applications; and spending by CMS after Feb. 28.”

        The Hill (9/25, Viebeck) reports that, according the same analysis, the implementation of the Affordable Care Act has cost a total of more than $73 billion to date. One of the reports authors noted, “Whether policymakers and the public judge the $73-billion-plus tab for health reform reasonable or exorbitant may ultimately turn on what’s used as the measuring stick,” noting it exceeds the cost of the DOD’s F-35 program but pales in comparison to total healthcare spending. The Centers for Medicare and Medicaid Services (CMS), the Federal agency responsible for implementing much of the ACA, pushed back against the report, with spokesman Aaron Albright saying, “The GAO, HHS’s Inspector General and the Department all measured the cost of Marketplace-related IT contracts for Healthcare.gov. But this report measures different things, and not surprisingly, produces a different number.”

CASTLE BIOSCIENCES DEVELOPES MELANOMA TEST THAT PREDICTS METASTATIC RISK

Castle Biosciences is a cancer focused molecular diagnostics company with six laboratory-developed tests clinically available (www.castlebiosciences.com).  They have developed a cutaneous melanoma test (DecisionDX-MELANOMA) which is a proprietary gene expression profile (GEP) assay that accurately predicts metastatic risk and survival from the primary melanoma tumor. In over 600 cutaneous melanoma samples obtained from 13 U.S. centers, the GEP assay has been shown to be superior to, and independent of AJCC stage, Breslow Thickness, Ulceration status, Mitotic Rate, and Sentinel Lymph Node Status.  The test identifies a low risk (Class I: 97% 5 year metastasis free survival) and a high risk group (Class II: 31% 5 year metastasis free survival) with high accuracy, as presented at the 2014 ASCO and AAD meetings.

IMMUNE CHECKPOINT INHIBITORS MAY BE THE KEY TO TREATING MANY CANCERS

In the last couple of years, there has been active research looking at enhancing our immune system to fight cancer.  Dr. James Allison, Ph.D., a professor at University of California in Berkeley, and now a professor and chair of the Department of Immunology at MD Anderson, discovered Cytotoxic T Lymphocyte Antigen 4, (CTLA-4) a protein that attached to the T cell lymphocytes and  "puts the breaks" on the T lymphocytes preventing these important cells from fighting cancer.  It is thought that the CTLA-4 occurs when there is a genetic mutation, which produces this abnormal protein.
T lymphocytes are very important in the immune response to actively fight cancer cells. Dr. Allison and his team discovered that blocking the CTLA-4 allowed the T Lymphocytes "get to work" attacking and inactivating cancer cells resulting in tumor regression.  An antibody drug was developed, initially known as anti-CTLA-4 (and now known as ipilimumab - approved by the F.D.A. in 2011), to inhibit the CTLA-4 antigen. This drug and other drugs being developed along these same lines (see my previous blog posting) are known as "Immune Checkpoint Inhibitors".  In the past, there was very little hope for patients with metastatic and advanced melanoma.  In clinical trials, these newer drugs are significantly extending the survival of patients with advanced melanoma and other forms of cancer, such as Renal Cell Carcinoma. My prediction is that developments in enhancing the immune system to fight cancer is the future of cancer treatment and will be a "game changing" blessing.

NEW DRUG FOR TREATING ADVANCED MELANOMA

FDA approves new immunotherapy for melanoma.

There was wide coverage of the news that Merck & Co. on Thursday received FDA approval for a novel cancer medication called Keytruda (pembrolizumab), with major newspapers, news agencies and trade journals reporting. Many media outlets highlighted the significance of the medication, noting that Keytruda belongs to a new class of medications for treating advanced melanoma, using the body’s own immune system. The Wall Street Journal (9/5, Loftus, Subscription Publication) discusses the importance of the approval, noting that it is aimed at treating patients who have exhausted other therapies, including those people who did not respond adequately to Bristol-Myers Squibb Co.’s immunotherapy Yervoy (ipilimumab).

        Writing about the mechanism of action of the new therapy, the New York Times (9/5, Pollack, Subscription Publication) reports that cancer researchers have been struggling to solve how cancerous cells manage “to evade the body’s immune system” and the “answer is that tumors activate brakes on the immune system, preventing it from attacking them.” The paper notes that Keytruda “is the first drug approved that inhibits the action of one of those brakes, a protein known as PD-1, or programmed death receptor 1.” The Times notes that the general approach could “work for many types of cancer, though so far the main successes in clinical trials have come against the deadly skin cancer melanoma, lung cancer and kidney cancer.”

        Discussing the results of trials that facilitated the approval of the medicine, the Los Angeles Times (9/5, Healy) reports the FDA disclosed Keytruda “showed promising early results in 173 clinical trial participants with advanced melanoma whose disease progressed after prior treatment.” About a quarter who were given one of two doses of Keytruda “saw their tumors shrink.” According to the piece, “the effect lasted at least 1.4 to 8.5 months and continued beyond this period in most patients.”

        According to Bloomberg News (9/5, Edney, Koons)melanoma “accounts for 2 percent of skin cancer cases and causes the majority of deaths from the disease,” including nearly 10,000 expected this year, citing the American Cancer Society. The article notes that the treatment “was approved under the FDA’s accelerated approval program,” but Merck will still have to show “the benefits through an improvement in survival or disease-related symptoms.”

        The treatment, however, does not come cheap, with “early shipments” of Keytruda costing “$112,000 a year for an average patient,” and later versions reaching $150,000 a year, reports the Philadelphia Inquirer (9/5), citing Bernstein Research analyst Tim Anderson. In a note to clients Thursday Anderson expects “that Merck’s sales from Keytruda will be about $3.5 billion in 2020,” the paper adds.