Maurie Markman, MD

In the ongoing debate regarding the role of randomized trials in defining the standard of care in cancer management, adherents of this so-called gold standard acknowledge the problems associated with conclusions drawn from prospective nonrandomized studies or retrospective analyses of patients managed with different approaches.

The impact of the Trump administration's agenda is being felt in the healthcare arena, prominently in the oversight for drug approvals.

There is an intense and seemingly growing debate within the clinical, research, and regulatory arenas regarding what should be appropriately required to declare that a new or novel strategy be considered an acceptable standard-of-care approach to cancer management within a particular setting.

Randomization designed to isolate the impact of a specific factor has enabled practitioners to understand the value, or lack of value of particular drugs, procedures, or processes in a given clinical setting.

It is common for third-party payers to deny payment for N-of-1 molecular testing at the same time they continue to pay for multiple lines of chemotherapy, even though there is often little evidence that the particular patient's cancer will respond or that the quality of life will be improved.

In general, where surgery is a medically appropriate option, it is the surgeon who takes the leading clinical role in discussions with the patient and her or his family regarding the development of an optimal strategy for that individual.

Research on a scalp-cooling device to help patients with breast cancer avoid hair loss during chemotherapy illustrates this question: what level of evidence might individual clinicians require before they would suggest, recommend, or support the use of a particular approach in treating patients outside the realm of the mandates of governmental agencies or payers?

Despite the importance of clinical trial data, there are problems with the way these data are presented. There is a need to simplify what is being discussed so that it can be more easily understood or summarized by patients and their advisers in their decision-making process.

It has long been recognized that the elderly are acutely underrepresented in the clinical trials that help to define the standards of care in oncologic management in the United States.

Maurie Markman, MD, president, Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses what he would like to see accomplished in the field of ovarian cancer over the next year.

Certain components of the cancer care continuum have the potential to favorably impact the rapidly encroaching crisis in cancer care costs at the societal level.

The current status of clinical cancer research in the United States falls far short of what is necessary to effectively and efficiently change this amazing opportunity to improve both the quantity and quality of the lives of patients with cancer into an objective reality.

"Uncertainty" is a routine dilemma when discussing a prognosis with a patient with cancer and his or her family. The prognosis is, at best, a statistical probability—assuming the available objective data are somewhat representative of the individual patient.

Maurie Markman, MD, president, Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses combination treatments in ovarian cancer.

Maurie Markman, MD, president of Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses the development of immune targeting in ovarian cancer.

It is perhaps a little unusual that an oncol­ogy commentary would begin with a highly provocative discussion about the future of driverless cars, but there are similarities in the sharp corners of the debate over this new tech­nology and emerging trends in cancer care.

Maurie Markman, MD, president, Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses the search for actionable biomarkers in the treatment of patients with ovarian cancer.

Negative reports evaluating molecularly selected agents should not derail the process of developing future therapies by employing a precision medicine approach.

It was not that long ago that decisions regarding cancer management were essentially made exclusively by the treating physician, with patients simply being informed of “the plan” for their treatment.

One of the basic tenets of science is the concept that all accepted “truths” are subject to objective testing and, through this process, can be shown to be false.

Those responsible for developing and implementing governmental health policy have an extremely difficult job. Not only do they have to attempt to satisfy often highly unrealistic expectations of legislators for overall goals and timelines, but they also are frequently asked to accomplish a task with woefully inadequate funding.

Maurie Markman, MD, president, Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses the current status of immune targeting as potential treatment for patients with ovarian cancer.

In a most provocative commentary published in a recent issue of The Lancet, two authors present a strong argument that it is sometimes ethical to provide therapy that is known to be validated but less effective than the standard of care if this therapy is also so significantly less expensive that access is substantially enhanced.

Twenty-five years ago, WHO declared that coffee was a potential carcinogen. Now, the public health agency has reversed course, raising a host of questions about the accuracy and value not only about the original research but also about the recent report.

Maurie Markman, MD, president, Medicine and Science, Cancer Treatment Centers of America, editor-in-chief, OncologyLive, discusses the most important factors of bilateral salpingo-oophorectomy (BSO) to convey to patients with ovarian cancer.

Perhaps oncologists know that having a detailed understanding of population-based survival statistics is very different from such knowledge of the future clinical course of an individual patient.

Fifty years after Henry Beecher’s landmark critique finally helped begin breaking the “code-of-silence” regarding the conduct of unethical clinical research in the United States—sadly including the oncology arena—many serious concerns linger.

Oncologists eagerly await clinical trial results that will permit them to provide additional strategies to their patients. However, the impact of such randomized trial results can be quite limited where preexisting beliefs, training, economic interests, or well-established practices conflict with what the "evidence" demonstrates.

Although chemotherapy has changed dramatically since it was introduced, platinum-containing combinations remain standard in ovarian cancer. Often, the established regimen can be modified for patients who quite justifiably may fear the toxicities of platinum agents.

Discussions with patients must carefully consider the understandable desire of patients for definitive and hopeful information while at the same time appreciating that poorly understood biology often makes definitive statements and declarations regarding prognosis problematic and not infrequently incorrect.