Mike Thompson, MD, PhD, FASCO
146.5K posts
@mtmdphd
VP Clinical Partnerships @TempusAI #PrecisionMedicine #mmsm #lymsm #MDSsm #leusm #CCC19 @COVID19nCCC @ASCO COI: https://t.co/A6GQmWZ302
Only few days to #ASCO26. For breast oncologists, this edition will deliver a new promising biomarker to spare unnecessary chemo, informative updates from practice-changing trials across subtypes, and major innovations coming from China. See you in Chicago next week! #bcsm
How does major clinical practice change happen in medicine? What are the requirements? Do influential voices on social media have influence? Smoldering multiple myeloma (SMM) offers a great perspective on this with the rapid adoption of daratumumab in the community after the AQUILA trial results. These 5 points on how practice change happens will apply to any new treatment or disease. 1) Practice change happens when the evidence is strong. This means convincing trial results. 2) Practice change happens when the treatment actually works. The drug must work and work as promised in the trial. This is important. If physicians in practice get outcomes contrary to what a trial reports, they will abandon it. 3) Practice change happens when the treatment is feasible. FDA and EU regulatory approval is essential for major practice changing treatments. 4) Practice change happens when the treatment is aligned to what physicians and patients actually wanted to do all along. This is important. In smoldering myeloma most were uncomfortable with watch and wait. So when there is effective therapy, practice changes. 5) Practice change is probably influenced by influential voices on social media, but only if it rings true, aligns with above 4 points, and is delivered by experts. I don’t think having a lot of followers alone helps; credible subject matter expertise is important. Background for those not familiar with smoldering myeloma For decades observation without treatment was the standard of care. After AQUILA trial results for smoldering myeloma came out, many including me (biased of course as the lead investigator) felt that the trial results were compelling. We therefore recommended daratumumab for high risk SMM. But we were sandwiched on both sides by contrary opinions. One side were some who felt we needed to be even more aggressive and use full myeloma therapy, and on the other side by some who felt we should not use any drug for treatment and just watch and wait. All voices were active on social media. 18 months later, we know from market research is that uptake of daratumumab for high risk SMM is very high. Practice changed. Basically we can criticize and comment all we want but to have real impact it must reflect reality, reflect concerns of patients, reflect clinical practice concerns of physicians, and social media comments and criticisms must be credible. As I write this, personally I have experienced this many times: adoption of low dose dex and adoption of weekly SQ bortezomib, adoption of DRd, adoption of quads in MM etc. They all fulfilled the 5 points. @SagarLonialMD @szusmani @Mohty_EBMT @Myeloma_Doc @RahulBanerjeeMD @Transplant_Doc @mtmdphd @DavidSteensma
How does major clinical practice change happen in medicine? What are the requirements? Do influential voices on social media have influence? Smoldering multiple myeloma (SMM) offers a great perspective on this with the rapid adoption of daratumumab in the community after the AQUILA trial results. These 5 points on how practice change happens will apply to any new treatment or disease. 1) Practice change happens when the evidence is strong. This means convincing trial results. 2) Practice change happens when the treatment actually works. The drug must work and work as promised in the trial. This is important. If physicians in practice get outcomes contrary to what a trial reports, they will abandon it. 3) Practice change happens when the treatment is feasible. FDA and EU regulatory approval is essential for major practice changing treatments. 4) Practice change happens when the treatment is aligned to what physicians and patients actually wanted to do all along. This is important. In smoldering myeloma most were uncomfortable with watch and wait. So when there is effective therapy, practice changes. 5) Practice change is probably influenced by influential voices on social media, but only if it rings true, aligns with above 4 points, and is delivered by experts. I don’t think having a lot of followers alone helps; credible subject matter expertise is important. Background for those not familiar with smoldering myeloma For decades observation without treatment was the standard of care. After AQUILA trial results for smoldering myeloma came out, many including me (biased of course as the lead investigator) felt that the trial results were compelling. We therefore recommended daratumumab for high risk SMM. But we were sandwiched on both sides by contrary opinions. One side were some who felt we needed to be even more aggressive and use full myeloma therapy, and on the other side by some who felt we should not use any drug for treatment and just watch and wait. All voices were active on social media. 18 months later, we know from market research is that uptake of daratumumab for high risk SMM is very high. Practice changed. Basically we can criticize and comment all we want but to have real impact it must reflect reality, reflect concerns of patients, reflect clinical practice concerns of physicians, and social media comments and criticisms must be credible. As I write this, personally I have experienced this many times: adoption of low dose dex and adoption of weekly SQ bortezomib, adoption of DRd, adoption of quads in MM etc. They all fulfilled the 5 points. @SagarLonialMD @szusmani @Mohty_EBMT @Myeloma_Doc @RahulBanerjeeMD @Transplant_Doc @mtmdphd @DavidSteensma
