Ongoing Challenges in the Management of B-Cell Malignancies

Before concluding his discussion on the management of B-cell malignancies, an expert shares insight on the ongoing challenges in this space.

Michael A. Kolodziej, MD: So the biggest challenges I think that we will continue to face are that we have to make decisions based on incomplete data. As I said earlier, it is certainly true that our options are better than they used to be, but we still don’t know what the best option is. And we need to be sensitive to that when we’re counseling a patient about treatment options. I think we’re going to continue to be challenged by the cost. The cost is a huge issue: the cost to society, as well as the cost to the individual patient. And we have to come to grips with how we’re going to deal with that. And I’m not going to take a political stance on whether I like anything that the administration proposed or not, that doesn’t really make any difference. It’s just true that we’ve got to do something.

And then the last challenge I think is sometimes I get the impression that we fall into certain lanes because we have a target that we know works. And my friend, Peter Bach, MD, MAPP, has written extensively on this and I think he’s right. And Richard Pazdur, MD, director of the FDA’s Oncology Center of Excellence, has actually said this too, that we need to take chances, we need some real discovery. We need to come to grips with the idea that we’re going to actually cure certain malignancies or we’re going to treat them as chronic diseases. Either one is OK as far as I’m concerned. Each one has its relative advantages, obviously.

That we have a good option and maybe a better option is almost unfathomable because for years we had no good options. But I think we’re going to have to start sorting that out because it affects a lot about what our patients expect. It affects a lot about how much we’re willing to spend for this stuff.
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