Talk:Blinatumomab

Does it kill normal B cells

Presumably CD19 are on normal/non-cancerous B cells so could article clarify if the treatment kills all B cells or why it targets cancerous rather than normal B cells. Rod57 (talk) 03:31, 16 August 2008 (UTC)

Since read that it kills all B cells and the body replenishes the B cells with presumably non-cancerous ones. Rod57 (talk) 18:34, 5 January 2009 (UTC)

more on mechanism

Can we say if/how one molecule of MT103 can activate multiple T-cells ?
Which end of MT103 releases first ?
Can we say if/how it stimulates more T-cells ? Rod57 (talk) 02:07, 11 March 2011 (UTC)

The image suggests that one drug molecule can only link one T cell to one tumour cell. I think that's exactly how it is, and I suspect that the two cells are usually connected with a fair number of drug molecules instead of just one. --ἀνυπόδητος (talk) 12:51, 11 March 2011 (UTC)

Use for lung and GI cancers (Uncited)?

Can't any current clinical trials involving blinatumomab for lung and GI cancers (http://www.clinicaltrial.gov/ct2/results?term=blinatumomab).

I believe this is a mistake, as it is a different BiTE antibody (EpCAM - MT110) that is being examined for lung/GI cancers (http://cancerres.aacrjournals.org/content/69/12/4941.full.html). Both blinatumomab and EpCAM are mentioned in the same article, which is probably the source of confusion.M dee gee (talk) 21:17, 3 November 2014 (UTC) — Preceding unsigned comment added by M dee gee (talk • contribs) 16:49, 3 November 2014 (UTC)

Accelerated approval

Blinatumomab seems to have been approved on the basis of Phase II studies with no control groups. There are no Phase III studies. There are no studies with an outcome of survival. --Nbauman (talk) 22:16, 9 August 2015 (UTC)

MSK "abacus"

Nbauman, about this - the problem with this, is its lack of context. the WSJ article makes it clear that there are several values you can change to calculate the "right" price of a drug - "For instance, a user can select what he sees as the monetary value of an additional year of life, ranging from $12,000 to $300,000. Other adjustable components include a "toxicity discount," which lowers the price to reflect the severity of drug side effects; and cost of development, which can move the price higher based on the number of patients in clinical trials." The article's author (apparently arbitrarily) set $120K for a year of life and a $15% toxicity discount for some of their discussions. Again - apparently arbitrarily. What encyclopedic value do the calculations based on those random parameters have? In my view, none. Maybe there is some other sources on the DrugAbacus that give a more context-ful and less random discussion? If not, I don't think it makes sense to include content on this. But please do explain from your perspective... Thanks. Jytdog (talk) 16:03, 13 August 2015 (UTC)

Jytdog, the context is that Peter Bach is one of the leading cancer drug developers, and clinical oncologists, in the world; he and many of his equally authoritative colleagues have been writing in peer reviewed journals and other WP:MEDMOS and WP:RSs about the high costs of cancer drugs, which they feel is unreasonable and unethical. Bach and others are developing this DrugAbacus pricing tool as one way to calculate the value of these drugs. Other tools are the ASCO Value Framework and the European Magnitude of Clinical Benefit Scale. Bach and the WSJ specifically used blinatumomab as an example. DrugAbacus hasn't been validated in randomized, controlled trials, but neither has blinatumomab, which got accelerated approval. For you or me to say that Bach's numbers (as reviewed by the WSJ) are wrong would be WP:OR.

"This is not a forum for general discussion of the article's subject." It's for a discussion of whether that text belongs in this entry according to WP guidelines. I don't see from the articles that the value of $120,000 for a year of life and 15% toxicity discounts are random or arbitrary. They chose representative figures based on reasonable assumptions. Bach, the WSJ and Medscape know far more about drug pricing than I (or you) will ever know. There are many other ways of calculating it, and they believe that this is one reasonable one. I'm not qualified to second-guess them. I'm just an anonymous Wikipedia editor, not an oncologist. They are WP:MEDRS or at least WP:RS, and I (and you) are not.

There has been a huge amount of discussion of the high costs of drugs, particularly cancer biologics and specifically including blinatumomab, in many WP:RS and WP:MEDRS. That establishes WP:WEIGHT. So it belongs in the entry.

http://www.medscape.com/viewarticle/847755_print

New Abacus Calculates Price of Cancer Drug Based on Value

Roxanne Nelson

Medscape.com

July 10, 2015

http://blogs.sciencemag.org/pipeline/archives/2015/06/19/the_drug_abacus

In the pipeline

Derek Lowe's commentary on drug discovery and the pharma industry. An editorially independent blog from the publishers of Science Translational Medicine.

The Drug Abacus

By Derek Lowe

Science Translational Medicine

June 19, 2015

"The two worst are Blincyto (blinatomumab) and Provenge."

Thank you for discussing this in talk first rather than just deleting it. --Nbauman (talk) 17:52, 13 August 2015 (UTC)

I didn't say the numbers about the pricing of the drug produced by DrugAbacus are wrong - I said nothing like that! What I said is that they don't have any meaning - is it reasonable to say a year of life is $120K/year? The WSJ article doesn't say. I love Derek Lowe (thanks for bringing him in) and this is the same thing he says. Jytdog (talk) 18:52, 13 August 2015 (UTC)

Doctors and health economists use numbers like that all the time. This week for example: http://jama.jamanetwork.com/article.aspx?articleID=2425732 "The authors calculated that the net benefit of the policy change was just less than a half-billion dollars per year, for which they valued the additional life-years gained at $100 000 per year."--Nbauman (talk) 02:49, 14 August 2015 (UTC)

This is an encyclopedia and what we discuss should have context so it makes sense to an every day reader. Again, Lowe specifically discusses the context of how to value a year of life. Are you open to introducing context from that? Jytdog (talk) 12:31, 14 August 2015 (UTC)

Use of the drug on BCR-ABL positive ALL (Uncited)?

The FDA label has this in the section INDICATIONS AND USAGE. "BLINCYTO is indicated for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia" (https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/125557lbl.pdf). I think it is particularly important to indicate that this medication in particular is for Ph' negative ALL only or at least clarify that the use on Ph' positive ALL patients is not approved yet, although testing in Ph' positive ALL patients is consistent with Ph' negative patients (Martinelli et al, 2017, Journal of clinical oncology). DATrevino (talk) —Preceding undated comment added 19:11, 23 February 2018 (UTC)