Michael Lam, PharmD, BCOP

Critic of oncology drugs, clinical trials, and health policies.
Read Malignant and listen to Plenary Session.
KP - opinions are my own, not my employer’s

[Michael Lam, PharmD, BCOP @pharmatinib]

My paper with the brilliant team at @vkprasadlab was published today in @JAMAOnc FRONT PAGE EDITOR'S CHOICE!!! + an editorial. We highlighted the THOUSANDS of DOLLARS WASTED from oral anticancer drugs. I hope lawmakers will MAKE BIG PHARMA MORE ACCOUNTABLE for this wastage.

[Vinay Prasad MD MPH @VPrasadMDMPH]

OUT NOW in @JAMAOnc
Led by great @pharmatinib

We calc. the cost of the PILL WASTE that happens when patients DOSE REDUCE or DISCONTINUE and throw out rest of bottle!

An entirely novel approach
tl;dr
For some drugs this is 10% of drug cost!
https://t.co/uO6up2TsvJ
🧵

[Michael Lam, PharmD, BCOP @pharmatinib]

@GuiperiniMD At first I read this post incorrectly and saw "we may get full blown cancer with 12 months of tec" 😳

[Michael Lam, PharmD, BCOP @pharmatinib]

@adamcifu The legend is back!! Excited to see what VP will do next!

[Michael Lam, PharmD, BCOP @pharmatinib]

Happy Birthday to Richard M. Nixon! He is one of the most astonishing, significant, and interesting world leaders I’ve ever studied. I’m excited to dive into these 2 books today in honor of his birthday @nixonfoundation @NixonLibrary

[Michael Lam, PharmD, BCOP @pharmatinib]

A person will live and die; a nation will rise and fall; but an idea lives on forever. This book encapsulates an idea and a dream that truly light the world through the power of words. Great book highly recommended! @dicktofel

[Michael Lam, PharmD, BCOP @pharmatinib]

DESTINY-Breast05: cost of 14 cycles of T-DXd = $259,210, vs. T-DM1 = $201,054 for a 75 kg pt. Difference of ~ $58,000. Biosimilars for T-DM1 are expected to become available significantly earlier than T-DXd. Is T-DXd worth the extra $$?

[Michael Lam, PharmD, BCOP @pharmatinib]

@DrRishabhOnco How would you sequence T-DXd given the abundance of data in the later-line setting? I believe T-DM1 still has a place in therapy. The ILD risk with T-DXd cannot be ignored—it may be better to save it for later lines.

[Michael Lam, PharmD, BCOP @pharmatinib]

@NEJM @SABCSSanAntonio Notable takeaway: DESTINY-Breast05 has minimal US enrollment, despite the US accounting for 40% of T-DXd’s global market share. There is a major disconnect between the study population and real-world usage. How much is a vial of T-DXd in the US vs in Asia?

[Michael Lam, PharmD, BCOP @pharmatinib]

The issue with DESTINY-Breast05 is that T-DXd is being studied in a very SMALL percentage of US patients. DB05 probably has <3% US patients, though I don't know the real % because they don't disclose it! Btw, 40% of T-DXd market share is in the US per their earnings report.

[Michael Lam, PharmD, BCOP @pharmatinib]

Love the comments about changing how overseas sites will get inspected by the FDA. Unannounced inspection is needed for high accountability!

[Dr. Marty Makary @DrMakaryFDA]

Fun conversation with FDA’s newest edition, Dr. Vinay Prasad. Few physicians have co-authored 500 scientific articles and two books… let alone by age 42!

[Michael Lam, PharmD, BCOP @pharmatinib]

@DrMakaryFDA EXCELLENT CHOICE!! There is hope for US healthcare after all! 🇺🇸

[Michael Lam, PharmD, BCOP @pharmatinib]

Dr. Vinay Prasad is a brilliant physician scientist who is deeply devoted to ensure a bright future for the U.S. Health system. Excellent choice!! 👏👏 @VPrasadMDMPH

[Dr. Marty Makary @DrMakaryFDA]

I’m proud to welcome Dr. Vinay Prasad, MD, MPH, as the new head of FDA’s Center for Biologics Evaluation & Research. With 500+ peer-reviewed publications and two books, Dr. Prasad brings the kind of scientific rigor, independence, and transparency we need at CBER—a significant step forward. Welcome aboard, Dr. Prasad.

[Michael Lam, PharmD, BCOP @pharmatinib]

@BijoyTelivala Nice! ASHP?

[Michael Lam, PharmD, BCOP @pharmatinib]

In layman's terms, isn't treating smoldering basically treating a patient's lab value?

[Vincent Rajkumar @VincentRK]

AQUILA trial for high risk smoldering myeloma published in @NEJM today.
@thanosdimop

Personally for me, it is a huge milestone along 25 years of work that started in 1998. #ASH24 #ASH24VR

This story below may help those interested in a clinical trialist career.
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[Michael Lam, PharmD, BCOP @pharmatinib]

The best talk in #ASH24 was free, funny, and super important. I finally got to meet all these 3 giants in the oncology field! They are just as awesome in person as they are on X! @VPrasadMDMPH @AaronGoodman33 @ManniMD1

[Michael Lam, PharmD, BCOP @pharmatinib]

@AaronGoodman33 @VPrasadMDMPH Man I remember when they had the 99 cent fish taco Tuesday.... Great place!

[Michael Lam, PharmD, BCOP @pharmatinib]

Happening soon!! 4pm
The most important talk at #ASH24 #ASH2024

[Vinay Prasad MD MPH @VPrasadMDMPH]

Starting soon

[Michael Lam, PharmD, BCOP @pharmatinib]

This is the only talk I am looking forward to at #ASH24 #ASH2024!!
See yall tomorrow!!

[Vinay Prasad MD MPH @VPrasadMDMPH]

Coming soon @AaronGoodman33

[Michael Lam, PharmD, BCOP @pharmatinib]

@DrYujiUehara @StephenVLiu Stephen Liu does have some great tweets!

[Michael Lam, PharmD, BCOP @pharmatinib]

@AaronGoodman33 Definitely a game changer. I didn't know either until my wife showed me like 2 years ago!!

[Michael Lam, PharmD, BCOP @pharmatinib]

Treating smoldering with CAR-T is pointless. Even worse some people celebrate this like we're making some scientific breakthroughs