AYA

By

Leonard
Zwelling

       Any good business should be on the
lookout for growth opportunities, especially if these new markets contain a
currently underserved group of potential customers. In the cancer business (and
make no mistake about it; cancer care in the United States is a huge business),
it would seem really challenging to unearth a new market. Heck, we are probably
running out of colors for ribbons by now.

The fact that the more we learn about cancer the more it
seems that the divisions among the types of cancer organized by anatomic
disease site are more arbitrary than if molecularly organized. But that hasn’t
stopped the drive for more charitable donations to breast, ovarian, pancreatic,
gastrointestinal, and prostate cancer. These are the big killers among
post-pubertal Americans who usually are beyond the age of conception as well. I
only bring that up because we seem to forget that cancer is mostly a disease of
those over 50 and curing these people will have no bearing on the long-term
survival of the species or alter the genetic make-up of future generations. It
may seem counterintuitive but medicine is the most anti-evolutionary of scientific
practices as it does everything in its power to undo natural selection. I need
to get that part out of the way first.

There are, however, two groups of cancer patients who
deserve a bit more attention than they are getting from the sea of ribbons and
pink walkers. And the major reason is in their cases, successful treatment has
profound impact on the species as well as the US economy. These two groups are
the children with cancer and an even more invisible minority, adolescents and
young adults (AYA).

In all the heat and occasional light that bathes the
cancer world, it is sometimes forgotten that the initial success in the
treatment of systemic malignancy was realized in childhood leukemia in the
1960’s. We are blessed 50 years later with still having some of those pioneers
to whom we can speak who blazed trails in Memphis, Tennessee, Boston, Bethesda
and Houston by using sub-lethal combinations of cellular poisons and eradicating
ALL to the point at which it is now about 90+% curable. This is an amazing
triumph for the medical scientists and the courageous patients. The clinical
investigators, using mostly trial and error, devised regimens to allow many of
these kids to survive a previously fatal disease and now be the major
contributors to a new branch of oncology—survivorship.

But the kids were not the only ones to benefit. Teenagers
and young adults who very rarely contract malignant diseases also have
benefitted. Lance Armstrong is as good an example as any of the healing power
of systemic chemotherapy in this patient population. That being said, even with
a high profile survivor like Mr. Armstrong, the AYA population is still wanting
for its own focus and most clinical trials in this population go wanting for sufficient numbers of volunteers. This is where the major cancer centers like MD Anderson
could and should step in.

In the UK, there is a special unit for these AYA patients
and this has led to better overall clinical results. These cancers were the
focus of a front page article in the Wall Street Journal D Section on April 29,
2014 that demonstrates the steps some academic centers have taken to address
the needs of this unusual group of patients whose cancers are often treatable
with the resultant survivorship leading to long and productive work and
tax-paying lives. Oh yes. Some go on to have families and become oncologists
themselves.

This one hits pretty close to home because Dr. Kleinerman
has been on the forefront of the therapy of this patient population for many
years due to her interest in the treatment of osteosarcoma in the AYA setting,
the group in whom the disease most commonly presents. So what I am about to say
is biased, self-serving and definitely not objective. MD Anderson could have
taken the lead in the AYA field. It did not, but it is not too late. It still
can. Rather than worrying about New Jersey and Arizona as emerging geographic
markets, how about focusing on these young people as an emerging clinical one?

MD Anderson seems to be looking for opportunities to
separate itself from the pack that includes Texas Oncology and Cancer Treatment
Centers of America. Here’s that chance. Why not take it?

Leonard Zwelling