The Pot Calling the Kettle Black

The January issue of the Journal of the National Comprehensive Cancer Network features a point-counterpoint on the topic of the validity of chemosensitivity assays for drug selection in recurrent ovarian cancer. Having conducted a similar exercise with Maurie Markman, MD, as a part of a special symposium at the Society of Gynecologic Oncology in New Orleans in February 2003 — attended by hundreds of gynecologic oncologists — I was surprised on several levels.

First, (and perhaps, in this case, to his credit) Dr. Markman’s position hadn’t changed whatsoever in eight years — one could virtually excerpt his commentary, verbatim from the discussion that we had almost a decade ago. His references and scientific arguments strike me as no more convincing today than they did then, but at least they are consistent.

Second, that the authors arguing in the affirmative neglected to mention seminal influences in the field. Strikingly, Dr. Larry Wiesenthal, a pioneer and mentor, was never mentioned. Of all the modern-day investigators in this field, Dr. Wiesenthal’s contributions should certainly have been referenced. Despite this, these authors do repeatedly cite the marginal contributions of other platforms.

Third, these investigators who claim that there are no published prospective clinical correlations in ovarian cancer, appear to not read their own literature. In a paper that I authored with the chairman of the Gynecologic Oncology Group (Dr. Philip DiSaia) we provided unequivocal, statistically significant evidence in a blinded prospective analysis that assay sensitivity correlated with response (P = 0.035) and time to progression (P = 0.022). (Nagourney RA., Brewer, CA., Redecki S., et al. Gynecologic Oncology ADA 35-39. 2003.)

At least in our neck of the woods, that’s called significant.

What is perhaps the most surprising aspect of these articles is the sudden, newfound interest in this field on the part of these investigators. After a decade of efforts on my and other investigator’s parts to incorporate these methods into GOG trials fell upon deaf ears, it’s surprising to me that these arguments are finally being heard. Maybe my voice, or that of pioneers like Dr. Wiesenthal, has gotten louder? I hadn’t noticed.

In the scientific literature we use statistical tools like analysis of variance (ANOVA) to discern trends and explore new findings. When I examine these two manuscripts for new insights, I find that Dr Markman’s position, to his credit, hasn’t changed; that the statistical significance of our response and survival data also hasn’t changed; that the well documented scientific basis of our work hasn’t changed. But, I do identify one new correlate associated with this sudden enthusiasm for the field. A small (but potentially loud) line found at bottom of the first page “receives research support from…”