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The New York Times should have its medical provider license revoked

“It was a small trial, just 18 rectal cancer patients, every one of whom took the same drug. But the results were astonishing. The cancer vanished in every single patient, undetectable by physical exam, endoscopy, PET scans or M.R.I. scans.”

You shouldn’t judge an article by its headline, so how about the first few paragraphs?

“Dr. Luis A. Diaz Jr. of Memorial Sloan Kettering Cancer Center, an author of a paper published Sunday in the New England Journal of Medicine describing the results, which were sponsored by the drug company GlaxoSmithKline, said he knew of no other study in which a treatment completely obliterated a cancer in every patient. “I believe this is the first time this has happened in the history of cancer,” Dr. Diaz said.”

So far we have “astonishing”, “vanished in every single patient”, “obliterated”, and the “first-time-in-history” gambit. Anything else?

“Dr. Alan P. Venook, a colorectal cancer specialist at the University of California, San Francisco, who was not involved with the study, said he also thought this was a first. A complete remission in every single patient is “unheard-of,” he said.”

“Unheard-of”! So be it.

Not until paragraph 18, long after it praised lack of toxicities in a 12-patient trial of a drug with a known side effect profile, and shortly after mentioning the C-word sandwiched between “remarkable” and “unprecedented” is it revealed that

“The inspiration for the rectal cancer study came from a clinical trial Dr. Diaz led in 2017 that Merck, the drugmaker, funded. It involved 86 people with metastatic cancer that originated in various parts of their bodies. But the cancers all shared a gene mutation that prevented cells from repairing damage to DNA. These mutations occur in 4 percent of all cancer patients.”

The “mutation” in questions is mismatch repair (MMR) deficiency is not actually a mutation, but that is this report’s least egregious journalistic error.

MMR deficient tumors respond well to immune checkpoint inhibitors. One of them, pembrolizumab, has broad FDA approval for all “advanced” (i.e. metastatic or unresectable) cancers with MMR deficiency. The goal of this most excellent study which absolutely should have been done is to see whether it can be used even earlier, to avoid possibly debilitating but potentially curative surgery.

And lo and behold, it can! Congratulations to the study team, immune checkpoint inhibitor manufacturers, and most of all to those people who are yet to develop an MMR-deficient tumor which is still resectable, but now maybe doesn’t need to be resected because it will melt away with immune checkpoint inhibition. NB: this is significantly less than the quoted 4%, which includes people whose cancers are advanced and who can already receive ICIs.

Note that I did not learn any of this from the new article, but rather from being a medical oncologist and reading the NEJM paper which is at least — let it not be said NYT does everything wrong — linked to early on.

How will others read it, one wonders?

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