Dr. West is ranked among the top 5% of social influencers on X in Lung Cancer. He is an outspoken clinician and researcher on X during major medical meetings and peer discussions.  He frequently engages with his peers in evidence based discussions and does not shy away from criticisms of big pharma, FDA decisions, or the cost/benefit analysis of major therapies. When analyzing his influence across major clinical trial discussion in Lung Cancer, his content generates significant engagement from his peers.  He also does a very good job engaging with his peers' content through replies, quoted tweets, and retweets.

 

ADAURA Trial: A Balanced Critique

Dr. West has frequently discussed the ADAURA trial, which evaluated the efficacy of adjuvant osimertinib in patients with resected EGFR-mutant non-small cell lung cancer (NSCLC). He raises important questions about its design and long-term impact. For instance, he queries whether adjuvant osimertinib confers an overall survival (OS) benefit compared to treating only upon relapse. In one tweet, he states:

"The real Q is whether proactive, adjuvant osi confers OS benefit vs. reliable administration of osi only to ppl who need it if/when dzs relapses." Source

Dr. West is also skeptical of the trial's lack of a crossover design, which he believes skews the perceived efficacy of osimertinib:

"Don't Try this at Home" Clinical Trial Criticism

With regards to the results from the NADIM II clinical trial, Dr. West stressed that the trial results may only be applicable if the treatment team has the same level of skill as the clinical trial teams, particularly the Thoracic Surgeon. This is a very good reminder that cancer care patients are treated in a variety of settings across the U.S. and globally. Understanding the local limitations of the care team, is an important aspect of translating evidence based medicine into clinical practice.

 

Cost-Effectiveness of Treatments

Dr. West often incorporates cost-effectiveness into his discussions, particularly when analyzing the long-term treatment regimens. For example, he highlights the financial burden of prolonged osimertinib therapy:

"Cost-effective at $440K x 20 years?" Source

He argues that resources might be better allocated elsewhere unless clear survival benefits can be demonstrated:

"IMO, BC mgmt is a bubble where min gains for huge costs are favored too reflexively... we can do far more good w/that 💰spent elsewhere." Source

The Ethics and Practicality of Clinical Trial Designs

Ethical considerations in trial designs are another recurring theme in Dr. West's tweets. He often emphasizes the need for control arms that reflect the best standard of care (SoC). Discussing ADAURA, he notes:

"Helpful background. But AZ promoted osi as clear optimal 1L SOC for relapsed/adv EGFRm+ NSCLC since 2017 presentation of ADAURA." Source

Furthermore, Dr. West appreciates designs that simulate real-world scenarios more accurately, as seen in his comments on LAURA incorporating higher crossover rates:

"Planned crossover in protocol, w/actual crossover >80% is also marked improvement vs. ADAURA & great to see." Source

Conclusion

Dr. Howard (Jack) West's tweets provide a rich, nuanced view of the oncology landscape. His critical approach encourages a deeper consideration of trial designs, ethical practices, and the cost-effectiveness of treatments. By questioning the status quo, Dr. West pushes for rigor and transparency in clinical research, ensuring that advancements in oncology are both clinically significant and economically sustainable.