DYNAMIC - Circulating Tumor DNA to decide Adjuvant Chemo in Stage II Colon Cancer | LEVEL - HARD

Vinay Prasad, MD MPH; Physician & Associate Professor
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[@jeffk8900]

I think your message would bet across better if you reduce your presence in the video. I think if you make slides bigger and put yourself in smaller video capture, it will improve the message and take your celebrity out of the picture. Message is the most important, for practice and for patients.

[@NurburgringUP]

Loved this analysis. Glad to have oncology back on the channel!

[@teresabenson3385]

Thank you for this. I train clinicians in EBM, and these videos are very helpful for walking them through the practical application of critical appraisal-- and knowing why even the dreaded statistics class is important.

[@Fruitcookieandmilk]

Yes please make slides bigger cuz likely most of us are watching on cell phone while doing our cardio before getting back on ehr

[@kylewalsh393]

I enjoy the analysis with the passion!

[@jamesparry1547]

My advice at this of the game, release everything you know that your to scared to publish ASAP. Also turn on your sound , we are at a stage where if the truth doesn't come out soon the blood stained hands of medical intervention will never be clean again.

[@saralotti7174]

That’s what they want imo. So they can replace the white costumed doctor distributors with artificial intelligence programs and diagnostics that cannot be swayed by “for profit” “consensus” and unethical greed. The angelic white coats cannot hide the piracy plummeting our health wealth for their own bounty. Pirates must walk the plank. Maybe they should learn to code😉

[@dedetudor.]

James... Please see latest post on Russell Brand... He has video of Klaus Schwab and Albert Bourla speaking at the WEF. Then see the latest post on DarkHorse with Brett and Heather Weinstein. Also David Martin World on yt. Latest post covers gov 2021 Tabletop Exercise for pox and other pathogens. Very very important. Please spread the word.

[@simonac4811]

@@dedetudor. I'll look it up. Thank you

[@sm-ed3kw]

@@dedetudor. Russel brand is clearly controlled opposition, check out Hugo talks video on him, he's heavily censored on theytube so go to his website

[@dedetudor.]

@@sm-ed3kw anyone can say that but they're wrong. I know Russell's history. He openly has spoken about it. He puts out the information and demands everyone be allowed to think for themselves. Make their own decisions. Make their own choices. Not to be coerced.

[@jeffk8900]

Implementation of the rule of thirds would really set up the visual on this.

[@DamienKee]

Video quality and production are top notch, but agree with layout criticism. 2 thirds slides, move Vinay to the right third (which moves the microphone out). (The academic content is as insightful and thought provoking as we've come to expect.)

[@cibarmartin]

Just bought your book, thanks VP!

[@casselfriemel]

Thank you for these videos Vinay. I am an Oncologist in Iowa, own my own business, and treat all cancers so when I attend ASCO virtually, I am just trying to gulp down the massive amount of info coming from the fire hose, and having a devil's advocate I can stream to put things into context is sublime.

[@mikelambert7256]

hack yeah!!! ONC IS BACK!!!

[@ninjagirl226]

Ok this is outside my field substantially, and I don't understand anything so I will just ask my question. How reliably can be detect these ctDNA sequences? What are the copies/uL in the sample matrix of the target sequences? From my experience trying to detect them in plasma it's not really easy and we were targeting high abundance mutations.

[@jose6183]

How strange there is audio from my country. Maybe you guys are being selectively censored depending on the location

[@sm-ed3kw]

Audio is fine in the UK

[@JCResDoc94]

another gr8 entry. thr is no reason for it o be like this. it isnt even cheaper. at a minimum we have to keep pointing it out. ppl dont want to be bad at thr job, especially if the money and accolades will be the same. this is important. -JC

[@jeffk8900]

Maybe put slides in the full video and reduce your video.

[@indianasb59]

LOL !!! At least a commercial played on the ‘tap to retry’ Hahahaha

[@danielnavarodrigues9175]

Thanks for this awesome video, Vinay.

[@slomo1716]

YOU sure look handsome with a cleanly shaven face and great hair and a NASA T-SHIRT!!!!

[@Soundsaboutright42]

Audio is back

[@Neillionaire]

I have no audio issues either playing straight from my phone or with wireless headphones (and I get audio on both the right and left channels), so I'm unsure why others are having issues.

[@oldschool8292]

No sound problem for me

[@jeffk8900]

Can’t see the tables and figures that you are putting up.

[@JCResDoc94]

*i have that shirt!* i think a lot of ppl do. -JC

[@cathyburkart9395]

No sound!

[@qianshi5489]

Totally agree the NI margin is very big

[@nasagolfer]

Love the NASA meat ball shirt!!!

[@mballer]

Hmm.

[@mattp1913]

Would one say this about other blood tests, such as grail?

[@indianasb59]

Did you get immediately blocked?!?

[@dedetudor.]

If you go seeking after the causes of the cancers, it is quite a 🐰🕳. Then we really wouldn't have to be talking about toxic treatments.

[@mballer]

Looks to me to be similar to what happened with stomach ulcers. Treatment was cut them out. Quite profitable. No financial reason to find the cause. Then some guy figured out it was a bacteria but cutting out ulcers continued on. Bacteria are creating chemicals all day long. There are trillions of bacteria that are not being mentioned here.

[@Think-dont-believe]

Instead of 🐰🕳️just paste it with 🐴🍎 .. no joke look it up 🍎🐴 does what you both said. Fixes the source of tummy and fast. No joke just 😢that’s why they not want peep to use on large scale cause all kinds go bye bye fast

[@mballer]

Is it better to avoid colon cancer? Consider.

[@JohnDoe-cb5nb]

Didnt quite understand the criticism. Seemed quite tangential to the crux of the study that ctdna guided approach especially the ctDNA negative patients can be safely omitted chemo without compromising the outcomes . Yes there are caveats , all of which are listed in the accompanying editorial.

[@joelpollen]

I agree that this talk lacked the clarity of message that Vinay usually brings, but I think his core argument was this: If we are already not very good at predicting who will have recurrence, and even in high-risk people the treatment doesn't reduce their risk that much, then proving that your test is no more than 8.5% worse than what we were doing is too low a bar. He points out that the current guidelines for adjuvant chemotherapy are based on low-quality, old data. Plausibly, you could achieve the same outcome as this study (giving chemotherapy to fewer people without reducing DFS rates) by just doing a fresh study of recurrence risk factors and identifying risk factors that were previously thought important but aren't. Or, more provocatively, you could achieve the same results by marketing a new "test" that's really just whatever we're doing now, plus a random number generator (i.e. a coinflip) which excludes some people from the chemo group. The difference is that the latter two would be far cheaper (free, actually) than ctDNA testing. ... Even if you don't agree with this specific critique, I think it's quite clear that there is a worrying trend in medicine of finding an area where there isn't good evidence, then showing non-inferiority (or very marginal benefit) of some wildly expensive alternative against standard of care. Absent a cost-benefit comparsion to all reasonable alternatives, being non-inferior to SOC isn't sufficient to justify using a new (likely patented) product. If your Honda Civic is starting to fail, you could replace it with a Lamborghini, or you could just get a new Honda Civic. And that's quite obviously a better decision. The difference in health care is that people aren't spending their own money.

[@JohnDoe-cb5nb]

@@joelpollen i get it now. Thanks for explaining it. But still see a lot of merit in this trial with a few caveats like do dMMR or T4 needs ctDNA. But be as it may I think ctDNA and MRD assessments are here to stay and as we get more data there utility will further get clarified. I mean we wildly expensive genomics tests like OncotypeDX that are now part of SoC so such technologies will continue to get incorporated.

[@maxwellkrem2779]

Simply put, the vast majority of stage 2 colon cancers should not get chemo. Why do we need an expensive new test to maintain that status quo?

[@teresabenson3385]

Hi, I wanted to share this with my colleagues and trainees, but KZbin has it designated as "Restricted"-- and since our corporation has all our laptops locked in KZbin Restricted Mode, we are unable to view it. Any chance one of your assistants can bleep out the bad language at the end and try to get it un-Restricted? (I'm guessing it's because of the F-word; the SHINE trial video had "s**t" in there and was not restricted.) Thank you in advance!

[@benjclarke5825]

I got exactly 2:13 into this video when I realized I was unqualified to listen further.