TASK DEFINITION: Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.
PROBLEM: Paragraph: This release makes no mention of the costs of the drugs compared in this study, even though the drugs have been in use for years and are widely available. Since the study is a comparison of various treatments for this form of cancer, it seems relevant to offer a cost comparison as well as a comparison of efficacy. It appears that the high dose methotrexate is given over a 24-hour period, presumably in the hospital, while the standard methotrexate is given as a single dose. Also, the high dose methotrexate isfollowed by leucovorin administration while the standard dose is not. According to the site GoodRx, the cost for methotrexate in low-dose (2.5 mg) pill form averages out to about $50 for a month's supply. Newer, injectable variations of the drug cost upwards of $500 a month for the 25 mg dose. The release states that patients receiving high doses of the drug methotrexate "had a significantly better outcome, by 5 to 6 percent" than did patients receiving the current standard of care, which is gradually escalating doses of the drug. The release also explains that patients nine years old or younger who were also treated with a steroid called decadron (dexamethasone) forhalf as long as normal (14 versus 28 days) benefited from the treatment while patients 10 and older did not. We're not sure of the meaning behind these results as portrayed in the release. Which outcome was better by 5 or 6 percent? The study has several. Does that mean the relapse rate was reduced or is it the event free survival that was better? It would be more meaningful to readers if the release had included the actual relapse and event free survival rates for each group analyzed in terms most people can understand. For example: "relapse rates were 5 percent lower in Group X compared to Group Y." We'll give this category a satisfactory rating largely due to the release including information that patients 10 and older receiving dexamethasone "were at much higher risk for a debilitating bone condition called osteonecrosis," although we would have been happier if that greater risk would have been quantified. However, the published study explains that there were toxicity problems beyond that of dexamethasone and the release would have been stronger including that information as well. The release stated the study was randomized and controlled, and provides a broad overview of the study design, for which we give the release a borderline satisfactory under this criteria. However, these are thesuperficial results. On deeper delving into the study methodology, the statistical significances of the results were very close to notstatistically significant. This is due to their planned interim stopping of the treatment and the fact that they were looking at multiple outcomes in multiple groups. This release doesn't demonstrate disease-mongering. While the release does say that this clinical trial was run by the Children's Oncology Group, which is funded by the National Cancer Institute and the National Institutes of Health, it makes no mention of possible conflicts of interest. Compounding that is the fact that the published study says, "Disclosures provided by the authors are available with this article at www.jco.org," but that information is behind the journal's paywall for most readers, so it's unknown if there is, or is not, a conflict. It appears as though five of the authors (out of a total of about 20) have some conflicts of interest, mostly from several types of drug company payments. The release is comparing the efficacy of treatment regimens using different drugs so alternative treatmentsfor B-acute lymphoblastic leukemia are noted. The release makes clear at the end that the treatment of this disease is improving thanks to refinement of the use of existing drug treatments, meaning that they are readily available for patient use. The release suggests the study findings could change the way childhood leukemia is treated. Modifying existing treatments to enhance a patient's survival is certainly novel enough to warrant a release. There is no use of unjustifiable language in this release. However, the tone may be a bit overly optimistic given the study findings. Claim: Relapses of childhood leukemia improve with high doses of common chemo drug

SOLUTION: This release reports the findings of a large clinical trial testing whether alternative dosing regimens of standard chemotherapeutic drugs can improve the treatment of B-acute lymphoblastic leukemia. The study showed that using high doses of the drug methotrexate, rather than the standard regimen of gradually increasing doses, improved the outcomes for patients with the disease. The study also showed that using the steroid dexamethasone increased a debilitating bone condition in patients 10 and older but not in patients nine or younger. While the study results are promising, they are by no means clear-cut in the release. The release needed some qualifiers in order to give a clear picture of the benefits. The release also neglected to discuss costs and potential conflicts of interest among the investigators. This form of cancer B-acute lymphoblastic leukemia is the most common cancer in children and a major cause of cancer death in patients under 40 years old. And while the majority of patients survive with appropriate treatment, anywhere from one-fifth to one-quarter of patients do not. This study showed that refining the dosing of standard cancer drugs may improve the outcome for some high-risk patients.

PROBLEM: Paragraph: Cancer patients increasingly are having their care guided by gene tumor boards, a new version of the hospital panels that traditionally decided whether surgery, radiation or chemotherapy would be best. These experts study the patient's cancer genes and match treatments to mutations that seem to drive the disease. "We dissect the patient's tumor with what I call the molecular microscope," said Dr. Razelle Kurzrock, who started a board at the University of California, San Diego, where Cairnes is treated. It's the kind of care many experts say we should aim for precision medicine, the right drug for the right person at the right time, guided by genes. There are success stories, but also some failures and many questions: Will gene-guided care improve survival? Does it save money or cost more? What kind of gene testing is best, and who should get it? "I think every patient needs it," especially if cancer is advanced, said Kurzrock, who consults for some gene-medicine companies. "Most people don't agree with me yet. In five years, it may be malpractice not to do genomics." Few people get precision medicine today, said Dr. Eric Topol, head of the Scripps Translational Science Institute. "The only thing that's gone mainstream are the words." HOW IT WORKS NOW If you have a cancer that might be susceptible to a gene-targeting drug, you may be tested for mutations in that gene, such as HER2 for breast cancer. Some breast or prostate cancer patients also might get a multi-gene test to gauge how aggressive treatment should be. Then most patients get usual guideline-based treatments. If there's no clear choice, or if the disease has spread or comes back, doctors may suggest tumor profiling comprehensive tests to see what mutations dominate. That's traditionally been done from a tissue sample, but newer tests that detect tumor DNA in blood liquid biopsies are making profiling more common. The tests cost about $6,000 and many insurers consider them experimental and won't pay. Gene tumor boards analyze what the results suggest about treatment. They focus on oddball cases like a breast cancer mutation in a colon cancer patient, or cancers that have widely spread and are genetically complex. The only options may be experimental drugs or "off-label" treatments medicines approved for different situations. But as tumor profiling grows, it's revealing how genetically diverse many tumors are, and that oddball cases are not so rare, said Dr. John Marshall. He heads the virtual tumor board at Georgetown Lombardi Comprehensive Cancer Center that also serves cancer centers in Pennsylvania, North Carolina, Michigan and Tennessee. "There is a little bit of faith" that testing will show the right treatment, but it's not a sure thing, said Dr. Lee Schwartzberg, who heads one participating center, the West Cancer Center in Memphis. Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, is optimistic yet wary. Drugs that target BRAF mutations work well for skin cancers called melanomas, but less well for lung or colon cancers. "Just because a mutation occurs it doesn't mean that drug is going to work in that cancer," he said. LUCKY CASES When it does, results can be dramatic. Cairnes' cancer was between her stomach and esophagus, and had spread to her liver, lungs and lymph nodes. Tissue testing found 10 abnormal genes, but on the liquid biopsy only EGFR popped out as a good target. Two drugs aim at that gene but aren't approved for her type of cancer. A tumor board advised trying both Erbitux and Tarceva, the drug her husband also had taken. Within two weeks, she quit using pain medicines. After two months, her liver tumor had shrunk roughly by half. There are signs that cancer may remain, but it is under control. She feels well enough to travel and to take care of her granddaughter. "I'm very, very grateful to have a targeted therapy," Cairnes said. "I cannot expect a better outcome than what we're seeing right now," said her doctor, Shumei Kato. WHAT STUDIES SHOW But is gene-guided treatment better than usual care? French doctors did the first big test, with disappointing results. About 200 patients with advanced cancer were given whatever their doctors thought best or off-label drugs based on tumor profiling. Survival was similar about two months. Another French study, reported in June, was slightly more encouraging on survival but exposed another problem: No drugs exist for many gene flaws. Tests found treatable mutations in half of the 2,000 participants and only 143 got what a tumor board suggested. Some doctors worry that tumor boards' recommending off-label treatments diverts patients from research that would benefit all cancer patients. For example, the American Society of Clinical Oncology's TAPUR study tests off-label drugs and shares results with their makers and federal regulators. LETTING PATIENTS CHOOSE Ann Meffert, who lives on a dairy farm in Waunakee, Wisconsin, endured multiple standard treatments that didn't defeat her bile duct cancer. "She was going to be referred to hospice; there was not much we could do," said Dr. Nataliya Uboha, who took the case to a tumor board at the University of Wisconsin-Madison. The panel gave several options, including off-label treatment, and Meffert chose a study that matches patients to gene-targeting therapies and started on an experimental one last October. "Two weeks in, I started feeling better," she said, and when she saw test results, "I couldn't believe the difference." Many lung spots disappeared and the liver tumor shrank 75 percent. She is not cured, though, and doctors are thinking about next steps. And that could involve a fresh look at her tumor genes. ___ Marilynn Marchione can be followed at @MMarchioneAP __ This Associated Press series was produced in partnership with the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content. Claim: Ultra-personal therapy: Gene tumor boards guide cancer care.

SOLUTION: Doctors were just guessing a decade ago when they gave Alison Cairnes' husband a new drug they hoped would shrink his lung tumors. Now she takes it, but the choice was no guesswork. Sophisticated gene tests suggested it would fight her gastric cancer, and they were right.

PROBLEM: Paragraph: Authorities are hoping large-scale manufacturers can use their low-cost supply chains and digital design expertise, including 3D printing, and repurpose some factories in order to make up the expected shortfall in vital medical hardware. Some of Britain's biggest aerospace and car companies have formed three teams to produce basic ventilators to help the country's National Health Service cope with the coronavirus outbreak. Meggitt Plc, which builds components including oxygen systems for civil aerospace and military fighter programs, is leading one consortium alongside engineers GKN, Thales SA and Renishaw Plc. The other two teams are being led by carmakers McLaren, which is looking at how to design a simple version of a ventilator, and Nissan Motor Co, which is working with others to support existing ventilator producers. Ventilators, machines which move air in and out of the lungs, could be the difference between life and death for coronavirus patients suffering breathing difficulties. But getting new production up to speed will not be easy, some in the manufacturing industry said. "Precision milling and 3D printing techniques could help manufacture complex parts," said Rene-Christopher Wollmann, program and platform director at Automobili Pininfarina, which uses virtual design software to build electric hypercars. "But this depends on how much know-how existing manufacturers (of ventilators) are prepared to share about the design of such a machine," he added. "Another bottleneck will be assembling such machines under conditions which are adequate for the medical industry." The idea of using automakers to supply medical equipment got started in China, where electric car maker BYD earlier this month began turning out 5 million face masks and 300,000 bottles of hand sanitizer a day. The Shenzhen-based automaker is backed by U.S. investor Warren Buffett. Since then the idea has spread to other industries and countries. European aerospace group Airbus is working across its processes to see if its 3D printing or production facilities can be of use. "The aim is for there to be a (ventilator) prototype in two weeks and for manufacturing to start in four weeks," one person familiar with the situation at the company said. In northern Italy, the epicenter of the virus outbreak outside China, Italian carmakers Ferrari and Fiat Chrysler Automobiles NV are in talks with the nation's biggest ventilator manufacturer to help it boost production, company officials said on Thursday. The Italian government has embarked on a big expansion of intensive care beds, many of which will require ventilators. A source familiar with the matter said sports car maker Ferrari NV would be ready to start manufacturing ventilator parts in its famous Maranello headquarters, close to a ventilator factory operated by small medical equipment maker Siare Engineering. The luxury carmaker had yet to make a final decision. "We're talking to Fiat Chrysler, with Ferrari and (component maker) Marelli to try to understand if they can lend us a hand in this process for the electronics part," Siare Engineering Chief Executive Gianluca Preziosa told Reuters. Siare could also benefit from the automakers' purchasing power, Preziosa said. A spokesman for Exor NV, parent firm of both Fiat Chrysler and Ferrari, said meetings had taken place on Thursday with Siare to study the feasibility of the idea and that a decision was expected shortly. The spokesman said two main options were being considered: help Siare to engineer a capacity increase at its plant with the support of technicians provided by Fiat Chrysler and Ferrari; or outsource production of ventilator parts to the carmakers' facilities. In the United States, the federal government is in talks with Detroit auto giants General Motors Co and Ford Motor Co about how they can help expand ventilator production, the companies and White House officials said on Wednesday. It would not be the first time Detroit retooled auto plants to confront a national crisis. During World War Two Ford, GM and the former Chrysler stopped building cars and directed their factories and engineers to mass-produce airplanes, tanks and other weaponry at unprecedented levels, earning Detroit the nickname the "Arsenal of Democracy." On Wednesday, U.S. President Donald Trump said he would invoke the Defense Production Act, a law dating back to the Korean War of the 1950s which grants the president broad authority to "expedite and expand the supply of resources from the U.S. industrial base," which could allow the government to speed production of masks, respirators, ventilators and other needed equipment. Ford CEO Jim Hackett told employees in a town hall meeting that Ford is working on building ventilators if the idea is feasible. GM CEO Mary Barra spoke to White House economic adviser Larry Kudlow about the issue after the company announced it would suspend North American production through March 30. Separately, Tesla CEO Elon Musk used his Twitter account to offer his company's services. "We will make ventilators if there is a shortage," Musk tweeted, responding to a suggestion that the billionaire repurpose a factory for the task. The comment immediately drew hundreds of replies urging him to act. Claim: World's governments draft manufacturers for virus treatment arsenal.

SOLUTION:
From Washington to London, Beijing to Rome, governments are drafting automakers and aerospace manufacturers to ramp up production of ventilators and other medical equipment to bolster what most experts say is an inadequate arsenal of coronavirus treatment tools.