This struggle has occurred in three public discussions (including JPM and on TV) that I have heard since ASH. It happened today.
The distinction is subtle (but important), as "secondary malignancy" (SM) can imply the likely existence of a cause-effect relationship, as in "the patient experienced a malignancy secondary to (caused by) his radiotherapy." Thus, "secondary malignancy" is used by some broadly to describe malignancies that occur after a primary malignancy, caused usually by some effect of the primary malignancy's treatment . It is unarguably ambiguous (it can also be used without implying primary malignancy's treatment as the cause), but its use in some instances suggests cause. One online definition: secondary malignancy
Oncology A cancer that arises in the background of another malignancy treated by RT or chemotherapy; SM is also defined as one caused by environmental toxins, physical agents, radiation Examples ANLL–eg, AML, acute promyelocytic leukemia, acute monocytic leukemia, erythroleukemia and myelodysplastic disorders–preleukemia Leukemogenic chemotherapeutics Chlorambucil, melphalan and, combined, doxorubicin, cisplatin Physical agents causing SM–Radiation–solar, X-rays to head & neck causes 2º BCCs;
In contrast, "second, primary malignancy" (SPM) means an additional malignancy likely not caused by a primary malignancy or its treatment. (Someone please correct me if I am wrong.)
In medicine, doctors unfortunately sometimes use terms imprecisely. It happens especially when the precise term is cumbersome and a frequently used, more convenient term is close in meaning. I suspect that happened at ASH, such that the term "secondary malignancy" may have been used in presenting and discussing the data even though there was no evidence of a cause-effect relationship (i.e., it was known that occurrence rates in the treatment arms were within (actually lower than, in some cases) the known occurrence rates for the underlying disease, and even though it was observed that followup of control patients had ceased once they had progressed in their primary cancer, eliminating the observation of those patients for any appearance of any additional primary cancer, while observation of treatment patients (for anything, including second primary cancer) continued, skewing statistical comparison of that outcome measure. I would not be surprised if CELG IR contributed to the confusion by using the term "secondary malignancy," as well, though such would be understandable if the doctors who had presented/discussed the data had done so. I did so, myself, after hearing about it.
In any case, most analysts have picked up and carried forward that ambiguous term. In their questions, they routinely use it. Their reports do, as well. Today, although Bob had initially used the term "second, primary malignancy" in the presentation, we repeatedly heard "secondary malignancy" in questions, and the repeated use of the term in questions went unchallenged. Also, we continue to read about "secondary malignancy" risk and in some instances the translation of "concerns that prolonged Revlimid use may cause cancer" in analyst reports and media stories. To my understanding, the data did not demonstrate any such causal effect in the minds of KOLs, and there is so far no reason to believe that it will.
When answering questions in a public forum, it is critically important to clear up any misleading information that is contained in the question. Doing so is at least as important as answering the substance of the question. This is because any facts or implications in a question that go unchallenged in the answer are often inferred by listeners to be true. The speaker's politely correcting any misleading parts of questions thus is imperative. Once the speaker has done it a few times, most people will start using the correct term in their questions. Doing this at first seems awkward, and it requires patience; but, the technique works.
Hopefully Bob (and IR) will be a little more persistent in correcting analysts who use the term "secondary malignancy" instead of acquiescing to their use of the term. Before answering any question in which the term "secondary malignancy" is used, they should, every time, start by repeating that the malignancies found in the data are believed to have been second, primary malignancies, not malignacies that were secondary to treatment, since they occurred at rates at or less than published rates for untreated patients, and in the studies control arm patients weren't followed after progression, skewing results; hence the term "second, primary malignancy" is more accurate. After making the clarification, they can proceed to answer the question. Or, If they want to stop with just the clarification, that is acceptable (and that encourages others to use the correct terminology if they want their question answered).
SPM, yes. SM, no.
It's unlikely that this genie will be put back in the bottle entirely until we have additional data where control patients are followed even after they progress; but for now, whatever they can do they should. Perception, and that includes misperception, is reality.