Oncologists share aspirations and hesitations for precision medicine in new research
CONTRIBUTOR
Will Seaton
Essential Insights contributor, healthcare writer
Featured experts
Vice President, Chief Medical Officer
Cardinal Health Specialty Solutions
Chadi Nabhan, MD, MBA, FACP
Healthcare industry executive
Joe DePinto
Healthcare industry executive
With its potential to advance cancer care and improve patient outcomes, "precision medicine" is the buzzword of the oncology community and served as the theme for the 2018 American Society of Clinical Oncology conference.
In the past year alone, the industry has seen U.S. Food and Drug Administration (FDA) approval for numerous precision medicines, including two CAR-T cell therapies for blood cancers, a PD-1 inhibitor for microsatellite instability (known as MSI) high tumors, as well as targeted therapies for acute myeloid leukemia and cancers of the bladder, ovary, breast and lung.
However, as more precision medicine therapies come to market, specialty care providers, biopharma companies and other healthcare stakeholders have a heightened need to understand these important advancements, as well as address challenges that may present barriers to their effective use.
In response to these needs, Cardinal Health Specialty Solutions released its third in-depth survey report, Oncology Insights, which details views on precision medicine from more than 160 U.S. oncologists nationwide. The report also assesses the availability of genomic testing and the current role it plays in the diagnosis and treatment of cancer.
Here are key insights from the report, which reveal both aspirations and hesitations from oncologists, regarding the growth of precision medicine.
1. Oncologists have high hopes for precision medicine, though concerns with cost remain
For nearly four in 10 oncologists, precision medicine is a potentially "game changing" approach that will likely cure certain chronic and life-threatening diseases.
Defined as "a form of medicine that uses information about a person's genes, proteins and environment to prevent, diagnose and treat disease," by the National Institutes of Health, precision medicine offers specialty providers an unprecedented new means by which to treat chronic and rare disease.
Oncologists see opportunities, challenges as precision medicine emerges
"The history and early clinical outcomes data suggest that precision medicine is more than the buzzword of the moment – it is the start of a new era in oncology care," said Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions.
Not only do 57 percent of oncologists see precision medicine as an important advancement in cancer treatment, but more than one third predict it will have a significant impact on oncology care within the next two to three years. While just 10 percent of malignancies are currently treated using precision medicine techniques, such as targeted or gene therapies, that number is sure to rise dramatically over the short term.
Despite this optimism, however, oncologists foresee challenges with precision medicine, in particular about its cost. "Cost is gradually eclipsing efficacy and toxicity in the value determination equation. As our research shows, whether it is the actual cost of a therapeutic, the patient responsibility, or the margins and fees for the administering provider, cost seems to be the elephant in the room for nearly 60 percent of providers," said Dr. Feinberg.
Such costs, along with the costs of accompanying genomic tests, will need to be carefully managed, in order for precision medicine to emerge as an effective and financially viable treatment option.
Meanwhile, oncologists also see the lack of available decision support tools as a barrier to adoption – especially as the complexities of patient selection and clinical decision-making only continue to grow.
However, the cost to patients remains the largest hurdle: 76 percent of oncologists feel that the most needed resource is greater financial aid and reimbursement support for patients undergoing precision therapies.
2. With the rapid growth of genomic testing, oncologists are seeking further guidance
With its ability to enable more personalized care, genomic testing is becoming an indispensable tool in oncology care. According to the report's findings, 97 percent of oncologists report it being either somewhat or very important in the diagnosis and treatment of cancer.
Genomic tests can help to identify single genes associated with inherited genetic disorders, indicate a heightened risk for disease, identify genetic variations that may influence a patient's response to oncology treatment, or single out genetic mutations that may be fully or partially responsible for certain hereditary cancers – all of which have significant implications for precision medicine.
"With more precision oncology drugs available, oncologists have grown more dependent on genomic tests to diagnose and treat various malignancies," said Dr. Chadi Nabhan, vice president and chief medical officer of Cardinal Health Specialty Solutions.
In fact, nearly two thirds of oncologists reported routinely using genomic tests to help determine an appropriate or ideal therapy, while nearly one quarter anticipate beginning to use genomic testing over the next year. "As more precision medicines come to market, hospitals and healthcare systems will need to be cognizant of the need to have these tests available with favorable turnaround times that allow for timely administration of therapies," Nabhan added.
Unfortunately, these tests and their results are not always readily available. Fifty-eight percent of oncologists stated that genomic testing is not available at their local institutions, while 36 percent of physicians routinely wait 15 days or longer for results, regardless of whether testing is performed locally or via a third-party vendor. "These delays could have therapeutic implications and create barriers that need to be looked at carefully," said Dr. Nabhan.
Meanwhile, there are also concerns about test selection and interpretation. There are currently thousands of genomic tests on the market, yet oncologists have relatively little guidance as for which tests to select, in which circumstances, and few resources for interpreting the output of testing, including which criteria will be used to select precision medicine treatments.
Currently, 59 percent of physicians report challenges in understanding testing results in a clinical context. This represents a significant opportunity for both manufacturers and academic institutions to provide better, and more, educational resources for prescribing physicians.
Looking ahead
With the potential for precision oncology drugs to dramatically improve cancer care, excitement about, and adoption of, their use will likely continue to grow in the present future. However, there are a number of variables that will affect their eventual commercial success.
"While many precision medicines have exciting potential, clinical data alone won't be enough to determine commercial success," said Joe DePinto, president of Cardinal Health Specialty Solutions.
In order to leverage precision medicine successfully, manufacturers, payers, specialty providers and other healthcare stakeholders will have to work diligently and collaboratively to remove current barriers.
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