Is Precision Medicine Worth the Hype? Oncologists Weigh In

Nabhan

While slightly less than half of oncologists view precision medicine as a potential game-changer, most say it’s too soon to predict its long-term impact, according to new research.

This new research from Cardinal Health Specialty Solutions provides important insights on how oncologists view precision medicine, a treatment approach that targets the molecular underpinnings of the disease. The research was fielded at three live summit events hosted by Cardinal Health Specialty Solutions in February, March, and April 2018, using audience response system technology. More than 160 oncologists from a mix of community and hospital-based practices participated in the research.

The research found that while nearly four in 10 oncologists view precision medicine as ground-breaking, 57% said it’s too soon to predict its long-term impact, according to the report. Oncologists see several barriers to adoption including cost of the drugs (51%); cost of genomic testing (25%); and lack of decision support tools (14%). Three out of four oncologists said more financial aid and reimbursement support is needed for patients to address cost concerns.

“Given the implications for quality and cost of care, healthcare executives have an important stake in the evolution of precision medicine,” says Chadi Nabhan, MD, MBA, FACP, chief medical officer, Cardinal Health Specialty Solutions. “This research will help them understand the perspectives from the frontlines of care, so they can anticipate how adoption of more targeted drugs may impact oncology care.”

The research findings may be particularly relevant given the recent advances in targeted therapies, including FDA approval of two CAR-T therapies for blood cancers as well as a PD-1 inhibitor for MSI-high tumors (MSI-high or MMR-deficient tumors are most commonly found in endometrial cancer, colorectal cancer, and other gastrointestinal cancers) regardless of origin. Targeted medicines for acute myeloid leukemia, bladder, ovarian, breast and lung cancers are also now available, and in some cases have delivered better outcomes than traditional chemotherapies.

Of particular importance, the research highlights issues around availability and timeliness of genomic testing. About two-thirds of participating oncologists said they use genomic testing to identify the best treatment options for cancer patients, while another 23% reported that they are likely to begin using it in the year ahead. Yet 58% said that testing is not available at their local institution, and 36% said they wait 15 days or longer for results, which can cause critical delays in patient care.

Other unique findings

• The term “precision medicine” means different things to different oncologists, though most agree it includes molecular-targeted based therapies. The diversity of responses shows the industry has not reached a clear consensus on what types of therapies comprise precision medicine.
• Challenges in interpreting results was cited as the most common reason for not using comprehensive genomic testing. About six in 10 participants said results are not easily interpreted for making clinical decisions.
• Practices regarding pre-authorizations for genomic testing vary widely among payers. More than half of participants said prior authorizations are required for the majority of genomic tests.

“One of the most important things hospitals can do is participate in clinical trials to investigate the efficacy of precision medicines,” Nabhan says. “This will allow their patients to access novel study drugs, while providing hospital-based providers with firsthand experience managing side effects and determining efficacy.”

In addition, the research highlights the vital role health systems can play in improving the processes around genomic testing and interpretation. Recommendations include:

• Improve access. Given the concerns about availability and timeliness of these tests, more hospitals should provide testing locally rather outsourcing it, according to Nabhan. “Turnaround times are critical, yet most health systems batch the tests once a week, leading to delays. Critical examination of processes around logistics of these tests is recommended,” he says.
• Provide comprehensive training for physicians. “Training should focus on the recent trends in genomic testing, its indications, where the tests fit in guidelines, and interpreting the results.” Nabhan says “These are all essential components of optimizing the testing process to benefit the patient.”
• Engage payers. Many payers still deny properly ordered tests or require a pre-authorization process that is long and cumbersome, according to Nabhan. “Hospital systems can engage payers effectively using evidence generated from clinical trials.”