Immunotherapy, Precision Medicine are Coming on Strong in Oncology

MHE Publication, MHE January 2022, Volume 32, Issue 1

But the future of value-based care in oncology is uncertain with no certain successor to the Oncology Care Model in sight.

The American Cancer Society estimated that by the end of 2021,
1.9 million new cancer cases will have been diagnosed and 608,570 cancer deaths will have occurred in the United States.

With many people worried about going to a doctor because of COVID-19, there is concern that a lack of cancer screenings may cause these numbers to rise in the years ahead. Paul Limburg, M.D., chief medical officer for screening at Exact Sciences and a professor of medicine at Mayo Clinic College of Medicine and Science in Rochester, Minnesota, expects that a big focus this year will be identifying innovative ways to encourage screening and understanding which options will suit people’s needs.

Oncologists and cancer experts are also looking forward to treatment advances this year. Michael Zinner, M.D., chief executive officer and executive medical director of Miami Cancer Institute, part of Baptist Health South Florida, expects that the biggest development this year will be the further maturation of immunotherapy as the fourth type of treatment alongside surgery, radiation and traditional chemotherapy. Roy S. Herbst, M.D., Ph.D., agrees and is hoping for a wider application of immunotherapy.

“Currently immunotherapy works really well in some cancers, but less so in others,” says Herbst, who is chief of medical oncology at Yale Cancer Center in New Haven and Smilow Cancer Hospital in North Haven, Connecticut. “I see this year bringing the opportunity to broaden the use of immunotherapy across all cancers by understanding what makes a tumor resistant and how we can combine different drugs based on what is happening in the tumor.”

Zinner also mentions a bright horizon for precision medicine — agents designed to attack tumor cells with specific mutation: “Both the academic world, in terms of drug development, and the pharmaceutical industry have focused on these as important areas for research and development — and they are also profitable for the pharmaceutical industry.”

Part and parcel of precision medicine is testing for the mutations that the medications home in on.

“Timely access and reporting of molecular testing will be further streamlined to reduce the time from testing to medical decision-making and incorporating the appropriate therapeutic agent in the treatment plan,” predicts Ajeet Gajra, M.D., M.B.B.S., FACP, chief medical officer at Cardinal Health Specialty Solutions. “This applies to solid tumors including lung, breast and colon cancers as well as hematologic malignancies including AML (acute myeloid leukemia), MDS (myelodysplastic syndromes) and multiple myeloma.”

Gajra believes a new generation of precision medicines will become available for clinical use soon, including agents that enhance the efficacy of immunotherapy agents.

Cost and delivery

One downside to the advances in oncology has been the rising cost of treatment and especially the drugs. “I worry that the cost of these treatments will continue to go up over the next year,” says Zinner, who is hopeful that telehealth and remote patient monitoring will yield some cost savings to offset the rise.

Herbst foresees more government-provided insurance, hospitals partnering with insurance companies and hospital-at-home programs. These are designed to provide hospital-level care but in a home setting — which is especially important as demand increases.

Oncology and value-based care, which is supposed to gear payment toward outcomes and not just volume, have had a rather uneasy relationship. Value-based care seems to be at a crossroads right now, observes Bruce Feinberg, D.O., vice president and chief medical officer at Cardinal Health Specialty Solutions. For more than a year, oncology groups have been expecting CMS to roll out Oncology Care First, the successor to the agency’s main oncology-focused value-based care arrangement, the Oncology Care Model. But the start of Oncology Care First was delayed because of COVID-19, and now it appears to be shelved, with a gap looming between the end of the Oncology Care Model in June 2022 and whatever may come next.

“While our research shows more than one-third of oncologists struggle to perform favorably in current government VBC (value-based care) models, there is a risk that a gap in the programs could reduce their engagement and focus on activities that could lower the cost of care,” Feinberg says.

According to Feinberg the foggy future of value-based care in oncology may affect the uptake of biosimilars because oncologists who have participated in value-based models have been among the leaders in the adoption of biosimilars.

In the pipeline

Over the past decade, there has been a large increase in the number of cancer drugs or cancer therapies approved by the FDA. As Managed Healthcare Executive® went to press, in 2021, 16 of the 46 drugs that FDA classified as novel drug approvals were for the treatment of cancer or related conditions.

Zinner, for one, is optimistic that this trend will continue into the future and that more new therapies and new possibilities will continue making headway in the years to come. “There are a lot of drugs in the pipeline that I’m familiar with, and they’re waiting for maturity of the clinical trials to look at their effectiveness or lack thereof.”

Many cancer experts are excited by the promise of liquid biopsy blood tests to screen for multiple cancers. A staggering 70% of incident cancers currently have no routine tests to detect disease early, and a multi-cancer blood test could help close this gap.

“Early detection of some of the deadliest cancers at earlier stages, when the disease can be more effectively treated, is our top priority, and we are energized by its potential to change cancer diagnosis and treatment,” Limburg says. “We expect to generate clinical validation data for our tumor-informed liquid biopsy test in the next 24 months.”

Keith Loria is a freelance writer in the Washington, D.C., area.