Health and Human Services Secretary Alex Azar has pledged to focus on finding ways to improve health care quality and reduce costs.
To that end, he recently called on the medical community to come forward with case studies and evidence of new programs that achieve these goals. “Now is not the time to be timid,” said Azar at a hospital executives conference.
I believe our field has great potential to meet this challenge, since we are on the cusp of enormous progress in cancer care following recent advancements in precision medicine treatments.
The goal of the process of precision cancer medicine is to be more “precise” in the selection of therapeutic strategies for individual patients. Through genomic tumor profiling it may be possible to discover specific molecular abnormalities that may permit both more effective and less toxic management for that individual. While it remains fair to state this paradigm-changing approach to cancer management remains in its early stages, evidence of the value of this basic approach is rapidly accumulating.
Today, we can examine the genomic make-up of a specific tumor, analyze that information through an enormous database of patients with similar tumor profiles, and potentially identify treatments that are more likely to be most effective in favorably influencing the course of that patient’s cancer.
But there remain significant obstacles that must be addressed for precision cancer treatment to become everyday practice.
Inspired by the Secretary’s challenge, I urge colleagues to come together to build a more robust infrastructure for precision cancer treatment to help speed the adoption of new treatments based on genomic testing. I believe, as a profession, we must:
• Break through data siloes and further accelerate the sharing of real-world evidence that is most effective in helping patients defeat their cancer by tumor type (as well as eliminate treatments that will not work);
• Drive greater, and faster, information sharing across the provider community about what works and what does not;
• Collect and analyze more information about on-label and off- label treatments that are most effective for patients based on genomic testing; and
• Drive new policies on how genomic testing and precision therapies will be paid for; insurers currently focus on treatments that are most beneficial to the ‘average’ patient – but with precision cancer treatment there is no ‘average’ patient.
We’ve seen progress, in the FDA’s stance to establish a regulatory framework for laboratory developed tests, with federal Precision Medicine and Moonshot initiatives, and through the implementation of the 21st Century Cures Act. Each of these is a good start, but there is much more to be done, including ongoing collaboration among industry, academia and patient advocacy groups to advance these efforts.
These are complex issues, and reaching consensus and alignment will therefore be difficult. But we owe the 1.75 million Americans who will be diagnosed with cancer this year our commitment to do everything we can to fully realize the promise of precision cancer treatment. Each patient deserves the best treatment available for his/her unique cancer.