Currently Viewing:
American Society of Clinical Oncology Annual Meeting
Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer
May 29, 2018
Remote Monitoring Can Reduce Radiation-Related Symptoms in Head and Neck Cancer
May 30, 2018
Despite USPSTF Recommendations, Lung Screening Rates Low Among Heavy Smokers
May 31, 2018
Nelarabine With Chemotherapy Boosted Outcomes in Pediatric and YA Patients With T-Cell Cancers
June 01, 2018
Dr Leonard B. Saltz on Deciding When a Patient Should Receive NGS Testing
June 02, 2018
Promising Early Phase Results With bb2121 CAR T Treatment in Relapsed Refractory Multiple Myeloma
June 02, 2018
Dr Peter Paul Yu Discusses the Impact of Health Information Technology in Oncology
June 02, 2018
Identifying Rational Immunotherapy Combinations for Glioblastoma: A Progress Report
June 02, 2018
Dr James Lin Chen Outlines Information Needs in Era of Precision Medicine
June 02, 2018
Ellen Miller Sonet Highlights Financial Burdens of Patients With Cancer
June 02, 2018
Utilization Management in Oncology: Current Strategies and a Path Forward
June 02, 2018
Immune Checkpoint Inhibitors Improve Outcomes in Mismatch Repair Deficient CRC, but Can Induce irAEs
June 02, 2018
ZUMA-1: Response to Axi-cel at Three Months Prognostic for Remission in B-cell Lymphoma
June 03, 2018
Cetuximab With Chemoradiation Worse Than Chemoradiation Alone in Older Patients With HNSCC
June 03, 2018
Dr Michael Thompson: The Role of Precision Medicine in the Community Setting
June 03, 2018
Currently Reading
Dr Victoria Villaflor Outlines Challenges With Pursuing Precision Medicine
June 03, 2018
Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Cancer
June 04, 2018
KEYNOTE-042 Confirms First-Line Pembrolizumab Superior to Chemotherapy in PD-L1–Low Advanced NSCLC
June 04, 2018
Cemiplimab, in GOG 3016, Looks to Break New Ground for Immunotherapy in Cervical Cancer
June 04, 2018
Nearly Half of Patients With Metastatic CSCC Respond to Cemiplimab, on Fast Track at FDA
June 04, 2018
Opdivo Plus Chemo Boosts Progression-Free Survival 26% Over Chemo Alone in Late-Stage NSCLC
June 04, 2018
Managing Cancer-Related Pain in the Era of the Opioid Crisis
June 06, 2018
Discussing the Cost Burden of Cancer With Patients
June 06, 2018
Study Underscores Value of PROs in Improving Lung Cancer Survival
June 07, 2018

Dr Victoria Villaflor Outlines Challenges With Pursuing Precision Medicine

There are multiple challenges associated with trying to pursue precision medicine, explained Victoria Villaflor, MD, associate professor of Medicine, hematology and oncology, Northwestern University. 


There are multiple challenges associated with trying to pursue precision medicine, explained Victoria Villaflor, MD, associate professor of Medicine, Hematology and Oncology, Northwestern University. 

Transcript

What challenges are associated with trying to pursue precision medicine?

There are multiple challenges. We’ll start with the clinician. So, when the physician comes in to see the patient, there’s so much data that’s out there, and depending on the environment the physician is seeing the patient in also dictates some of this. A physician [who] has to know every single tumor type [is not] going to be able to keep up with the massive data and the studies and everything that’s coming out for every single tumor type. So, keeping up with the data, integrating it, being able to actually teach the patient about it, and implement[ing] it is one of the great challenges that is out there.

Other challenges are who should we be testing with this, what test should we be doing, and keeping the physician up-to-date with that. [On] the patient's end of things, the willingness to do some of the precision techniques, because they do take time, and also their expectations may be somewhat unrealistic. Things that you have to worry about is that the patient says, "Oh great, I have this mutation, I should be responding to X therapy,” or perhaps, “My tumor proportion score of PD-L1 is 80, I should have a great response to one of the checkpoint inhibitors,” and in fact they don’t.

Studies have shown, with most of these agents, response rates are somewhere in about 50 percentile, maybe 54 percentile. A couple actually go up into the 60 to 70 percentile. But, not everybody who should respond is responding, so the expectations can be unrealistic on both the clinicians and the patient standpoint.

As far as testing, that’s a whole other ball of wax. You know, we start out with how do we identify the patients that should be getting testing, and how do we identify, of those patients, who should be getting treatment and who shouldn’t. One of the early examples of this is the Oncotype Dx, which is used in breast cancer to determine patients who have undergone surgery with estrogen-receptor positivity who should be getting adjuvant chemotherapy. Well, that’s only 1 example. How do we pick out other patients who should be being treated and who shouldn’t be being treated?

Another example would be: how do we pick out who is going to respond. What test should we be doing? Should they be immunohistochemistry? Should they be fluorescence in situ hybridization type testing? Should it be something along the lines of next-generation sequencing? Nobody really knows the answer to that, and there are standardization issues, other issues that occur are: what toxicity tests should we be doing?

Other things could include who should be being tested for germline mutations. We usually determine that if a patient comes in and has many of their family members affected by cancer, but those are the only patients that, right now, we’re recommending have germline testing. Are there are other families that we are missing? Other germline mutations we really don’t know about yet?

So, I think overall, it’s a very complicated situation, and really determining which patients should get what tests and as to what patients should get what tests is complicated.

Now, when we get to treatment, what are the actual treatments we should be having? Some of it has been well worked out. A lot of it hasn’t been. The other thing is, we need to have well-developed molecular marker-driven clinical studies for patients to be enrolled in.

The other thing are the master protocols and getting patients to participate in that, and then what about those that are nonresponders. What do we do about them? How do we figure out what the heck is going on with them? So, overall, it’s a very complicated and complex problem.

 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up