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Evidence-Based Oncology February 2018
Reimbursement Landscape for Molecular Testing in Non-Small Cell Lung Cancer
Dave Nellesen, PhD; Katerine Dea, MSc; Annie Guerin, MSc; Kenneth W. Culver, MD; Alex Mutebi, PhD; and Anand Dalal, MBA, BSPharm
Dave Nellesen, PhD; Katerine Dea, MSc; Annie Guerin, MSc; Kenneth W. Culver, MD; Alex Mutebi, PhD; and Anand Dalal, MBA, BSPharm
The Clinical Trial and the Patient's Voice: "I'm Extremely Lucky to Be Alive"
Mary Caffrey
Provocative Questions, Better Biomarkers, and the Prospect of Triple Therapy: A Conversation With NYU's Jeffrey S. Weber, MD, PhD
Mary Caffrey
Recent Approval of Trastuzumab Biosimilar, Ogivri, Has Implications for Patients and Industry
Samantha DiGrande
With Approval of CAR T-Cell Therapy Comes the Next Challenge: Payer Coverage
Mary Caffrey
Medical World News: Regulatory Updates
Medical World News: Clinical Updates
Medical World News: Clinical/Managed Care Updates
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Future Shock: Embracing Disruption in the Immunotherapy Revolution
Joseph Alvarnas, MD

Future Shock: Embracing Disruption in the Immunotherapy Revolution

Joseph Alvarnas, MD
Dr Alvarnas is editor in chief and director of Value-Based Analytics at City of Hope, Duarte, California.
In 1970, futurist Alvin Toffler published his book, Future Shock, which explored the idea that the pace of change was accelerating well past the ability of people to assimilate this change.1 The resulting sense of displacement and disorientation was reflected in the book’s title.

We are now in a period of unprecedented rapid change in the domain of medical oncology. From emerging diagnostic technologies that leverage genomic, transcriptomic, and
proteomic assessments of germline and somatic cell mutations to the analogous expanding portfolio of targeted and immuno-oncologic (IO) agents, the very nature of cancer care is changing at a pace that is difficult, at best, to assimilate. As the opportunities for more effective diagnosis and treatment grow at a near-exponential rate, our ability to deliver these therapeutics effectively and efficiently to patients in need is proving to be an increasingly formidable challenge.

The quantum leap in cancer care from the triad of surgery/radiation therapy/chemotherapy toward a new era of therapeutics enriched by IO agents has created both systemic and patient-specific challenges. In a recent paper in the Annals of Oncology, the authors note:

“. . . (A)n unprecedented number of new investigational agents and companies are entering the field of IO. As such, it has become challenging for oncology physicians conducting clinical trials, industry veterans developing IO drugs, and even regulators reviewing novel IO agents to keep track of the rapidly evolving landscape.”2

These challenges also include the practical issues of how best to select patients for care using these agents, to the systems-based challenges of how best to deliver such highly complex care, at scale, in a financially sustainable way across the American healthcare system.3

The proliferation of highly effective targeted therapies has markedly altered the nature of care and outcomes for patients with historically poor prognosis cancers, such as late-stage lung cancer, who may benefit from the use of targeted IO agents, such as the checkpoint inhibitors. For patients with non–small cell lung cancer (NSCLC), the
5-year overall survival for patients responsive to checkpoint inhibitors has quintupled over that of historic controls.

The potential of these agents to markedly improve patient outcomes is just one example of the potential of IO and targeted therapeutics to produce better care outcomes.
In this month’s edition of Evidence-Based Oncology™ (EBO™), we review the IO domain from perspectives ranging from that of the evolving standards of care for NSCLC to that of a patient who is undergoing IO treatment. Researchers from the Analysis Group review key changes in the evolving molecular/genomic diagnostic technologies that are
helping to change the prognosis for patients with NSCLC. In an interview, Jeffrey S. Weber, MD, PhD, provides his perspective on IO. And in a remarkable series of interviews, Mary Caffrey brings forth the voices of patients who have navigated the complexities of clinical trials related to immunotherapy. Their courage and resilience in the face of their
respective cancer journeys powerfully conveys the human dimensions of our evolving cancer armamentarium.

As the technologies at the heart of this new era of cancer diagnosis and therapeutics continue to evolve at a rate that is near impossible to assimilate, the challenges to cope with this emerging future will force us to grapple with the effects of our “future shock.” In conversations, such as those fostered by EBO™ amongst the respective cancer care
stakeholders, we hope to help ground the future in sustainable systems that are dedicated to ensuring the increasing efficiency, effectiveness, and equitability of these life-changing care technologies. 

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1. Toffler A. Future Shock. New York, NY: Random House; 1970.
2. Tang J, Shalabi A, Hubbard-Lucy VM. Comprehensive analysis of the clinical immuno-oncology landscape. Ann Oncol. 2018;29(1):84-91. doi:
3. Vermaelen K, Waeytens A, Kholmanskikh O, Van den Bulcke M, Van Valckenborgh E. Perspectives on the integration of immuno-oncology
biomarkers and drugs in a healthcare setting [published online November 21, 2017]. Semin Cancer Biol. doi: 10.1016/j.semcancer.2017.11.011.
4. Goodman A. Five-year survival quadrupled in responders to immunotherapy for non-small cell lung cancer. The ASCO Post. May 10, 2017.
Accessed February 6, 2018.
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