Precision Medicine in Oncology

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), takes place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what you'll hear when you attend this virtual meeting. In this interview we're speaking with Lee Schwartzberg, MD, FACP, the chief medical director of West Cancer Center and the chief medical officer of OneOncology, and who is moderating a stakeholder panel discussion on genomic profiling in cancer.

MRD assessments are probably 1 of the most powerful predictors that we have to see how well a treatment has worked, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Mantle cell lymphoma is a type of B-cell non-Hodgkin lymphoma with a typically poor prognosis. Even with an allogeneic stem cell transplant, patients can become resistant to chemotherapy. Most do not survive 4 or 5 years after diagnosis, and the 10-year survival rate hovers between 5% and 10%.

A major study of patients with osteosarcoma suggests new pathogenic and likely pathogenic germline variants associated with the bone cancer.

Ovarian cancer remains the most deadly of the gynecologic cancers. Researchers from Dana-Farber Cancer Institute may have discovered biomarkers that could predict which patients with platinum-resistant ovarian cancer would benefit from combination poly-ADP ribose polymerase (PARP) inhibitor/immune checkpoint inhibition treatment, as well as those who should pursue a different course of therapy.

Although it is true that there are people who still don't use minimal residual disease (MRD) testing, I think that its use is going to pick up based on results of emerging clinical studies, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Artificial intelligence (AI) could help predict responses to non-small cell lung cancer systemic therapies, according to a study published in Clinical Cancer Research.

Right now, it's not really used for decision treatment in most centers, but there are a lot of studies that have started this year or starting next year that have MRD as an endpoint so we will see, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Metastatic disease is the leading cause of death in the over 600,000 individuals worldwide who die of breast cancer each year. A new blood-based assay to detect minimal residual disease (MRD) in patients with stage 0 to 3 breast cancer was shown to have 100-fold greater sensitivity compared with digital droplet polymerase chain reaction.

A primary analysis of data from the GeparOcto trial showed no difference in pathologic complete response among patients with early-stage breast cancer enrolled in 2 neoadjuvant treatment arms: sequential intense dose-dense epirubicin, paclitaxel, and cyclophosphamide and weekly paclitaxel and nonpegylated liposomal doxorubicin.

Can we predict which patients are at high risk of hospitalization? How can we reduce this risk? Debra Patt, MD, MPH, MBA, executive vice president of policy and strategy at Texas Oncology, posed these questions during the ACCC 46th Annual Meeting and Cancer Center Business Summit.

The authors said their study is the first to show that targeted treaments for patients with certain molecular alterations could be a possibility in pancreatic cancer.

Some of the best ways to assess minimal residual disease (MRD) are using flow cytometry or using sequencing, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Rebecca Kaul, MBA, vice president and chief innovation officer at The University of Texas MD Anderson Cancer Center, said the best technology improves the patient experience.

Joshua Ofman, MD, MSHS, gave his keynote address during Patient-Centered Oncology Care, the annual multistakeholder gathering presented by The American Journal of Managed Care® in Philadelphia, Pennsylvania.

Education efforts among providers, payer, and patients can help answer the fundamental and important questions raised by the use of real-world data, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

Health-related quality of life (QOL) improved in 54% of patients 18 years or older with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) after therapy with tisagenlecleucel (Kymriah; Novartis), one of 2 FDA-approved chimeric antigen receptor (CAR) T-cell therapies. The patients’ general health, vitality, physical function, and social function improved the most.

Fragmentation in the US healthcare system hinders implementation of efficient workflows when it comes to real-world data, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

With patients living longer thanks to new therapies, we need more accurate, sensitive, and standardized tools to guide their therapy.

Opportunities for precision medicine can be lost if clinicians do not perform biomarker testing, and payers may be part of the reason, according to Stuart Goldberg, MD, a hematologist/oncologist and chief of the Division of Outcomes and Value Research at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey.

Radium-223’s (Ra-223) low levels of alpha particle radiation induce double-strand DNA breaks, which leads to cell apoptosis. Sipuleucel-T (SipT), which is an immunotherapy manufactured from a patient’s peripheral blood mononuclear cells, activates T cells to spur an immune response. Both are used to treat bone-metastatic castration-resistant prostate cancer (CRPC). Study data suggest a synergistic immune effect when Ra-223 is added to treatment with SipT.

Real-world data can help resolve some challenges commonly faced in clinical trails, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.

Flow cytometry (FCM), next-generation sequencing, (NGS), and polymerase chain reaction (PCR) are the 3 most common methods clinicians use to diagnose minimal residual disease (MRD) in patients with acute lymphoblastic leukemia who have undergone chemotherapy, radiotherapy, or immunotherapy. MRD can be found both in bone marrow via aspiration and peripheral blood circulation through a draw.

A testosterone-related genetic variant (HSD3B2[1245C]) is linked to poor outcomes in advanced prostate cancer, according to a recent study published in JAMA Oncology.

Instead of replacing clinical trials, real-world data will be used to supplement traditional clinical trial information, said Viraj Narayanan, MBA, vice president of Life Sciences at COTA Healthcare.