Innovation Is Not Enough: Oncology Experts Address Delivery Gaps

The tools to cure leukemia exist, as do the tools to keep a patient with myeloma off treatment for 7 years or to potentially cure stage IV breast cancer. What does not yet exist, at least not reliably, is the infrastructure, payment model, or care delivery ecosystem to provide those tools to every patient who needs them. The event, Pioneering the Next Era of Oncology Care, emphasized the importance of understanding not only what oncology can achieve but also how to deliver that care effectively. This regional Institute for Value-Based Medicine^® (IVBM) hosted by The American Journal of Managed Care^® took place on February 19, 2026, at the InterContinental Houston Hotel in Texas. Clinicians from leading academic and community institutions gathered to engage in crucial discussions.

Pioneering Leukemia Care: Genomics, Value, and Closing the Access Gap

The opening session, “Developments and Drug Delivery in Acute Leukemias,” brought together experts from The University of Texas MD Anderson Cancer Center in Houston to examine how genomics has transformed acute myeloid leukemia (AML) treatment and what it will take to extend those advances beyond major academic centers.

Moderator Elias Jabbour, MD, opened with a bold claim: For select patients, leukemia is a curable disease in 2026. Courtney DiNardo, MD, MSCE, traced the field’s journey from a one-size-fits-all era, when “7 and 3” was the standard for fit patients and a hypomethylating agent was the fallback for everyone else, to today’s precision landscape of roughly 40 AML subtypes with targetable mutations. IDH1, IDH2, FLT3, and NPM1 inhibitors have moved from experimental to standard of care. Acute promyelocytic leukemia, she noted, is now essentially curable. Starting therapy without up-front genomic profiling, the panel agreed, is doing patients a disservice.

However, genomics raises a practical question about who has access. Gautam Borthakur, MD, acknowledged that academic centers such as MD Anderson return comprehensive results in 2 to 5 days whereas community laboratories can take 3 to 4 weeks. He argued that gap is narrowing fast and predicted broader community access to rapid genomics within a few years. Mahesh Swaminathan, MBBS, added that for complex agents such as menin inhibitors, community providers, including advanced practice providers, need focused education on toxicity recognition, particularly about differentiation syndrome. The panel favored a hybrid model in which patients receive their initial diagnosis and treatment planning at a specialized center and then continue care in the community once a regimen is established and tolerable.

A pointed exchange on payers underscored the financial stakes. Jabbour described a scenario in which sequential treatment failures in acute lymphoblastic leukemia, each costing $500,000 or more, far exceeded what an optimal up-front strategy would have cost while achieving 70% long-term survival. DiNardo recounted keeping a hospitalized patient waiting for venetoclax approval while the insurer continued paying for inpatient days. “Someone says different parts of the insurance company don’t talk together,” she said. Borthakur put it plainly: “Societal cost is much higher. They don’t see it this way, but that has to change.”

The panel closed with unanimous optimism about where drug development is headed, with artificial intelligence (AI)–assisted protein modeling and smarter trial designs promising to shrink the timeline from bench to bedside.

Delivering Targeted Therapies: CAR T-Cell Therapy and Bispecifics in Multiple Myeloma

The second session, “Scaling Innovation: Delivering Targeted Therapies, CAR-T and Bispecifics in Multiple Myeloma,” dove into one of hematology’s fastest-moving areas: the proliferation of chimeric antigen receptor (CAR) T-cell therapies and bispecific antibodies in multiple myeloma and the operational reality of bringing them to patients. Moderated by Brian Primeaux, PharmD, of MD Anderson, the discussion examined how an unprecedented volume of high-cost, high-impact therapies is reshaping care delivery models.

Samip Master, MD, of Texas Oncology and HCA Houston Healthcare Clear Lake in Webster, recalled that myeloma had only 2 treatments when his father was diagnosed. Today, quadruplet regimens, B-cell maturation antigen (BCMA)–targeted bispecifics, and 2 approved CAR T-cell products have transformed the disease into something closer to a chronic illness, with patients routinely surviving 13 to 14 years. Ram Kamble, MD, of Texas Oncology, offered an analogy: “If you have LeBron James on your team and you have to make him sit on the bench, we have a problem. We have a problem of having so many good things.” He predicted that within a year, combinations of a BCMA antibody, a BCMA bispecific, and an anti-CD38 antibody would be standard first-line care.

Panelists were candid about the infrastructure gap. Hun Ju Lee, MD, of MD Anderson, described the CAR T-cell therapy ecosystem there, which includes dedicated pharmacists, immune effector cell therapy teams, and real-time toxicity monitoring, as a “true luxury” unavailable to most practices. Patients in rural areas may face 3- to 5-hour drives to reach a treatment center. The panel generally agreed that bispecifics are increasingly feasible in the community after the initial induction period whereas CAR T-cell therapy still requires academic infrastructure and 6 to 12 months of manufacturer onboarding.

The panel’s preferred metric of success is the treatment-free interval, which they found to be more meaningful than response rates or survival alone. In terms of treatment sequencing, the group generally agreed that prior exposure to bispecific therapies might compromise T-cell fitness and reduce the efficacy of CAR T-cell therapy. Therefore, they favored a CAR T-cell therapy–first approach for eligible patients whenever possible. Kamble summarized the nuances of bispecific management by noting that it typically takes 6 weeks to see a response. He emphasized the importance of spacing doses appropriately once a response is established and managing long-term infection risks. When asked whether hospitals profit from CAR T-cell therapies, the response was candid: “It’s very mixed. It’s not very clear.”

Operationalizing Targeted Therapies in Breast Cancer

Twelve new approvals for breast cancer drugs have occurred in the past 5 years. This context set the stage for the third session, “Targeted Success: Operationalizing Therapies in Breast Cancer,” which examined how oncologists are navigating an increasingly complex and sometimes overwhelming array of therapeutic options.

Moderator Giancarlo Moscol, MD, of MD Anderson, opened the discussion by asking what a new drug has to deliver to be considered valuable. Akshjot Puri, MD, of Houston Methodist, framed the answer in quality-of-life terms, pointing to oral regimens, shorter infusions, and community-compatible administration as tangible gains that would have been unimaginable just 8 years ago. Julie Rani Nangia, MD, of Baylor College of Medicine in Houston, went further, raising the possibility that certain metastatic subtypes may be approaching cure with agents such as trastuzumab deruxtecan. “For the first time in our lifetime, we’re going to be able to say we can cure stage IV breast cancer in certain subtypes,” she said.

Senthil Damodaran, MD, PhD, of MD Anderson, drew a key distinction between targeted therapy and precision medicine, arguing that comprehensive, multi-timepoint genomic testing is essential not only to identify actionable mutations but also to understand resistance mechanisms. MD Anderson has moved from a 70-gene liquid biopsy panel to a 600-gene liquid biopsy panel, enabling resistance profiling that guides postprogression decisions. The panel cautioned against reflexive antibody-drug conjugates (ADCs) after ADC sequencing, noting that all 3 estrogen receptor–positive ADCs share a similar payload, that sequential use lacks supporting data, and that traditional chemotherapy may offer better value at lower cost in that setting. Alpelisib, a PI3K inhibitor, was singled out as more toxic than most intravenous agents, a reminder that tolerability must drive sequencing decisions alongside efficacy.

For younger patients, the panel urged caution against overtreatment. Germline BRCA carriers are often highly chemosensitive, and fertility preservation, which is feasible without compromising outcomes, must be part of the treatment discussion for those considering pregnancy or expressing a desire for children. The session closed with a call for investigator-initiated trials to answer head-to-head sequencing questions that the pharmaceutical industry has little commercial incentive to fund. As Nangia put it, “We need to value quality and not just quantity when we make some of these decisions, especially in the metastatic setting, but when you look at the curative setting, maybe more toxicity and more cost are worth it if you can save lives and cure more people.”

Bridging Worlds: Academic-Community Partnerships in Value-Based Oncology

The evening’s final session, “Bridging Worlds: Academic-Community Partnerships in Value-Based Oncology,” stepped back from the science to examine the structural challenge beneath it all. How do academic and community oncology systems partner effectively to deliver sustainable, high-value care?

Moderator Altamash “Alti” Rahman, MBA, MHA, CSSBB, of the American Oncology Network (AON), opened by asking each panelist to define value-based oncology. Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, of AON, reframed it as “fee for value”: paying for outcomes rather than activity. Jonathan Coggins, MHA, of McKesson, noted that value-based care has drifted from its original intent of economic sustainability into something practices experience as administratively burdensome. Ryan Huey, MD, MS, of MD Anderson, identified the fundamental obstacle as a zero-sum dynamic among stakeholders in which gains for payers come at patients’ expense. “It’s going to be robbing from Peter to pay Paul,” he said, “and unfortunately, the folks who lose out are the patients.”

Three forces are driving the need to bridge the academic-community divide. Rising clinical complexity means CAR T-cell therapies and bispecifics require infrastructure that most community practices lack. Financial pressure is mounting because payers are unprepared to support therapies costing $400,000 to $500,000. There is also a persistent care delivery gap between inpatient and outpatient settings that lacks adequate monitoring infrastructure. Coggins added a fourth dimension in regulatory uncertainty. He described the current presidential administration as “a little distracted” and predicted that meaningful drug pricing reform will be limited to pharmacy benefit manager action in the second term, leaving Inflation Reduction Act mechanisms unresolved. Sabo-Wagner called the resulting environment “a standstill,” with organizations reluctant to commit strategically when the regulatory landscape could shift at any moment.

The panel’s most forward-looking exchange centered on AI and interoperability. Coggins argued that practices not already building their own AI applications are “behind the 8 ball,” describing an app he wrote on his flight over using a low-code platform for less than $2. He flagged a major investment in a health data infrastructure company with roots at Oracle Cerner as a signal of what is coming. Huey offered an important nuance: The more pressing question is not whether AI can bridge data systems but whether it can capture what patients care about, because those outcomes are systematically missing from both provider and payer data sets. The session closed on physician compensation, with Coggins outlining the emergence of value-based entities with formal economic-sharing structures and predicting that growing therapy complexity will force a fundamental rethinking of the relative value unit–based compensation model within 3 years.

The Gap Between Possible and Delivered

Taken together, the sessions painted a picture of an oncology field that has never had more to offer and is straining under the weight of its own progress. The science is outpacing the systems built to deliver it. Genomic testing that could guide better treatment decisions is denied by insurers who do not see the downstream savings. CAR T-cell therapies that can keep patients with myeloma progression free for years require institutional infrastructure that most of the country does not have. Drugs that could cure stage IV breast cancer in certain patients are accessible to some and out of reach for others. The tone across all sessions was one of genuine excitement about where the field is going, but the recurring message was that scientific advancement alone is not enough. The science is there. Providing it to patients is a systems problem, and solving it will require payers, providers, and care delivery institutions to collaborate in ways they largely have not yet.