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NSCLC Outcomes: Clinical and Non-Clinical Evidence


An oncology expert explains how clinical and non-clinical evidence impact the clinical pathway decision-making for patients with NSCLC.

Edward Arrowsmith, MD: We have a couple ways that we're tracking use of the pathways, and that's something we feel is critical. What we hope, both now and increasingly over time, will differentiate our pathways program. We're really striving to use real-time data to follow pathway adherence. At OneOncology, we have a robust program we call One Analytics that pulls information from a variety of sources and then allows clinicians and other practice leaders to better manage the patient care experience. We're able to follow how patients do and how providers are doing in adhering to the pathways. Something we're really excited about is a tool called Flatiron Assist. Flatiron Health is the maker of OncoEMR, which is our EMR vendor across OneOncology. This is a point-of-care tool that guides clinicians as they’re ordering treatment for non-small cell lung cancer and other cancers, that uses clinical inputs to suggest the kind of optimal- or pathway-based treatment to prescribe right at the point of care.

Non-small cell lung cancer, in some ways, has almost bifurcated in how we analyzed data. There's an increasing group of patients who, particularly talking here in stage 4 or advanced disease, have a specific target with EGFR mutant or ALK rearranged lung cancer as being the first examples of this. Increasingly, [there are] other targets, such as—[as of] a little less than a year ago—the KRAS G12C mutation. For those patients, sometimes we see dramatic results of phase 2 trials in highly targeted patient populations. In those groups, based on that phase 2 data, we and the lung cancer community as a whole integrate those treatments. Those are generally new compounds getting FDA approvals for that specific indication. Sotorasib for second-line therapy of KRAS G12C-mutated non-small cell lung cancer would be a good example of that. The other is the more common group that we're treating with chemotherapy, with immunotherapy or chemotherapy and radiation followed by immunotherapy. There, we're looking at overall survival as the primary endpoint, that we're looking to update our pathways and change our treatment algorithms.

There's a stepwise approach to the development of a pathway. The first is efficacy. The most effective treatment that helps patients live longer and better is going to be the key driving metric in pathway formation. If there are 2 treatments of equal efficacy or we think are likely to have equal efficacy, if they have not been compared head-to-head, look at the adverse event profile and go with a treatment that is likely to be easier on patients from an adverse event perspective. The third criteria if efficacy and adverse events appear is to look at value. Is a lower cost agent? Is it an agent where there are much better patient assistance programs, so for those patients who are uninsured or underinsured, there's value? It's that order of efficacy, safety, and then value when we think about agents. With things like biosimilars or generics, there is a clear example where value becomes paramount.

This transcript has been edited for clarity.

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