Oncology Leaders Call for Greater Collaboration to Advance Precision Medicine, Innovative Cancer Care

As oncology care grows increasingly personalized and complex, experts at the Institute for Value-Based Medicine^® event in Minneapolis, Minnesota, on June 23, 2026, highlighted the multidisciplinary strategies needed to expand access to innovative therapies. Across 4 panels, speakers emphasized that realizing the full potential of precision medicine in oncology will require coordinated care delivery, streamlined operations, sustainable reimbursement models, and stronger partnerships between community and academic practices.

Pharmacy’s Expanding Role in Complex Oncology Therapy Delivery

The event began with the “Advancing Pharmacy Operations & Workflows in Oncology” panel, moderated by Kirollos Hanna, PharmD, BCPS, BCOP, director of pharmacy at Minnesota Oncology, with experts Sara Moran Smith, PharmD, BCOP, oncology pharmacy program manager at Allina Health; Chelsee Jensen, PharmD, RPh, BCPS, director of formulary management at Mayo Clinic; and Paul Forsberg, PharmD, MHA, oncology and infusion pharmacy program manager at HealthPartners.

The Twin Cities pharmacy leaders discussed the operational, financial, and reimbursement challenges of expanding access to bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies, emphasizing pharmacy’s central role in safely implementing these treatments through multidisciplinary collaboration.

Although Allina Health has not yet launched a CAR T-cell therapy program, Moran Smith said pharmacists and clinical specialists have led development of outpatient bispecific protocols, including patient selection criteria and standardized toxicity management algorithms. At HealthPartners, Forsberg said pharmacy collaborates with nursing and physician leadership to identify outpatient candidates while managing prior authorizations (PAs), billing, and inpatient-outpatient transitions.

Mayo Clinic has already established outpatient CAR T-cell therapy and bispecific programs, and Jensen said the organization is evaluating expansion to regional sites. She noted that education and remote monitoring protocols are critical, with patients and caregivers trained extensively on recognizing early toxicities and knowing when to seek care.

Hanna described Minnesota Oncology’s phased implementation strategy for outpatient bispecific therapy, beginning with maintenance dosing, then progressing to outpatient administration with inpatient observation, followed by fully outpatient treatment and expansion across additional clinics; step-up dosing remains limited to core sites near hospital partners. Patients receive home monitoring kits containing thermometers, blood pressure cuffs, and pulse oximeters.

High-risk agents still require individualized outpatient protocols, Hanna said, including tebentafusp (Kimmtrak; Immunocore) for uveal melanoma, which carries an approximately 90% cytokine release syndrome (CRS) rate and a labeled requirement of at least 16 hours of monitoring after each of the first 3 doses.

As more therapies enter the treatment space, formulary management has become increasingly important. Forsberg noted that multiple myeloma therapies carry substantial financial toxicity but have dramatically improved outcomes, making access a priority. As a result, health systems are evaluating whether standardizing formularies around fewer products can simplify PA workflows.

The panelists emphasized that drug acquisition cost alone should not drive formulary decisions. Moran Smith said organizations must weigh reimbursement, patient convenience, operational efficiency, and clinical outcomes when evaluating biosimilars and other products. Jensen added that biosimilar management requires dedicated oversight, given the frequent shifts in payer preferences and manufacturer contracts.

At the same time, administrative burdens continue to grow despite technological advances. Moran Smith said PA requirements, peer-to-peer reviews, and reimbursement denials have increased substantially, contributing to provider burnout and delaying care. She highlighted artificial intelligence (AI)-driven batch denials on routine supportive care drugs, such as ondansetron and olanzapine, as an example of unnecessary rework.

Still, panelists said AI may help reduce documentation burdens and improve coding workflows. Jensen said Mayo Clinic is exploring AI-assisted documentation to support PAs, and Forsberg noted that ambient AI tools can capture provider-patient conversations, allowing physicians to spend more time with patients while improving documentation accuracy.

Hanna closed by arguing reimbursement models have not kept pace with oncology advances, and AI may not solve these underlying challenges. He pointed to value-based arrangements such as CMS’ Enhancing Oncology Model, which can penalize finite-duration regimens with higher short-term episode costs even when they offer comparable or better long-term value than continuous therapy. He also described payers routinely denying reimbursement for drug waste from vial-size mismatches after dose reduction, rather than allowing practices to avoid delaying care.

“We just fall under this algorithm where we are writing off $5000 worth of waste because the payer says we used [a] larger-than-necessary vial size,” Hanna said. “We have many systems in place, but AI is not going to be a solution for them.”

Advancing Precision Medicine in Lung Cancer Through Comprehensive Biomarker Testing

The evening continued with the “Precision in Practice: Implementing Biomarker Testing in Lung Cancer” panel, moderated by Kurt C. Demel, MD, MBA, medical oncologist and hematologist core investigator at the HealthPartners Institute, and featuring Robert Kratzke, MD, section head of medical oncology at the University of Minnesota, and Yan Ji, MD, and Priya Kumar, MBBS, medical oncologists and hematologists at HealthPartners.

The panelists discussed the growing importance of broad biomarker testing, strategies to improve testing workflows, and barriers limiting timely access to targeted therapies and biomarker-driven trials. Kumar said comprehensive biomarker testing is increasingly being used in earlier-stage disease as targeted therapies demonstrate benefit in adjuvant and neoadjuvant settings; she said she prefers broad next-generation sequencing (NGS) panels over limited mutation testing, even for patients with early-stage disease. Kumar added that testing decisions depend on disease stage and whether actionable alterations have approved therapies, but that a comprehensive approach provides the greatest clinical utility.

Kratzke agreed that broad-based testing should be the standard of care, highlighting the University of Minnesota’s reflex testing approach, in which all lung cancer cases automatically undergo molecular profiling. He added that comprehensive sequencing provides information beyond currently actionable alterations, including emerging biomarkers that may inform future treatment. Ji noted that as targeted therapies move earlier in the treatment continuum, obtaining molecular information at diagnosis may become increasingly valuable for patients who later experience recurrence.

The discussion also addressed ensuring patients receive appropriate biomarker testing regardless of entry point into the health care system. Kratzke emphasized the importance of multidisciplinary tumor boards to coordinate tissue collection and molecular testing, but he acknowledged that processes vary across institutions, especially those in community and rural settings.

Drawing on her experience at HealthPartners, Ji highlighted the role of lung cancer navigators in coordinating care. She explained that they help identify patients with suspicious findings, facilitate communication among specialists, coordinate biopsies and staging, and ensure appropriate samples are obtained for molecular testing. Ji shared the case of a patient with stage IIIA EGFR-mutated lung cancer whose course changed after biomarker testing identified an actionable mutation, allowing the use of neoadjuvant chemotherapy plus osimertinib before surgical resection.

“Without this, we probably would not have offered neoadjuvant treatment,” she said.

Despite improved insurance coverage following Minnesota’s biomarker testing mandate, Demel, Kratzke, and Ji said operational barriers continue to delay precision care. Demel highlighted that the Medicare 14-day rule can prevent molecular testing from being ordered during inpatient hospitalization. Although sequencing technology can theoretically generate results within a day, Kratzke said clinicians are often stuck waiting roughly 2 weeks for results, delaying access to targeted therapies for patients with newly diagnosed metastatic disease.

Because turnaround times are unpredictable, Ji said results can sometimes take even longer; she highlighted a patient whose tissue NGS remained pending after nearly 4 weeks, during which they developed an effusion. As a result, clinicians are often forced to begin less targeted therapies such as empiric chemotherapy on critically ill patients while awaiting NGS results, Ji said.

The panel also explored challenges in identifying patients for biomarker-driven clinical trials. Kumar said matching patients often requires collaboration with research teams at other institutions when trials are not available locally. Ji highlighted emerging AI-based screening tools within molecular testing platforms that may help identify patients with rare genomic alterations eligible for precision medicine studies. She also emphasized the potential of decentralized trial models, which would allow patients to participate at academic centers while receiving most care locally.

In addition, Kratzke highlighted Minnesota’s emerging statewide MNconnect initiative to improve clinical trial awareness and enrollment across institutions.¹ However, Kumar cautioned that busy physicians are unlikely to routinely search standalone websites or mobile applications for eligible studies. She argued that trial matching should be embedded directly into electronic health records, so clinicians are automatically alerted when patients qualify.

Demel closed by emphasizing that precision medicine has fundamentally changed lung cancer care, making timely biomarker testing essential to delivering effective treatment.

“The take-home message here is that we’re all huge proponents of precision medicine and getting access to this for our patients because it has impactful outcomes and value,” he said.

How Emerging Immunotherapies Are Reshaping Frontline Myeloma Care

After a short break, attendees returned for “Scaling Innovation: Delivering Targeted Therapies, CAR-T, and Bispecifics in Multiple Myeloma,” a panel featuring Mayo Clinic experts: Shaji K. Kumar, MD, Mark and Judy Mullins Professor of Hematological Malignancies; S. Vincent Rajkumar, MD, chair of the Myeloma, Amyloidosis, Dysproteinemia group; Saurabh S. Zanwar, MBBS, hematologist; and moderator Scott A. Soefje, PharmD, MBA, BCOP, director of pharmacy cancer care services.

The panel explored evolving frontline treatment strategies, the expanding role of measurable residual disease (MRD), financial considerations surrounding increasingly complex regimens, and the future role of bispecific antibodies, CAR T-cell therapies, and trispecific antibodies as they move into earlier lines of therapy.

Kumar emphasized that treatment selection should continue prioritizing the most effective available therapies up front. Current frontline care typically includes quadruplet induction therapy, autologous stem cell transplantation for eligible patients, and maintenance therapy, with progression-free survival (PFS) now exceeding 10 years for many patients, a dramatic improvement from outcomes seen 2 decades ago. The availability of approximately 20 drugs across 8 mechanisms of action gives clinicians flexibility to switch approaches at relapse, individualized based on efficacy, patient preference, prior response, and toxicity, he noted.

Rajkumar agreed that frontline quadruplet therapy has transformed outcomes, citing 4- to 5-year survival rates of approximately 70% in older adults and 80% in younger patients. Still, he said, the field is increasingly focused on cures rather than incremental survival gains, and bispecific antibodies and CAR T-cell therapies being tested in newly diagnosed patients should remain investigational until trial data demonstrate superiority over current standards.

Zanwar said high-risk disease remains a major unmet need; despite treatment advances, these patients still experience PFS of only 2.5 to 3 years and may need more intensive strategies, including prolonged consolidation, multiagent maintenance, and earlier incorporation of immunotherapies through clinical trials.

Kumar also explained that the FDA is encouraging MRD as an early surrogate end point while still requiring long-term PFS follow-up before full approval, allowing promising therapies to reach patients sooner without sacrificing long-term safety data. Zanwar warned, however, that a single negative result should not automatically prompt treatment de-escalation, particularly in high-risk disease; sustained MRD negativity may eventually help guide treatment intensification and discontinuation decisions.

Although high-cost therapies generate revenue for health systems, Rajkumar noted they pose growing challenges for Medicare and other payers financing long-term cancer care. Kumar said value-based care should focus not just on drug cost but on identifying the right treatment for the right patient for the appropriate duration. Both advocated for finite-duration treatment over indefinite maintenance, as Kumar noted that newer definitions of cure in myeloma require patients to eventually stop treatment. Rajkumar added that demonstrating that patients can discontinue CAR T-cell or bispecific therapy and remain disease-free would meaningfully improve quality of life and health care value.

Kumar also pointed to growing interest in home administration of subcutaneous therapies to improve convenience and reduce burden, although reimbursement and regulatory barriers continue to limit adoption. At Mayo Clinic, Zanwar said most patients complete bispecific step-up dosing without hospitalization, supported by structured monitoring protocols, caregiver support, remote patient monitoring tools, and clear plans for managing low-grade CRS at home. Rajkumar suggested using prophylactic tocilizumab to help reduce CRS and enable broader community use of bispecifics, but said he remains skeptical it will spread outside academic centers due to the burden on practices of having to purchase and stock the drug themselves.

Kumar was more optimistic, noting that payer pushback on stocking tocilizumab appears to be easing now that National Comprehensive Cancer Network guidelines list it as an option, and the cost is minor relative to the rest of a bispecific regimen.

Beyond current therapies, Kumar highlighted promising early data for trispecific antibodies, which simultaneously target multiple myeloma antigens and may improve response rates while reducing resistance. Zanwar discussed cereblon E3 ligase modulators as a promising strategy that may complement immunotherapies with fewer infectious complications. All 3 experts advocated for routine intravenous immunoglobulin prophylaxis in patients receiving bispecific antibodies or CAR T-cell therapy, rather than waiting for severe hypogammaglobulinemia or recurrent infections, as early use reduces infection-related complications and optimizes outcomes.

Looking ahead, the panelists expressed optimism that multiple myeloma is moving toward an era of prolonged treatment-free remission.

“I think the goal is going to be over the next 5 to 10 years to find that right combination to make sure we can get the maximum number of people to be MRD-negative [and] stay MRD-negative for a long period of time,” Kumar said.

Strengthening Clinical Trial Access Through Collaboration

The event closed with “Collaboration in Today’s Environment for Successful Clinical Trials,” a panel featuring Eric Lander, MD, physician director of research at Minnesota Oncology, and Supriya Gupta, MBBS, and Christopher Graham, MD, both assistant professors at the University of Minnesota. Moderated by Emil Lou, MD, PhD, professor at the University of Minnesota, the discussion highlighted how partnerships across health systems can overcome barriers to innovative therapies while ensuring timely, high-quality treatment.

Gupta said collaboration begins with patients and caregivers, who form the foundation of a care team. The care team also includes community oncologists, primary care physicians, academic investigators, research nurses, care coordinators, and patient advocates. Together, these stakeholders form what she called a “well-oiled machine” focused on improving patient outcomes.

Graham noted that as more cancer care shifts to community settings, expanding clinical trial access into those practices is critical; he described the community-academic relationship as a symbiosis in which each contributes unique expertise toward shared goals. Lander said building strong physician-to-physician relationships, often through direct phone calls or texts, helps expedite referrals and avoid delays common in administrative channels. Graham agreed, emphasizing the importance of “keeping the door open” between providers, with Gupta emphasizing that such communication matters equally for routine care, particularly when patients are being considered for transplant or CAR T-cell therapy.

The panel also highlighted geographic challenges across Minnesota and neighboring states. Lou noted that many patients travel several hours for specialized cancer care, creating financial and logistical burdens, with Gupta explaining that relocation requirements, transportation, socioeconomic factors, and patient perceptions often complicate participation in advanced therapies and clinical trials.

Beyond geography, the speakers identified diagnostic testing as one of the greatest barriers to timely treatment. Gupta noted that patients with aggressive hematologic malignancies often require extensive testing before cellular therapy or trial eligibility can be determined. Graham described challenges in acute myeloid leukemia, where specialized biomarker testing may differ across institutions, complicating coordination. Lander also recounted a patient with suspected metastatic gastric cancer whose biomarker test came back only as negative, without the graded result his trial required, showing how inconsistent pathology reporting can leave physicians without the information needed to determine trial eligibility before treatment must begin.

Lander added that current trial designs sometimes create additional obstacles, as frontline studies frequently require extensive screening and centralized laboratory testing before enrollment, delaying therapy for patients with rapidly progressing cancers. Allowing patients to begin standard-of-care treatment while confirmatory testing is completed could improve enrollment without compromising study integrity, he suggested, and simplifying companion diagnostic requirements could make trials more practical for community oncology practices.

In addition, the discussion addressed persistent misconceptions about clinical trials. Gupta said many patients worry they will be treated as “guinea pigs” or receive a placebo instead of appropriate therapy. Addressing these fears requires acknowledging patient concerns while clearly explaining how trials are designed and what treatment options patients will receive, she said. Gupta added that trusted relationships with primary oncologists and patient advocacy organizations can help dispel misinformation.

Graham echoed the importance of advocacy groups, describing how transplant support organizations connect newly diagnosed patients with survivors who can share experiences and offer reassurance. Gupta added that advocacy groups also help investigators understand patient priorities and treatment-related burdens, citing the Rajkumar-led ECOG E4A03 study (NCT00098475) comparing high-dose vs weekly low-dose dexamethasone in multiple myeloma²; the lower-dose regimen, which was determined to be superior, was studied after a patient advocate raised concerns about steroid-related toxicity.

Lander also advocated for giving patients greater visibility into available clinical trials, saying that as patients increasingly seek information online, more accessible trial-matching information could encourage informed discussions with physicians and improve awareness of research opportunities.

In closing, the speakers expressed optimism about Minnesota’s collaborative environment, pointing to strong partnerships among health systems, research networks, and advocacy organizations. However, they acknowledged that communication, awareness of available studies, and operational challenges still require improvement.

“It’d be great to know what other providers are doing...so we can all sort of be aware... I have a patient that would fit your trial, you have a patient that would fit my trial, and we can just work together,” Graham said.

References

1. McCormick B, Kratzke R. Optimizing biomarker testing to guide early-stage NSCLC treatment: Robert Kratzke, MD. AJMC. July 9, 2026. Accessed July 23, 2026. https://www.ajmc.com/view/optimizing-biomarker-testing-to-guide-early-stage-nsclc-treatment-robert-kratzke-md
2. Rajkumar SV, Jacobus S, Callander NS, et al; Eastern Cooperative Oncology Group. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010;11(1):29-37. doi:10.1016/S1470-2045(09)70284-0