Phoenix IVBM Spotlights Oncology Innovation, Access Barriers, and Partnerships

The Institute for Value-Based Medicine (IVBM) event, held on March 19, 2026, in Phoenix, Arizona, addressed current practices, challenges, and solutions for translating oncology care and operationalizing novel therapies for cancers, including breast cancer and multiple myeloma, as well as bispecifics in the space. The theme “Pioneering the Next Era of Oncology Care” encompassed a diverse panel of clinicians, oncology experts, and pharmacists to drive discussion, leaving its audience with tools and suggestions applicable to oncology practices.

Advancing Value-Based Oncology Through Multistakeholder Partnerships

Brian Washburn, MHA, chief operating officer of Ironwood Cancer & Research Centers (Ironwood), moderated the first panel on common challenges and practices in translating oncology care from an academic setting to community practice. He began the session by defining both.

Community practices refer to “cancer care delivered in locally based outpatient oncology practices that operate independently or as part of a regional medical group,” he said. Academic oncology “refers to cancer care provided in university-affiliated medical centers or National Cancer Institute [NCI]–designated academic cancer centers.”

One of the biggest differences between community and academic oncology care lies in how communication is handled between the settings, panelist Chad Cherington, MD, director of genitourinary oncology at Ironwood, explained during the discussion.

“It’s more just organizing it, getting the people together, and having the meetings for the different strategies,” he said.

Matthew Callister, MD, a senior oncology physician at Banner Health, added that the application and scaling of therapies, research, and education also vary between academic and community oncology settings.

“For [community oncologists], subspecialization came first…followed by research. Then later on, education became a mandate and central to our program as we kind of live in this world of trying to meet the community and have the reach and the access the community has. Also, a health care system that’s well connected to the community,” Callister said. “But at the same time, respect the fact we’re not an NCI-designated center or a university at this point.”

Another aspect of the conversation about translating care is private practice, according to Danielle Keller, PharmD, MBA, director of pharmacy at Ironwood. Because Ironwood is privately owned, Keller said it is easier to start patients on drugs newly approved by the FDA and build a custom regimen almost immediately after approval.

“Whereas in the health system, you submit a ticket, you ask for the Cerner build, and maybe 3 to 4 months later, you’ll get one,” she said. “I think the speed with which we can offer those new therapies is really exciting.”

The panel concluded that the future of oncology will be defined not by a divide between academic and community practices but by how effectively these settings share expertise, align operations, and cocreate flexible, data‑driven models that bring cutting‑edge care safely and equitably to patients where they live.

Addressing Cost Barriers and Improving Patient Access to Care in Breast Cancer

Diagnostic protocols vary when treating a disease as vast as breast cancer. This panel discussion, moderated by Qing Zhao, MD, a breast medical oncologist at Banner MD Anderson Cancer Center and Banner Gateway Medical Center, addressed the process of developing treatment plans for patients with breast cancer, given the tumor heterogeneity, the treatment landscape, and payer challenges.

Despite advancements in therapies and standards of care, community oncology settings often face hurdles. Aside from coordinating a care team for a patient, essential units of a patient’s care team are often inaccessible in the community setting and must be outsourced, said Anu Batra, MD, a medical oncologist at Ironwood.

“By being in the community…we don’t have the ability to have pathology under 1 roof,” she said. “There is a challenge, sometimes, in getting stains back in a timely fashion, or if you have a question regarding the review of pathology, to actually reach out to the individual pathologists who may have run the stains.”

The other panelists agreed with Batra’s statement so much so that Elisa Tso Bomgaars, MD, a medical oncologist at Ironwood, cited a recent patient case in which treatment was delayed due to hospital policy and infrastructure.

“[Because of the] Medicare guidelines, the hospital wouldn’t release their specimen until 2 weeks after to do molecular profiling, Oncotype, or MammaPrint,” Bomgaars said. “That is frustrating to the patient, because the patients are going, ‘What’s the next plan? Do I get chemotherapy? Do I get radiation?’ And they’re at a standstill, and we have to wait for treatment.”

Another barrier to operationalizing breast cancer care is related to the payer system. Zhao encouraged the panelists to discuss payer barriers to care that may hinder or delay treatment for patients.

“I’ve had issues where the payers don’t want to pay for it, and even with the overall survival benefit, I’ve had them say it’s not enough,” Sandra Savaya, PharmD, a breast oncology clinical pharmacist at Banner Health, said during the discussion. “Eventually they approved it, but it did take 3 months.”

The conversation shifted slightly to encompass emerging therapies, still in the research phase but demonstrating promise as potential therapies, thus increasing treatment options for patients.

“There’s a new trial, SERENA-6, which is exciting, and that’s the only interventional trial that is based on molecular progression ahead of radiographic progression,” Zhao said. “Currently, it’s not in the guidelines yet and hasn’t been approved yet, but I [want to know] how you can implement it in the clinics."

The SERENA-6 phase 3 study (NCT04964934) evaluated camizestrant, an oral selective estrogen receptor degrader, in patients with estrogen receptor–positive and HER2-negative breast cancer, demonstrating favorable efficacy by improving progression-free survival.¹

“I think what remains to be determined is whether the benefit that we saw would remain at crossover or not,” Batra said. “I think there are still some unanswered questions in this space, but I think it’s an evolving situation [and] more data are needed before we decide whether or not this is going to be.”

In sum, the breast cancer panel underscored that operationalizing cutting‑edge therapies now depends as much on pathology workflows, payer navigation, and toxicity management as on the drugs themselves. Their consensus was that the next leap forward will come from smarter biomarker‑ and circulating tumor DNA–guided personalization and de‑escalation, rather than simply layering on more intensive treatment for every patient.

The panel emphasized that fragmented testing, payer denials and delays, and complex toxicity management often block patient access to new breast cancer therapies. Streamlining these steps is critical so that innovative treatments can actually reach patients.

Optimizing Treatment Sequencing in Multiple Myeloma Care

The third panel discussion featured a wide array of pharmacists and clinicians specializing in multiple myeloma and hematology, focusing on how autologous transplant, chimeric antigen receptor (CAR) T cells, and bispecifics fit into the evolving treatment sequence for multiple myeloma.

Moderator Jeffrey R. Schriber, MD, FRCP, hematologist-oncologist and medical director of transplant and cellular therapy at City of Hope Cancer Center Phoenix, was joined by Shikha P. Patel, PharmD, BCPS, BCOP, a clinical pharmacist specializing in multiple myeloma at Mayo Clinic College of Medicine and Science; Tibor Kovacsovics, MD, a hematologist-oncologist at City of Hope Cancer Center Phoenix; and Atefeh Sharif, PharmD, BCPS, a clinical oncology specialist at Banner MD Anderson Cancer Center.

The panelists agreed that up-front autologous transplant remains central, despite questions about minimal residual disease–guided omission and the rise of novel therapies.

“I personally think that we haven’t seen anything change in terms of referrals in transplants. I don’t think I’ve seen too much change,” Patel said.

Another panelist elaborated on the previous point, emphasizing the importance of transplant therapy. “In my opinion, in the first line, transplant remains absolutely central. There is a documented, real survival advantage,” Kovacsovics said.

Schriber continued the conversation, framing candidacy as primarily about function, not age. “I would say that almost everyone is a transplant candidate…. You get these people kind of bent over in wheelchairs, but it’s their disease that’s terrible, not so much the patient. What were you doing 6 months ago, you ask them? ‘I was chopping wood,’” he said.

The panelists further outlined a modern up-front paradigm of quadruplet induction, early stem‑cell collection, and a total of about 6 cycles followed by maintenance, achieving markedly improved survival, especially in standard‑risk disease.

“It’s just over 10 [years], and that’s gone from about 4—10 years ago, it was 4 years if you did [a] transplant,” Schriber said. “That’s without the benefit of CAR T-cell therapy, bispecific T-cell engagers [BiTEs], [and] all of the other things we’re going to talk about.”

The panelists argued that this supports the idea of a functional cure in many older patients.

“If you get 10 years for those people, most of those have functional cures,” Schriber said. “I think nowadays, most myeloma folks…think we can cure this disease, at least get functional cures for a lot of these patients.”

In discussing relapsed disease, the panel weighed second-line CAR T-cell therapy vs bispecifics vs repeat transplant, with a strong lean toward early CAR T-cell therapy in fit patients and reserving B-cell maturation antigen bispecifics to avoid compromising CAR T-cell therapy efficacy.

“Personally, if they only got Revlimid [lenalidomide], I would probably—if they are fit—want to consider doing CAR T-cell therapy in the second line, because the CARTITUDE‑4 data [NCT04181827] just came out, and that curve looks very, very flat,” Patel said.

Kovacsovics pointed out the difference in efficacy between the therapies. “If you do BiTEs before CAR T-cell therapy, you may lose some efficiency. So personally, I would favor CAR T-cell therapy and keep the BiTEs for later,” he said.

However, the panelists cautioned that CAR T-cell therapy carries distinct risks, such as Parkinsonian syndromes, gastrointestinal (GI) toxicities, infections, and secondary malignancies, as well as a somewhat higher nonrelapse mortality than auto transplant.

“The late neurologic toxicities are actually much more common in Carvykti [ciltacabtagene autoleucel]. They’re not common—about 3% to 4%,” Schriber said. He added that there’s a new GI issue “that looks for all the world like graft-vs-host disease, and it can be terrible—liters and liters of diarrhea…. So the mortality with Carvykti [ciltacabtagene autoleucel] over the first year or so ends up being higher than with auto transplant.”

Bispecifics were positioned as more flexible, off‑the‑shelf options, especially for frailer patients, but with similar risks of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), as well as a heavy long‑term infection burden due to chronic B‑cell depletion.

Expanding the Role of Bispecific Antibodies in Solid Tumors

The final session, moderated by Jiaxin Niu, MD, PhD, codirector of the Lung Cancer Program at Banner MD Anderson Cancer Center, discussed the differences between bispecific therapies for solid tumors and how health systems can adopt protocols for administering and managing newer therapies.

“Bispecifics are definitely a new thing for solid tumors but are quickly reshaping precision oncology practice,” Niu said.

An important distinction made early in the conversation was the difference between bispecific antibodies and BiTEs. Bispecific antibodies target 2 different tumor antigens, whereas BiTEs operate as tumor antigens and T-cell engagers, explained panelist Amit Kulkarni, MD, an assistant professor of medical oncology and a thoracic medical oncologist at City of Hope Cancer Center Phoenix.

“Because of this T-cell engager activity of BiTEs, in short, their toxicity profile is different from the other bispecific antibodies,” Kulkarni said.

Although these emerging therapies have shown promise with positive patient outcomes, the application of bispecific antibodies vs BiTEs varies, especially in terms of toxicity management, explained Tanios S. Bekaii-Saab, MD, the David F. and Margaret T. Grohne Professor of Novel Therapeutics for Cancer Research I at the Mayo Clinic College of Medicine and Science.

“The advantage for us, at least with these bispecifics, is that we don’t have to deal with a lot of the toxicities that you have to deal with with the T-cell engagers or the cell therapies,” he said. He added that bispecifics have shown greater tumor-targeting efficacy than monoclonal antibodies, but this has yet to be tested clinically. However, recent data on gastric cancers, he said, “look super impressive.”

“It’s some of the best numbers we’ve seen in gastric cancers, in residual cancers,” he continued. “It’s not multiple myeloma, but we’re seeing survival approaching 2 to 3 years in a disease that takes away lives in 6 months.”

The conversation next addressed the translation of bispecifics and cell therapies moving from inpatient to outpatient care. To accommodate these therapies, panelists agreed that centers must rapidly reconfigure infrastructure, staffing, and monitoring to safely manage CRS and ICANS outside the hospital.

“It’s a changing time, but I think it’s all to the benefit of our patients,” Bekaii-Saab said. “It certainly is evolving, and I think we’re going to get to the point where all this, like everything else—like with imatinib [and] all the antibodies that we started with, the EGFR inhibitors and others—we learned how to maneuver around them, understand the toxicities, and minimize the risk."

Scientifically, the field is racing toward more complex constructs—multiantigen bispecific, trispecific, and bispecific antibody-drug conjugates—that integrate functional and nonfunctional targets with the tumor microenvironment. But this raises parallel challenges in toxicity management and clinician training.

“I truly and sincerely think that we’re ready to start moving some aspects of our operation into the outpatient [setting], and ultimately, in a short few years, most of it will be outpatient. Not all of it, but most of it will be outpatient,” Bekaii-Saab concluded.

As oncology care rapidly evolves, the discussions at this IVBM underscored that innovation alone is not enough. Equitable access, coordinated partnerships, and scalable care delivery models are essential to ensure transformative therapies reach all patients who need them.

Reference

1. Bidard FC, Mayer EL, Park YH, et al. First-line camizestrant for emerging ESR1-mutated advanced breast cancer. N Engl J Med. 2025;393(6):569-580. doi:10.1056/NEJMoa2502929