Turning the Tide Against Cancer: Conference Preview
Turning the Tide Against Cancer: Conference Preview
06.11.12 | By Kate Connors
ASCO's Annual Meeting last week highlighted some of the exciting advances that are emerging in the fight against cancer. PhRMA has joined with many other organizations in supporting a conference tomorrow, "Turning the Tide Against Cancer Through Sustained Medical Innovation," which is focused on the critical issue of how we sustain this progress in an era of increasing cost-cutting pressure. Conference participants will examine how we measure the value of new treatments and how we can promote high quality, patient-centered care.
>> 6/12 Update: Watch the conference live.
The conference is being convened by the American Association of Cancer Research, the Personalized Medicine Coalition, and Feinstein Kean Healthcare. We sat down with each of the conference co-hosts about the event and progress in cancer care.
Conversation with Edward Abrahams Ph.D., President, Personalized Medicine Coalition
Q: What are the implications of personalized medicine's growing role in research and patient care in oncology?
Ed Abrahams: Technological improvements in genetic sequencing and molecular profiling of tumors have given researchers and clinicians a new ability to understand the molecular and genetic characteristics of cancer patients and their tumors. By more accurately classifying disease, patients can benefit from targeted treatments that are more likely to work.
Simply put, personalized medicine means better patient care. Personalized treatment regimens allow clinicians to select treatments that are more likely to attack specific tumor types. But personalized medicine also delivers better value to patients and the health system because it enables clinicians to spare patients the expense and side-effects of treatments that are not likely to provide tangible benefits and thereby to help address the challenge of rising health care costs.
We believe that the future of cancer therapeutics lies in molecular biology and genomics, supported by electronic health data systems and advanced health information technologies that support a rapid learning health care system. Increased collaboration between academia, the biopharmaceutical industry, philanthropic organizations, and patient advocacy groups will maximize the development of new personalized medicine technologies and treatments.
Q: What are some of the barriers to personalized medicine that need to be addressed to facilitate the adoption of personalized medicine?
Ed Abrahams: Clearer regulatory and reimbursement pathways are needed to ensure that developers of new personalized medicine products - therapeutics, diagnostics, and others laboratory services - have a reasonable pathway to get their products approved by regulatory agencies and to ensure that products are reimbursed at rates reflective of the innovative value of the product and the investment necessary to develop it.
We must also aligning comparative effectiveness research (CER) with the science of personalized medicine and the fact that we are not always aware of all of the uses for a new therapy at the time of its approval. If we rush to judgment about value too early, we will cut short the process of continuous learning through which value emerges. If we take a traditional "one size fits all" approach to CER that judges "average" value at a point in time, we will stifle innovation.
Finally, our education system must evolve to ensure that our health care workforce is trained in genetics, genomics, and the technologies needed to integrate personalized medicine into cancer treatment decision-making.
Q: What is your goal for the conference?
Ed Abrahams: This conference will provide stakeholders a forum to discuss major developments in oncology research and development and link the science of personalized medicine with public policy.
We intend the high-level discussion at the conference to illuminate policy solutions that will spur the development of new personalized medicine approaches to cancer. By brining patients, payers, industry, and academe, we hope to identify ways to continue to deliver high value care in a cost constrained environment and to sustain innovation to improve cancer patient outcomes.
Conversation with Marcia Kean, Chairman, Feinstein Kean Healthcare
Q: In the course of 30+ interviews of national thought leaders that you conducted to develop a Discussion Paper for the Turn the Tide conference, what themes emerged most strongly?
Marcia Kean: I was very surprised at how much consensus there was from such a disparate group of stakeholders from academe, patient advocacy, industry, providers and payers. There was strong agreement, for example, that as daunting as cancer is, innovation is going to be the best way to overcome both the clinical and economic burden of cancer in coming years, and that above all, innovation has to be protected.
Five major themes recurred. The first was around the need for an ongoing, community-wide commitment to overcome the issues we face as a society in oncology. I don't mean that everyone had the same perspective about those issues - remember, this was a very diverse set of individuals - but rather, there was agreement that we have the opportunity at this moment to do things differently to accelerate research and improve care, and that in order to reward innovation, it's important for stakeholders to identify overlapping interests rather than remaining rigid in their safe and separate silos. Creating a joint, defined vision of what constitutes value will help to outline a pathway for development.
Second, while everyone recognizes that we've made progress toward patient-centered cancer care, much more needs to be done. We need a better system for measuring value that puts patients' needs and preferences first, and keeps up with the rapidly evolving scientific and clinical environment. As personalized medicine becomes more central, of course, this kind of dynamic measurement will only become more difficult.
Third, there's huge excitement about the potentially positive impact of digital technologies to accomplish the dramatic productivity gains in cancer research and care that they've done for other fields. Developing effective tools for shared decision-making and clinical decision support is seen as a major opportunity in that regard.
Fourth, there's a desire to move to "next-generation" tools for assessing value through Health Technology Assessment, as well as a fervent desire to develop next-generation Comparative Effectiveness Research that aligns with personalized medicine and gives a fuller picture of real-world value. We heard that current approaches aren't centered enough on patient value, and don't do an adequate of job keeping pace with how the use and value of tests and treatments evolves over time - they are just too static in a highly dynamic world.
Finally, there's a strong drumbeat about the shift to models of "continuous learning" that give a more dynamic, patient-centered picture of value, so that every clinical encounter informs our overall knowledge base and research advances are moved rapidly into clinical use. That virtuous circle is seen as the light on the horizon for all of us.
Q: Your firm has been very active in efforts to implement health information technology and develop a learning health care system. How will these concepts accelerate progress in cancer care?
Marcia Kean: In some ways, the field of biomedicine has been the last to benefit from the digital revolution. For many cultural - and technical - reasons, we just haven't been able to move data rapidly from lab bench to doctor's office to hospital to patient, and so on. But there is a growing cadre of researchers and clinicians and patients who are demanding the kind of 'data liquidity' in science and health care that they see in every other sector of their lives, and they are gaining traction. Once we have seamless data exchange, based on the use of standards in Health Information Technology and bioinformatics tools, we'll have a solid foundation for a learning health care system. In that picture, everyone wins: innovators can accelerate and improve research; patients and doctors can get the information they need to make wise decisions; and the efficiency of the process can drive down costs.
However, we need to remember that even a digitally-enabled system doesn't happen in a vacuum -- it has to unfold in a community where every sector is interconnected and working towards a common, patient-centered vision, because all these challenges and solutions are inter-related in a very complex and dynamic ecosystem.
Conversation with Margaret Foti, Ph.D., M.D. (h.c.), CEO, American Association for Cancer Research
Q: In looking at where we want to go in progress against cancer, we sometimes lose sight of where we've come. Set the stage for us - how has scientific progress changed the outlook for patients against cancer in recent years?
Marge Foti: We have made tremendous progress against cancer. There are more than 12 million cancer survivors in America today and cancer mortality rates continue to decline. This progress is thanks to scientific discoveries that have revealed the underlying biology of a cancer cell and how the survive and grow in our bodies-knowledge that has given us a new understanding that cancer is not, in fact, a single disease but more than 200 diseases, each with unique causes and characteristics that require different treatments. New advanced technologies have improved our ability to turn this knowledge of how cancer works against cancer. We now are better able to prevent, detect and treat cancer.
Q: AACR put out a great report last year, the Cancer Progress Report, which describes many of the exciting advances being made in cancer research. What big trends do you expect we will hear about at the upcoming conference? What big challenges?
Marge Foti: Personalized medicine is more than just a buzz word; it is offering great promise to transform the outlook for many forms of cancer. We are truly entering an era when every patient's tumor can be characterized at the molecular level, which is helping us redefine how we prevent, diagnose, and treat cancer. While this unprecedented progress is the direct result of fundamental discoveries from the past 40 years, further exploiting this knowledge to improve the outlook for cancer patients is going to require that our national policies keep pace with the continual advances that take place in science. For example, the recent approval of two new cancer medicines along with companion diagnostics is marking a new day of progress, but also is one that poses new challenges to researchers, companies, and regulators.
In addition, cancer's complexity is astounding and exists at all levels--from populations, to individuals, to specific cancers, to the genes that underlie cancers. A major hurdle in the treatment of cancer is that that there is a high degree of variability in gene mutations-even within a single tumor in a single patient-and the variability increases with later stage disease.
Cancer research takes time and progress builds over time as new treatments are added on to one another in a step-wise fashion. Our growing scientific knowledge has the potential to change the face of drug development, to combine therapies in a rational way based on the mutations within an individual patient's tumor. This is an enormous scientific and regulatory challenge, but the science is telling us this is the path forward.
Q: Why is it important to connect the science to policy?
Marge Foti: Continued progress is not a given. Advancing care for patients is an incredibly long, complex and expensive process. We need to provide continued support for basic research, and we need to preserve strong incentives for private sector investments in this process. Without a good understanding of the science, we risk taking policy approaches that will hamper the progress we so desperately need to make for current and future cancer patients.