Oncology Treatment’s Next Frontier: Precision Medicine
At the ASCO 2019 congress, the annual meeting of the American Society of Clinical Oncology, I had the opportunity to connect in various meetings and discussions with the Oncology Community. Precision oncology is one of the hot topics in the oncology area and seen as the promise for the future.
However, this rapid advancement of science also bears some challenges. In that regard, I was honored to participate in a panel discussion at the sideline of the congress with renowned colleagues to discuss the future of precision oncology. I would like to share with you some key insights that I took away from the meeting:
1. Progress against cancer is at a critical turning point
It’s an exciting time, as a wave of innovation in precision medicine is starting to shift cancer treatment from the traditional “one-size-fits-all” approach for large patient groups to tailored treatments for specific patient groups. We are used to hearing about cancer based on the location of the tumor, such as breast, prostate or lung. Today, we are on the verge of a paradigm shift with a true, tumor-agnostic approach to treatment, where we’re developing medicines to treat patients based on the genomic profile of their tumors, and select the best treatment choice for their patient.
2. Testing is key to get the right treatment to the right patient
Understanding a patient’s genomic profile is the key to painting a more precise picture of their individual cancer and allows the patient along with their doctor to understand what is causing it to grow and spread. Given the tremendous benefit that is seen from some of those newer highly selective treatments, identifying the patients through genomic testing is a key priority. Genomic testing may help doctors recommend treatments that have been approved or are in clinical trials based on the specific alteration identified. Of patients who undergo genomic testing, 30-49%1,2 have one or more actionable alterations, which means that they could be matched to either an approved therapy or a drug in a clinical trial. The results of the genomic testing can lead to treatment options that are tailored to a patient’s specific cancer, supporting them with potentially more effective treatments and reducing the use of ineffective or highly toxic treatments, as well as associated costs in the process.
3. Widespread adoption of comprehensive genomic testing is crucial
While the mainstays of current organ based clinical treatment will continue to play a large role in patient care, I believe precision oncology will be rapidly integrated into the overall treatment paradigm to provide optimal care for patients, and extend and improve their quality of life. Today, the cost of sequencing has come down so much that already one third of metastatic cancers are being sequenced in the United States. In 5 years, our goal should be to ensure that widespread genomic testing has become part of routine clinical practice.
4. Partnering and collaboration is key to progress
Adoption of new technologies does take time and effort, and it varies from country to country. Continued collaborative efforts between the pharmaceutical industry, diagnostic companies, payers, academic institutions, and regulatory agencies are contributing to a real paradigm shift of a true, tumor-agonistic, precision approach to oncology treatment. It was this type of collaboration; that made the development and commercialization of some of the new precision oncology treatments possible. We must unite as a cancer community to make genomic testing routine, so we can get precision therapies to those who need it most.
5. The use of AI bears great potential
Leveraging the power of artificial intelligence and machine learning, Bayer is exploring technologies, to help us understand the patient biology and improve our knowledge of patient selection. This will better inform the diagnosis and treatment of patients, as well as design of clinical trials, which will ultimately lead to new and better treatment options for patients. In that regard, Bayer is developing machine learning algorithms to help identify for example NTRK gene fusion patients. This algorithm is trained on molecular and pathological features to help understand the patients likely to have this alteration. Ultimately, the goal would be to help physicians more rapidly define this patient population.
I left the discussion with renewed energy to be pushing forward a revolution in precision oncology. With the focused effort on targeted drug development for specific patient populations and wider adoption of genomic testing, I expect that there will be many tumor-agnostic treatments that will be delivered to patients. We must work together in the cancer community to develop a blueprint for success. This includes making high-quality and broad genomic profiling part of routine clinical practice to better understand the underlying drivers of cancer. It also requires improving the reimbursement processes in many countries for diagnostics to increase uptake of precision medicines; and adjusting value frameworks to take into account the value of precision oncology. We at Bayer are proud to be at the forefront of precision oncology, and, I personally am looking forward to what’s to come!
1 Boland GM, Piha-Paul SA, Subbiah V, et al. Clinical next generation sequencing to identify actionable aberrations in a phase I program. Oncotarget. 2015;6(24):20099-20110.
2 Massard C, Michiels S, Ferte C, et al. High-throughput genomics and clinical outcome in hard-to-treat advanced cancers: results of the MOSCATO 01 trial. Cancer Discov. 2017;7(6):586-595.