Lectures and presentations in the virtual ESMO Congress, which will take place September 16-21, shows that cancer research is entering a new era of bespoke treatments. The treatment armament is expanding to include new immunotherapies and molecularly guided therapies in both advanced and early stages of the disease, but translating key data into approved therapies that provide significant benefits for each individual patient is not yet a reality. To meet this unmet need, innovative solutions combined with effective policy change are required.
Precision oncology is a topic of great interest in the community: personalized healthcare in oncology before the ESMO virtual symposium, sponsored by Roche, explored how it could improve each phase of the patient care continuum while Search for “Precision” in the ESMO 2021 virtual program presents new data on precision oncology in all cancer indications. Personalized health care in oncology is evolving beyond the application of prognostic and predictive biomarkers to a more holistic approach that closes gaps in the entire care continuum and optimizes outcomes. However, a data-driven practice with measures from political decision-makers, regulators and payers is required in order to successfully anchor the concept in community hospitals.
Recent results in targeting optimal care
Research presented at the ESMO Congress 2021 highlight recent successes, unmet needs and future opportunities on the path to optimal personalized care.
A retrospective analysis presented by Lenz et al. highlighted the increased use of comprehensive genome profiling (CGP) in patients with metastatic colorectal cancer (mCRC) prior to the start of first-line therapy. From 2013 to 2020, the Flatiron Health Database collected anonymized data from electronic health records from 18,679 patients with metastatic colorectal cancer (mCRC). A moderate increase in the rate of RAS Tests were found (from 40.6 percent to 55.3 percent) while a greater uptake was in BRAF (from 11.0 percent to 51.7 percent) and microsatellite instability tests (MSI) (from 19.7 percent to 76.0 percent). The advent of targeted therapy for BRAF-mutated mCRC and cancer immunotherapy for MSI-high mCRC may have contributed to these trends. The study also showed that the use of next-generation sequencing (NGS) has increased across all biomarkers. Despite these trends, mCRC testing rates were compared to other cancers such as: B. advanced non-small cell lung cancer (NSCLC), still relatively low.
Although the frequency of testing varies between cancer types, the availability of effective, targeted treatments – for example for mCRC and NSCLC – is increasing, demonstrating the benefit of identifying targeted genomic changes. However, many other malignancies such as carcinoma of unknown primary disease (CUP) are still underserved by their current standard of care.
CUP has a poor prognosis due to addiction to chemotherapy, according to ESMO guidelines. Results based on the molecular profiling of Foundation Medicines CGP tests of the CUPISCO study population, reported by Westphalia et al. and in the ESMO press program, found that about 30 percent of patients with CUP had a potentially targetable genomic change. The data also showed that patients with CUP could be clustered through molecular profiling. If further validated, these results can support the development of new clinical approaches and approved treatment options for patients with CUP. The first global CUP awareness week, led by patient organizations and with presentations from some of the doctors involved in the CUPISCO study, ran from September 20-24 and provided valuable insights into the progress and challenges that remain at CUP.
Support of an early, accurate diagnosis
Speeding up slow diagnostic processes can have a critical impact on patient survival, as the risk of death increases by around 10 percent with each month that treatment is delayed Research published in the British Medical Journal. The impact of COVID-19 on already overloaded pathology services illustrates this grave health care concern.
Using digital pathology tools could help improve the speed and accuracy of cancer diagnosis. Advances in diagnostic technology, including the digitization of pathological slides and artificial intelligence that can detect and quantify disease, can speed up the start of treatment and improve patient outcomes.
In addition to these tools, blood-based biopsies could also be used to aid treatment selection and to allow monitoring of response to treatment. In the community setting, the technology can allow clinicians to perform CGP with just a blood sample before, during, and after treatment. In addition, sequential liquid biopsies can reveal tumor heterogeneity in space and time to make treatment decisions that could ultimately extend a patient’s life.
Some guidelines, including those from the National Comprehensive Cancer Network, already recommend the use of liquid biopsies in certain situations across Europe chest, esophagus, Stomach-, NSCLC, prostate, and pancreas Cancer diseases and the increased use of such innovations in the corresponding patients could help to reduce the psychological, physical and budgetary burdens on workers and health systems in the future.
Include a data-driven approach
Gathering real world data from patients treated in the community and clinic will also be critical to realizing the promise of personalized care and shouldn’t be underestimated. While conventional clinic visits only provide a discrete snapshot of a patient’s condition, technical advances such as wearable sensors and apps to collect Patient-reported results Simplify the collection of real-time information to aid treatment decisions.
Beyond supporting an individual patient’s continuum of care, Real-world data can stimulate ongoing research. By collecting individual patient data, investing in electronic health records, building molecular tumor boards, and joining registries or global CGP databases, clinicians can help identify clinically relevant genomic changes. Findings from global CGP databases hold predictive and prescriptive potential and can improved intelligence for regulators, Shortening the deadlines for the approval of medicinal products and expanding access.
Put politics in the spotlight
The European Alliance for Personalized Medicine recently launched one Round table discussion at ESMO, defining the healthcare ecosystem and examining the need for change. Participants agreed on the urgency of multi-stakeholder collaboration and the value of data in translating innovative solutions into routine clinical practice for the benefit of patients.
The health system has limited resources and payers, and policymakers need to have confidence that precision oncology in general practice is effective in delivering better outcomes. Real-world data of sufficient quality to complement randomized clinical trials (generated from collaboration between clinicians and pharmaceutical companies), can be used by the payers to assess the benefits and risks, which leads to more sustainable cost-benefit decisions in the entire health system.
An effective personalized health system requires investment in infrastructure that combines advances in data and technology with transformative changes in delivery and policy. This includes coordinating the availability of diagnostic tests and treatments, quality assurance of centralized test facilities, more comprehensive data collection and dissemination, as well as information and decision-making support for stakeholders. Some of these solutions have already been implemented at EU level in political frameworks (e.g. EU plan to fight cancer), but the next step is to ensure pathways for implementation at EU Member State level and in other regions around the world.
If personalized health care is to become a reality for everyone, genome testing should no longer be seen as just a companion diagnostic tool. Generating and sharing data across the care continuum can help patients achieve optimal outcomes while reducing complexity, potential inconsistencies and costs in health systems.
Access to personalized health care requires collaboration across the spectrum of interests of the health system. All stakeholders must commit to improving the integration of genome tests and digital solutions into daily practice and advocating for changes in health policy.
Further information on personalized healthcare in oncology can be found on the Roche Personalized Health Center.
Sponsor: F. Hoffmann-La Roche Ltd.
Disclaimer: The editors of GenomeWeb were not involved in the preparation of this article, and the views expressed do not reflect those of GenomeWeb or the GenomeWeb newsroom.