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ASCO 2016: Cancer Care Reaches Its Inflection Point

In June, over 35,000 researchers, oncologists and players in the pharmaceutical and biotech industries descended on Chicago for the annual American Society of Clinical Oncology (ASCO) meeting. Guided by its theme of “Collective Wisdom: The Future of Patient-Centered Care and Research,” the 5-day gathering offered a smorgasbord of the latest and greatest in oncology, ranging from exciting clinical results of cutting-edge therapies to an update on the “Cancer Moonshot.” Key stories from ASCO and their impact on cancer care follow.

One Year Later: Immuno-oncology Remains the “Belle of the Ball”
Hailed as ASCO’s 2016 “clinical advance of the year,” immunotherapy remained at the epicenter of oncology as new clinical results highlighted potential indications for the pipeline of immunotherapies beyond approved use for its first 2 indications, melanoma and non–small cell lung cancer (NSCLC).  Multiple immunotherapy drugs and treatments are under investigation for the treatment of tumor types such as renal, bladder, lung, ovarian, pancreatic, brain, gastric, colorectal and breast cancer.

As existing drugs expand their indications and additional therapies enter the market, Sg2 anticipates that the various immunotherapies will drive tumor-specific chemotherapy growth going forward. This is in contrast to our current chemotherapy infusion forecast, which shows softening in the overall demand for chemotherapy given the use of oral chemotherapies, targeted therapies and less utilization of end-of-life treatment (Sg2 forecasts 16% growth in OP chemotherapy over 10 years, vs 20% population-based growth).

Programs will need to evaluate immunotherapy’s early success and tremendous potential amidst lingering concerns over its high costs, lack of benefit to some patients and the small number of tumor types currently approved for treatment with it. The ongoing debate between immunotherapy’s clinical efficacy and elevated costs will persist. Dr George E Peoples of the San Antonio Medical Military Center aptly articulated this delicate balance. “The checkpoint inhibitors have ushered in the new era of immunotherapy,” he noted. “It was more of a religion than a science for a long time, but I think we’re past that now. People realize that immunotherapy is here to stay, and that the immune system has the capacity to recognize and destroy cancer. We’re not there yet, but we’re off to a great start.”

The immunotherapy “buzz” is led by nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck & Co, Inc). Newly released studies demonstrating their long-term survival benefits, improved efficacy over traditional chemotherapy and ability to provide treatment for patients who otherwise have no options reinforced enthusiasm generated at last year’s ASCO and suggested wider adoption and expanded indications for tumor types such as head/neck, brain and esophageal cancer in the near future.

Cancer Moonshot: Harnessing Big Data to Accelerate the Use of Precision Medicine
Alongside an exhibit hall filled with a veritable who’s who of pharmaceutical companies, device manufacturers and vendors offering services such as genomic sequencing, genetic tests and molecular tumor board services, Vice President Joe Biden’s “Cancer Moonshot” keynote address kept precision medicine front and center. Imbuing his speech with the conference theme of “collective wisdom,” Biden unveiled the Genomic Data Commons (GDC), highlighting the importance of a multi-institutional, team-based approach to harness big data in precision medicine and transform patient care more broadly.

The brainchild of the National Cancer Institute (NCI) and the University of Chicago, the GDC is an open-access database that stores, analyzes and integrates genomic and clinical data from the NCI in a single repository. The long-term vision is that GDC will evolve into a robust “knowledge network” that allows researchers easy access to data that will help them to identify both the genes that influence a particular cancer and the potential therapeutic pathways, and then use this information to advance cancer care. GDC creators hope to use this database to improve cancer patient access to and participation in clinical trials, which currently sits at roughly 3%. The GDC currently houses genomic and clinical data on 12,000 patients with additional profiles to come.

Though in their infancy, GDC and other vendors in this space such as OPeN, CancerLinQ, Orion Health and Project Genie are continuing the shift toward big data and greater data sharing. No longer is the emphasis on mere data collection, but on the integration, aggregation and synthesizing of multiple data sets to drive decisions. As the vice president noted, oncology’s relationship with data is evolving, “We have to allow the data to yield the answers. We need to share not only clinical data but ALL of the data that will drive progress in the fight against cancer.”

The single takeaway from the meeting is this: cancer care has reached what Vice President Biden described as its “inflection point.” Given the renewed public attention and research dollars, the exciting clinical breakthroughs in immunotherapy and the use of data sharing to further precision medicine, the oncology world is beginning to leverage this “collective wisdom” to transform cancer care by improving treatment regimens, quality of life and, even, survival rates.

However, important near-term decisions await. Programs will need to determine when to invest in these promising but costly advancements, given recent moves toward cost control and value-based care across the industry. On one side of the coin, immunotherapy and precision medicine may expose programs to significant financial risk, but they also offer the reward of better patient outcomes. And on the other side lies the known path (using traditional chemotherapy treatment)—a reliable one, but one lacking the firepower to redefine patient care.

Next Steps
Oncology is undergoing a period of rapid change, and all signs point to precision medicine, immunotherapy and big data as the future of cancer care. While the scope and size of these topics can make it difficult to determine where to begin, below are actions steps to help you “right-size” these initiatives for your institution.

  • Know Your Market: Look to your local market to see what treatments or services competitors are offering to help you determine market demand.
  • Start Small: Consider offering one particular service within precision medicine (eg, genetic testing and counseling) before making further investments.
  • Outsource: To offer services but avoid some of the high infrastructure costs, utilize one of the growing number of third-party vendors that provide services like genomic sequencing, virtual genetic counseling and molecular tumor board services.
  • Partner Up: For smaller institutions, evaluate the potential benefit of affiliation with larger institutions or academic medical centers to gain access to immunotherapy clinical trials. For larger institutions, look to smaller institutions as a means of growing your clinical trial population.
  • Sign Up and Log In: Enroll in one of the growing number of data-sharing platforms to gain insight from peer research and connect patients to immunotherapy and precision medicine clinical trials.

Sg2 Senior Analyst Janelle Kwan contributed to this post.

Sources: ASCO. ASCO Annual Meeting: Collective Wisdom 2016. June 3–7, 2016, Chicago, IL; Peel N. ASCO 2016: will fine-tuning treatments require redefined tumours? Cancer Research UK. June 15, 2016; ASCO. Immunotherapy with CD19+ CAR T cells produces durable complete responses in B-cell malignancies. ASCO Daily News. June 4, 2016; ASCO. Exploring immunotherapy’s present and future. ASCO Daily News. May 26, 2106; ASCO. Vice President Joe Biden discusses cancer moonshot initiative during ASCO 2016. ASCO Daily News. June 6, 2016; Vose JM. 2016 ASCO Presidential Address: “Collective Wisdom: The Future of Patient-Oriented Care and Research.” ASCO Connection. June 1, 2016; National Cancer Institute. Newly launched Genomic Data Commons to facilitate data and clinical information sharing [press release]. June 6, 2016; Ong MBH. Biden designates NCI’s Genomic Data Commons as foundation of cancer moonshot. The Cancer Letter. 2016; Miliard M. Intermountain, Stanford, others launch data sharing network for Biden’s Cancer Moonshot. Healthcare IT News. June 29, 2016; ASCO CancerLinQ website; Orion Health website; AACR Project Genie website; All websites accessed June 2016; Impact of Change® v16.0; OptumInsight, 2014; The following 2014 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; The Nielsen Company, LLC, 2015, 2016; Sg2 Analysis, 2016.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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