A New Horizon: Precision Medicine and Value-Based Care in Lung, Gastric, and Sarcoma Cancers

Advancements in oncology are transforming the way we diagnose, treat, and care for patients with cancer, offering a glimpse into a future where innovation and precision medicine take center stage. From the promise of liquid biopsies and personalized therapies to the challenges of integrating value-based care models, the oncology landscape is undergoing a profound evolution.

As novel treatments such as antibody-drug conjugates (ADCs) and T-cell receptor gene therapies emerge, the focus is shifting toward improving outcomes, optimizing patient selection, and addressing disparities in access to care. At the heart of these developments lies a shared goal: to redefine cancer care by combining cutting-edge science with a patient-centered approach that prioritizes equity and meaningful health outcomes.

Speakers at the Institute of Value-Based Medicine event in Tampa, Florida, on December 12, 2024, detailed how treatment, diagnosis, and value-based care strategies have developed across several key oncology sectors, including the treatment of gastric and lung cancer. Richard D. Kim, MD, service chief, Medical Gastrointestinal Oncology and senior member, Gastrointestinal Oncology Department at Moffitt, served as the evening’s chair.

Daniel Anaya Saenz, MD, a particle researcher and newly promoted department chair of gastric, intestinal surgical oncology, and gastroenterology at Moffitt Cancer Center, delivered a keynote address on the benefits and principles of value-based care. He expressed deep interest in care delivery models.

Anaya said that value-based care seeks to improve patient health outcomes relative to the cost of care, emphasizing patient outcomes over mere cost reduction. He advocated for a patient-centered care relationship model that measures meaningful outcomes beyond clinical results and called for cultural transformation within institutions to implement value-based care effectively.The lecture addressed challenges in oncology, such as
fragmented care that forces patients to navigate multiple systems
and specialists. Anaya praised Moffitt’s integrated care model but noted that many regions still struggle with fragmentation. He highlighted the lack of transparency in real-life outcomes and underscored the need to address financial constraints and changing reimbursement models.

Anaya discussed the evolving health care environment, highlighting the demographic shift toward younger, more involved oncology patients, as well as the older population that is growing in Florida. He noted the formation of health networks and the need for coordinated, nonfragmented care. He also touched on the evolution of payment models toward patient-centered approaches, emphasizing satisfaction and outcomes.

To build value-based care frameworks, Anaya outlined the importance of understanding shared health needs and introduced integrated practice units designed to address patient segments’ needs through standardized and systematic activities. He emphasized measuring factors impacting clinical outcomes and patient well-being, using data to negotiate with payers and implement value-based payment models.

Anaya shared real-life examples of value-based care in oncology. He recounted a 20-year-old initiative in the Veterans Affairs system, where a virtual tumor board improved survival rates for patients with colorectal cancer and hepatocellular carcinoma. He described the development of a multidisciplinary care program at Moffitt, which allowed patients to receive comprehensive evaluations and treatment plans in a single visit. This model led to faster treatment initiation and increased patient engagement, and it expanded capacity to include advanced practice providers, which significantly boosted new patient numbers.

In discussing cost measurement and value-based payment models, Anaya explained how Moffitt measures costs and outcomes to create systematic processes for care delivery. He provided an example comparing the costs of 2 surgeries for the same cancer, illustrating how higher-cost surgeries can deliver greater value. He described the development of an episode-of-care payment model that focuses on the patient journey, improving care and resource allocation.

Anaya concluded by summarizing the essential components
of value-based care, emphasizing the importance of understanding patient needs, quality improvement, and integrated care frameworks. He also highlighted the benefits of value-based care, including improved quality, growth, innovation, and research, while advocating for financial payment models centered on the patient journey.

The gastroenterology session focused on advancements in gastrointestinal cancer treatment, highlighting value-based care and precision medicine. Tiago Biachi, MD, PhD, an associate member at Moffitt and an associate professor at the University of South Florida, discussed liquid biopsy, particularly circulating tumor DNA (ctDNA), for detecting minimal residual disease and resistance mechanisms, noting its high specificity but low sensitivity, which requires multiple draws.

Iman Imanirad, MD, an assistant member at Moffitt and a professor of oncology at the University of South Florida College of Medicine, emphasized precision medicine in colorectal cancer, focusing on KRAS mutations and targeted therapies. “Precision medicine is here to develop, validate, and predict biomarkers through diagnostics, general clients, somatic profiling, and liquid biopsies…. It aims to define parameters of care, optimize specific demographics, define the optimal use of technologies such as DNA analysis and liquid biopsies, and deliver the right treatment to the right person at the right time,” Imanirad said.

Mintallah Haider, MD, a medical oncologist and associate, Department of Gastrointestinal Oncology and the Neuroendocrine Tumor Program at Moffitt, highlighted novel treatments for endocrine tumors, including cabozantinib and peptide receptor radionuclide therapy (PRRT), showcasing their efficacy.
The session featured presentations on ctDNA’s clinical applications, including its role in guiding treatment through trials and complementing tissue-based next-generation sequencing. Imanirad detailed the impact that genetic mutations have on colorectal cancer treatment responses, whereas Haider explored advancements in treating neuroendocrine tumors with tyrosine kinase inhibitors and PRRT.

The thoracic oncology session highlighted advancements in lung cancer treatment. Edgardo S. Santos Castillero, MD, FACP, FASCO, a hematologist and medical oncologist at the Oncology Institute of Hope and Innovation and medical director for Broward County, Florida, discussed precision medicine’s impact, including checkpoint inhibitors, lung cancer vaccines, and bispecific antibodies, alongside technologies such as PET scans, artificial intelligence, and liquid biopsy for early detection and personalized treatment. He emphasized the need for better screening and equitable care.

Bruna Pellini, MD, an assistant member at the Department of Thoracic Oncology at Moffitt and an assistant professor at Morsani College of Medicine at the University of South Florida, focused on using ctDNA to monitor metastatic lung cancer treatment response, presenting data on its prognostic value and the challenges of applying ctDNA assays across populations.

Sonam Puri, MD, a medical oncologist specializing in lung cancer at Moffitt, covered how ADCs and bispecific antibodies could be transformative therapies, discussing their mechanisms, clinical applications, and the importance of managing toxicities and optimizing patient selection. Future directions included bispecific ADCs, radionuclides, and combination therapies, with an emphasis on addressing disparities in cancer care.

The final session focused on the latest advancements in sarcoma treatment, with an emphasis on novel therapies and technologies. To start, Andrew Brohl, MD, a medical oncologist and physician-scientist at Moffitt, focused on sarcoma patient selection for immune checkpoint inhibitor therapy, exploring the criteria and considerations for optimizing patient response to these therapies. The session highlighted the latest advancements and strategies in treating sarcoma, aiming to improve patient care through innovation and precision medicine.

Mihaela Druta, MD, an assistant professor, Sarcoma Medical Oncology, discussed the potential of T-cell receptor gene therapy, highlighting its role in targeted treatment. She highlighted synovial sarcoma and its treatment options, the importance of value-driven cancer care, and advancements from clinical trials such as SPEARHEAD-1 (NCT04044768).1 Druta also discussed progress in novel therapeutics for soft tissue sarcomas and emphasized collaboration and ongoing efforts in cancer research as essential for continued progress.

Lastly, Gina D’Amato, MD, a professor of clinical medicine and medical oncologist at the University of Miami Miller School of Medicine, presented advancements in early detection methods for sarcoma, emphasizing the importance of early diagnosis for improved outcomes.

Reference
D’Angelo SP, Araujo DM, Abdul Razak AR, et al. Afamitresgene autoleucel for advanced synovial sarcoma and myxoid round cell liposarcoma (SPEARHEAD-1): an international, open-label, phase 2 trial. Lancet. 2024;403(10435):1460-1471. doi:10.1016/S0140-6736(24)00319-2