Dr Jordan Berlin Discusses Precision Medicine and Factoring Patient Preferences Into Treatment

Jordan Berlin, MD, FASCO, of Vanderbilt University Medical Center (VUMC), discussed how physicians consider patient preferences during tumor boards and how they implement new treatments. He also gave insight into what he is currently working on and his biggest takeaway from The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, TN on August 17, 2023, where he was co-chair.

At VUMC, Berlin is the associate director for clinical research and director of the division of hematology and oncology. He also is the director of phase I cancer research and an Ingram Professor of Cancer Research.

Transcript

How does the team take into account patient preferences and needs when debating treatment options and making decisions?

The physicians who've met with the patients, the people we care for, are responsible for relaying their feelings, their needs, their wants, and their other medical issues. All these things have to play a role in what we decide.

I had a tumor board presentation yesterday where we could decide to operate on a specific situation or not, and, as I pointed out to the team, one of the things pushing the family to want surgery is that another family member had recently died of cancer and felt that the surgery had been delayed too long on their other family member. That makes them really want the surgery, so we're going to present them the opportunity to get to the surgery, even though it's also okay to watch for a little longer.

Those types of things do play a role. You have to take into account people's needs, people's wants, and, of course, how people are feeling, whether or not they're healthy enough from other illnesses to get whatever we want to do done.

When new treatments become available, how does the team begin to consider adding them into the armamentarium?

There are a couple of ways. Of course, somebody may spontaneously bring it up—that's the most common way, to be honest. When there's a person who might be eligible for the new treatment presented in the case presentation or tumor board, then what we will do is somebody will bring it up, and then they'll tell us something about the data that led to this being a new treatment available.

Other times, sometimes a new treatment comes up and we don't have a patient, but we feel like it's an important enough treatment that we need to talk about it so people are thinking about it for the future. So, somebody may give a 2-, 3-, or 5-minute–long lecture on this new treatment.

It depends on the situation, but the most common thing is we usually have a person sitting in front of us in the meeting, so to speak, and we want to discuss that treatment as an option.

In fact, I get included on a lot of emails from a lot of people, and I know our myeloma team is considering treatment for one of our myeloma patients with a treatment that just got approved by the FDA within the last month. Because it's not yet been evaluated by our formulary committee to put it on formulary, we'd have to appeal to get it in despite the lack of it being on formulary; they will do it if it's the right thing to do. In the end, it's still needed to go to their tumor board, but they started the conversation on an email conversation.

What are you currently working on that you're excited to share?

I'm largely administrative; I'm also the head of phase one, which is new drug development. For us, some of the most exciting things we see, because I treat pancreas cancer, are inhibitors of something called RAS [renin-angiotensin system].

RAS inhibitors look like they could have an impact on the history of pancreas cancer, and they may not work that well on their own, but I think that maybe in combination with other things may make them all much better.

So, we're pretty excited about RAS inhibitors. In pancreas cancer, almost everybody's excited about new ways to make immune therapies even better.

Of course, the thing that Vanderbilt has been the leader in, and continues to be a leader in, is precision medicine—finding out the right treatment for the right patients, finding out what makes somebody more susceptible to a certain treatment or less susceptible. We guide the treatment to the right people so they can get the best benefit from the outset. Those are the things that excite me.

What do you think the biggest takeaway was from this meeting?

Because this was a value-based medicine conference, I think one of the things that should come through is that the things that we just talked about are all about value.

If you start a person with the treatment that they're most likely to benefit from, from the very beginning, and you take the people who are less likely to benefit to something else, you're not going to waste as much value of either their time, their effort, their lives, the cost, all that stuff is not going to be wasted on people who aren't going to derive benefit. So, personalized medicine really helps with that.

The multidisciplinary management where you choose what is considered to be the best option for that person based on their history, based on all the data that we have about them, taking that course of therapy is most likely giving the best value for their medical dollars, so to speak, if you want to call value-based.

For me, it's the value that they place on their lives, which is the most valuable thing they have, that we can give them the best chance of having the best quality and quantity of life possible.