Payer Stance on Immunotherapy in Oncology Care

Steven Peskin, MD, MBA, FACP: I have very high expectations for immunotherapy as it relates to outcomes and reduction in use of chemotherapy, and in [incidence of] side effects. We’re already seeing some very positive gains in liquid tumors, most especially, but increasingly, in solid tumors as it relates to immuno-oncology and this notion of precision medicine.

What do we mean by precision medicine? It means, to me, the way that we can more specifically design, develop, and target therapies to particular cancers in a way that is not the shotgun, but is more of the rifle approach. So, you’re specifically targeting certain pathways in the cancer and you’re really getting at that exact tumor versus taking a more radical approach of attacking the body, in a sense, broadly.

I’m very sanguine about immuno-oncology and its impact in reducing side effects, improving outcomes from chemotherapy or immunotherapy, and in reducing the drug burden for patients. We’re seeing that while these therapies are not devoid of their side effects—peripheral neuropathy or other kinds of things—they certainly have less profound side-effect profiles in terms of febrile neutropenia and some of the more untoward consequences on cardiovascular health and renal health as it relates to end-organ damage from the more traditional cytotoxic chemotherapies. So, we are definitely seeing a reduction in side effects associated with these drugs.

From an overall population health [perspective], where I sit, that means that cancer, increasingly, is [becoming more of] a chronic condition where people are living 3, to 5, to 7, to 10 years or longer. Then, you have the untoward consequences of that chemotherapy or radiation therapy that might have happened 7 to 10 years ago. So, there’s a very important positive impact of immuno-oncology.

[In regard to] combination therapies in the context of immuno-oncology (immunotherapies), immunotherapies are used together with more of what we might call traditional chemotherapy. Immunotherapies are used in combination, certainly, with surgery or immunotherapies are used in combination with radiation oncology.

Just as we’ve been doing for the last 30 or 40 years, we’ve looked at cancer and looked at multiple ways to treat that cancer—to attack certain aspects of the tumor and how it evolves. That said, again, the Holy Grail of being ever more targeted and selecting and avoiding some of the very significant untoward side effects of, again, the shotgun versus the rifle approach. So, absolutely, there are multiple pathways that tumors act on [in] the body and move from DNA, to RNA, to proteins. And studying this area of immuno-oncology includes the development of cancer vaccines, which again, is another very exciting area.