Precision Medicine, the Oncology Care Model, and PD-1s

The third segment of The Clinical and Reimbursement Landscape of Immuno-Oncology series, focusing on the new PD-1 agents, addressed personalized or precision medicine and CMMI’s new Oncology Care Model. Dr Kolodziej, an Aetna national medical director of oncology strategy, believes that precision medicine is not a perfect fit for the new model, but at least partially it can be paid for through “innovation” payments. He points out that precision medicine should not evolve greatly within the timeframe of the Oncology Care Model (3-5 yr), so it should not have a great deal of effect on the success of the model.

The PD-1 class, although very much part of the precision medicine treatment concept, “which kind of throws it all on its head,” says Dr Feinberg, Cardinal Health Specialty Solutions vice president and chief medical officer. Instead of identifying unique molecular and genetic phenomenon occurring in individual tumors, PD-1s may be active against “half or two-thirds of all malignancies,” not a tiny proportion of a population with a particular cancer.

Dr Feinberg emphasizes that the mechanism of action of PD-1 agents to abort tumor growth applies to a majority of tumor types. He comments, “It’s personalized, precision medicine that may be precision for everyone.”