Revolutionizing Cancer Treatment: A Focus on Personalization and Equity

The Chicago regional Institute for Value-Based Medicine (IVBM) event brought fresh perspectives on the future of oncology, emphasizing personalized care, patient education, and collaboration, with experts tackling challenges in access, costs, and improving outcomes in a rapidly evolving field.

Faculty explored immunotherapy advancements in non–small cell lung cancer (NSCLC), HER2-targeted therapies in breast cancer, predictive biomarkers for sarcomas, and pharmacy decision-making in value-based care models.

One of 4 dynamic panel discussions centered on the evolving treatment landscape in lung cancer, covering rapid advancements in immunotherapy, emerging therapies, and the ongoing challenges in equitable care.

Frank Weinberg, MD, PhD, assistant professor in the Department of Medicine, Division of Hematology and Oncology, University of Illinois Chicago (UIC), emphasized the evolution of immunotherapy from second line to first line and early-stage treatments, which has revolutionized care in a short time frame.

Ryan Nguyen, DO, physician and researcher in the Division of Hematology and Oncology at UIC, discussed how lung cancer screening programs at UIC have led to more early-stage diagnoses, although determining the optimal treatment regimens remains a challenge. Divya Gupta, MD, assistant professor of medicine at the Northwestern University Feinberg School of Medicine, added that the abundance of options in the perioperative setting underscores the need for guidance tailored to patient characteristics such as risk and response rates.

The conversation shifted to groundbreaking research and clinical trials in immunotherapy. Gupta highlighted trials exploring therapy escalation or de-escalation based on patient risk factors and postsurgical responses, as well as early promising data from PD-1 and VEGF inhibitor combinations. Nguyen addressed challenges in rechallenging patients with VEGF and immunotherapy in second-line settings, citing studies such as the HARMONi-2 trial presented at the World Conference on Lung Cancer.¹ He also noted the work that goes into balancing adverse events and clinical benefits associated with these lifesaving medications.

“It’s not just a challenge of efficacy, but also toxicity. A big challenge in my patient population is patients who I know are going to respond really well to immunotherapy but develop really severe immunotherapy-related adverse events,” Nguyen said. “I’ve seen their tumors melt away with immunotherapy, but I’ve also seen the kind of debilitating [adverse] effects of immunotherapy, and it puts me and the patient in a very challenging position where we have something that I know is going to melt your cancer away, but it’s going to cause you severe [adverse] effects.”

Weinberg introduced emerging technologies, including bispecific T-cell engager molecules and cancer vaccines, which hold potential for precision oncology. Nguyen noted the promising results of messenger RNA vaccines in melanoma, suggesting similar innovations could benefit lung cancer treatment.

A key focus was the emergence of antibody-drug conjugates (ADCs) as transformative therapies. Weinberg highlighted trastuzumab deruxtecan (Enhertu, AstraZeneca), which has significant progression-free survival benefits in second-line settings,² while Nguyen emphasized the need for standardized testing to optimize ADC use. Gupta discussed the investigational drug patritumab deruxtecan as a less toxic option for patients with EGFR-positive disease compared with current therapies.³

The panel also addressed disparities in molecular testing and access to biomarker-driven treatments. Weinberg identified racial and socioeconomic disparities, as well as geographic barriers, as major issues limiting equitable care. Nguyen proposed standardized protocols to ensure comprehensive DNA and RNA testing for all patients, while Gupta emphasized the importance of next-generation sequencing (NGS) in early-stage cases and the challenges faced by community providers in adopting advanced testing.
To bridge these gaps, the panel called for enhanced education and collaboration. Weinberg highlighted the role of molecular tumor boards in supporting general oncologists with interpreting complex test results.

Nguyen suggested that academic centers act as resources for community providers to improve molecular testing and trial access. Gupta underscored the importance of educating patients about the value of genetic testing and empowering them to advocate for it when necessary.

Concluding the session, the panelists reflected on the progress made in lung cancer treatment while stressing the importance of continued research, education, and collaboration to address unmet needs and disparities. The insights shared reaffirmed the value of these discussions in driving innovation and improving outcomes across the cancer care continuum.

Oncology Pharmacy Offers Keys to Equal Access
Experts in oncology pharmacy discussed delivery models for advanced therapies, patient navigation, and the challenges of providing equitable and cost-effective care.

Sandra Cuellar, PharmD, clinical associate professor in the Department of Pharmacy Practice at UIC, shared how her institution started with cautious outpatient administration of bispecific therapies such as blinatumomab, highlighting the importance of patient monitoring and cost savings. Mary Golf, PharmD, director of pharmacy at Northwestern Medicine, emphasized the role of technology and multidisciplinary collaboration in ambulatory care.

Daniel Dangler, PharmD, associate vice president of strategic sourcing, pharmacy, at Advocate Health, discussed leveraging multihospital networks for equitable care, while Priyank Shah, oncology and biotech pharmacy services manager at the University of Chicago, focused on managing adverse events in outpatient settings.

Education and patient navigation were key topics. Cuellar stressed the need for educating clinicians, nurses, and patients on complex therapies. “I think education is so critical, and making sure that our patients have a reliable family member support system, so we’re not just working with the patient but there’s someone else who understands the patient’s condition and can aid with giving these very complex treatments that we’re [prescribing], so the patient can better understand how to navigate through these toxicities,” she said.

Golf added that treatment protocols must be tailored to individual needs, while Dangler and Shah highlighted the importance of patient navigators in ensuring care continuity and trust in the health care system.

The panel also addressed challenges in patient navigation, particularly in integrating services and managing costs. Cuellar discussed how biosimilars can increase access to expensive biologics, and Dangler emphasized the role of therapeutic value analysis committees in managing high-cost therapies.

The discussion concluded with a call for multidisciplinary teams, including oncology pharmacists and nurse navigators, to enhance patient care. The panelists stressed the need for education, efficient management of high-cost therapies, and improved patient support to ensure value-based, patient-centered care.

Additionally, a separate panel discussion focused on recent advancements in multiple myeloma treatment and care. Panelists Attaya Suvannasankha, MD, associate professor of clinical medicine, Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine; Kaitlin Kelly, PharmD, BCOP, clinical pharmacist at the University of Chicago; and Matías Sánchez, MD, assistant professor in the Department of Medicine at UIC, sharing insights on the evolving landscape of myeloma management.

Key points included the shift of myeloma from a fatal disease to a chronic condition with longer survival rates, supported by the use of novel therapies such as immunotherapy and quadruplet therapy. The importance of stratifying patients, especially those with high-risk factors, was emphasized, with a focus on achieving minimal residual disease negativity. The role of bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies in managing relapsed/refractory myeloma was also discussed, along with their cost-effectiveness and collaboration between community and academic settings.

“When we think about cost of care like CAR T, it’s actually a big cost right off the bat, and hopefully when people are in remission, the cost of care will actually go down because they do well and don’t need a whole lot of transfusions and [doctor] visits are less frequent. If you’re using standard of care that continue to require patients to stay on therapy until there’s [disease] progression, then there’s actually ongoing cost. It’s not big up front, but it’s actually adding up over time,” explained Suvannasankha.

The panel also addressed the importance of supportive care and infection prophylaxis, particularly for patients undergoing CAR T-cell and bispecific therapies, with a focus on vaccinations and infection management to prevent long-term complications. The discussion concluded with a recognition of the rapid changes in myeloma care and the need for ongoing innovation and collaboration.

The final panel discussion focused on the use of cyclin-dependent kinase 4/6 inhibitors in early breast cancer, highlighting the balance between their benefits and risks. Speakers discussed the approval of ribociclib (Kisqali, Novartis) and abemaciclib (Verzenio, Eli Lilly) for adjuvant settings, with abemaciclib having more trial data.

Patient education on toxicity profiles and the challenges of insurance coverage were emphasized, particularly with ribociclib. Speakers also addressed the impact of adverse effects like QT prolongation, liver enzyme elevation, and diarrhea on treatment decisions. The importance of shared decision-making and patient compliance, especially for high-risk or older patients, was underscored.

The discussion also covered the integration of genomics in breast cancer treatment, focusing on NGS and its role in detecting mutations, including ESR1, and guiding second-line therapy. Precision medicine, including the use of circulating tumor DNA as a biomarker for high-risk relapse, was highlighted as an evolving tool for personalized treatment. The panel also examined the role of ADCs in metastatic breast cancer, discussing their efficacy, challenges in patient identification, and managing toxicities. Finally, the panel noted promising research areas, including novel ADCs and oral agents for ESR1 mutations, and the importance of optimizing therapy sequencing for better patient outcomes.

References
1. Zhou C, Chen J, Wu L, et al. Phase 3 study of ivonescimab (AK112) vs pembrolizumab as first-line treatment for PD-L1–positive advanced NSCLC: primary analysis of HARMONi-2. Presented at: 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Abstract PL02.04.
2. Hurvitz SA, Hegg R, Chung WP, et al. Trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer: updated results from DESTINY-Breast03, a randomised, open-label, phase 3 trial. Lancet. 2023;401(10371):105-117. doi:10.1016/S0140-6736(22)02420-5
3. Mok T, Jänne PA, Nishio M, et al. HERTHENA-Lung02: phase III study of patritumab deruxtecan in advanced EGFR-mutated NSCLC after a third-generation EGFR TKI. Future Oncol. 2024;20(15):969-980. doi:10.2217/fon-2023-0602