Standardized Testing, Moves to Oral Therapy, and Cost Challenges Get Attention

Precision medicine is transforming the treatment landscape for hematologic and solid tumors. On March 6, 2025, experts highlighted breakthroughs in multiple myeloma, lung cancer, and chronic lymphocytic leukemia (CLL) at an Institute for Value-Based Medicine (IVBM) event in Tampa, Florida.

The evening opened with a panel discussion on best practices for testing in multiple myeloma. Featured experts included Melissa Alsina, MD, specialist in multiple myeloma and bone marrow transplantation at Moffitt Cancer Center; Gustavo A. Fonseca, MD, FACP, hematologist and oncologist at Florida Cancer Specialists and Research Institute; and Ariel F. Grajales-Cruz, MD, hematologist-oncologist at Moffitt Cancer Center.

The speakers discussed how multiple myeloma has progressed over the past decade, including the impact of CD38 monoclonal antibodies such as daratumumab (Darzalex; Janssen Biotech, Inc) and isatuximab (Sarclisa; Sanofi-Aventis US LLC) on treatment outcomes.

Additionally, the panelists touched on the use of CD38 antibodies in frail patients and the pros and cons of bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies, highlighting their potential to provide deep responses while also managing toxicities using minimal residual disease (MRD) testing.

Melissa Alsina, MD | Image: Moffitt Cancer Center

“The toxicit[ies] [these therapies] present are toxicities that we as oncologists are all used to dealing with, like infections or immunosuppression, these types of things,” said Alsina. “These [bispecifics] are things that definitely can be given in the community, in contrast to CAR T. Still, you need a more specialized center, like a center that would do transplants, cellular therapies, and [so on].”

The second panel was on advancements in precision medicine in lung cancer and featured speakers Christopher Elder, PharmD, BCOP, associate director of pharmacy clinical services at Florida Cancer Specialists and Research Institute; J. Kevin Hicks, PharmD, PhD, FCCP, personalized medicine specialist at Moffitt Cancer Center; Maen Hussein, MD, medical oncologist and hematologist and at Florida Cancer Specialists and Research Institute; and Sonam Puri, MD, medical oncologist at Moffitt Cancer Center.

Topics of discussion involved advancements in personalized therapy for non–small cell lung cancer, including targeted therapies and immunotherapies. The panelists noted the importance of comprehensive molecular testing for all stages of lung cancer, including the impact of biomarkers such as EGFR, ALK, and KRAS on treatment decisions.
As for best practices for molecular testing in lung cancer, the speakers discussed the importance of integration, the need for heterogeneity, and standardized panels. Data management and the potential for artificial intelligence and machine learning are also factors that facilitate accurate and timely molecular testing.

J. Kevin Hicks, PharmD, PhD, FCCP | Image: Moffitt Cancer Center

“At Moffitt, we do have a cloud-based security platform to where all our NGS [next-generation sequencing] results are available,” explained Hicks. “They’re discrete, and then, sort of like a spoke and wheel model, you can have these different data marks. We do have a precision medicine data mark that basically drives our clinical services, both from day to day with the consult notes plus with the molecular tumor boards. We use that to drive [decisions] as well,…so we can go in and build cohorts of patients.”

The third panel of the evening discussed the patient’s journey in CLL treatment, including personalizing therapy based on patient lifestyle choices, unmet needs, and financial toxicity associated with different CLL therapies.
Speakers included D. Alan Kerr II, MD, PhD, hematologist-oncologist and physician-scientist at Tampa General Hospital Cancer Institute; Jose Sandoval Sus, MD, FACP, hematologist and oncologist at Moffitt Cancer Center; Nikesh Shah, MD, hematologist and oncologist at Tampa General Hospital Cancer Institute; and Sarah Rockwell, PharmD, BCOP, clinical oncology pharmacist at Florida Cancer Specialists and Research Institute.
The panelists highlighted the shift from traditional chemotherapy to personalized oral therapies, with options increasingly based on patient factors such as age, fitness, and lifestyle. As for unmet needs in CLL, Richter transformation remains a significant challenge, with emerging treatments including new BCL-2 inhibitors, bispecific antibodies, and Bruton tyrosine kinase (BTK) degraders under investigation.

Nikesh Shah, MD | Image: Tampa General Hospital Cancer Institute

“I think the other thing to mention is this kind of new class of BTK degraders that are being studied on trial, and I think we’re seeing some promising early results there,” said Shah. “I’m curious to see, and I’m kind of excited to see, how those are going to play out because those may be BTK-mutation agnostic. They may still work for patients who have had prior BTK mutations.”

Regarding cost and value-based care, the panelists addressed financial toxicity and the impact of treatment-related visit burdens. They explained that fixed-duration therapies can reduce long-term costs, although upfront expenses may be higher.

The speakers also emphasized the importance of ongoing research to advance therapies, particularly for high-risk patients, to further improve outcomes in CLL.

Jose Sandoval Sus, MD, FACP | Image: Moffitt Cancer Center

“In terms of ongoing BTK inhibitors, I try to limit it to patients with very high risk,” said Sandoval Sus. “For example, with TP53 mutations or deletion 17p, we should be doing a FISH [fluorescence in situ hybridization] every time…we diagnose the patient and the type of relapse, as well as an NGS panel.”

The final panel covered the role of pharmacy in decision-making in oncology, featuring Kristen Boykin, PharmD, RPh/CPh, BCOP, BCPS, director of pharmacy operations at Florida Cancer Specialists and Research Institute; Paul Chadwick, chief value and procurement officer at Florida Cancer Specialists and Research Institute; Ken Komorny, PharmD, BCPS, vice president and chief pharmacy officer at Moffitt Cancer Center; and Frank Scimeca, PharmD, MBA, BCOP, vice president of pharmacy services at Florida Cancer Specialists and Research Institute.

Panelists discussed the challenges and opportunities of CAR T-cell therapy and bispecific antibodies. Komorny highlighted Moffitt’s experience treating 1860 patients and reducing hospital stays from more than 30 days to 7. Boykin addressed the financial strain of therapies reimbursed only at cost, stressing the need for sustainable models.

Kristen Boykin, PharmD, RPh/CPh, BCOP, BCPS | Image: Florida Cancer Specialists and Research Institute

“You have to have your financial teams involved [and] your operations teams involved, [and] everyone who touches that patient through their journey needs to be involved and…know what’s going on in order to make it successful,” said Boykin. “It’s just [become] so complicated, and everyone has…different pieces of expertise that they can bring to the table. I think that’s why a number of our more recent collaborations have been successful,…understanding that really, we need to have all the experts at the table, and not one person is expected to know everything.”

In discussing real-world evidence and patient care, the panelists emphasized the critical differences between controlled clinical trial environments and actual patient experiences. They discussed how medically integrated pharmacies can provide more comprehensive patient monitoring, connecting electronic medical records (EMRs) with direct patient interactions to track real-world treatment outcomes. Additionally, Komorny explained that medically integrated pharmacies significantly improved prescription filling speed and refill accuracy compared with out-of-state specialty pharmacies.

Ken Komorny, PharmD, BCPS | Image: Moffitt Cancer Center

“We’ve done some work a little bit in this space to look at some surrogate markers [in] time-to-fill percent of late refills,” explained Komorny. “We’ve demonstrated that if we’re filling the prescription, it’s 3 times as quick as if it’s going to an out-of-state big box specialty pharmacy. Late refills are twice as high if [the refill] goes to a big box specialty pharmacy vs if it’s filled by ours.”

Moreover, the panelists emphasized that real-world evidence goes beyond clinical trial data. It involves continuous patient monitoring, proactive adverse effect management, and adapting protocols based on patient experiences to improve treatment success and reduce health care costs.

“One of the amazing things about a medically integrated pharmacy is the ability to look at that information, connect with your EMR, and see the physician’s notes––not just what you’re seeing on your end as you fill the script, but also interacting with the patients, to have those phone calls with them, those touch points,” Boykin said. “[Adjusting] your protocols and changing your follow-ups with patients to make sure that if you keep patients on therapy, they’re going to be more successful [will] drive down the cost of care.”

It’s crucial, she said, to address these issues up front, “and not wait to have someone else tell you what the real-world evidence is [by] examining your own.”