ASCO’s Annual Report: Major Advances in Oncology and the Challenge of Value-Based Care

Eileen Koutnik-Fotopoulos

April 2015, Vol 6, No 3 - Health Policy

Significant gains in cancer research and prevention have led to longer survival, improved quality of life, and decreased disease burden. The 2015 annual report on “Clinical Cancer Advances” from the American Society of Clinical Oncology (ASCO) outlines the biggest advances made in oncology, and for the first time designates one cancer as the Advance of the Year, as well as emphasizing the ongoing challenge of value-based care (Masters GA, et al. J Clin Oncol. 2015;33:786-809).

“Clinical Cancer Advances is a comprehensive overview of advances across the cancer care continuum—from prevention and screening to treatment and survivorship—and it covers a broad range of cancer types, including progress against rare cancers,” ASCO President Peter Paul Yu, MD, Director of Cancer Research, Palo Alto Medical Foundation, CA, told Value-Based Cancer Care (VBCC).

Dr Yu noted that this report “presents a narrative of the top trends in oncology taking place across disease areas. This narrative highlights exciting areas of cancer research and the growing number of treatment options we have now, that we didn’t have 20, 40, or 60 years ago.”

In addition, however, the report emphasized the ongoing challenge of paying for these advances in oncology and the high cost of cancer care, which present barriers for patients and for oncologists, negatively affecting patient outcomes, and making value-based care an urgent topic requiring continuing discussions and new solutions.

Advance of the Year: Chronic Lymphocytic Leukemia

The biggest advance in cancer research was identified as the transformation of treatment for chronic lymphocytic leukemia (CLL), the most common form of leukemia in older adults, with the approval of 4 new therapies. These include 2 immunotherapies, obinutuz­umab (Gazyva) and ofatumumab (Ar­zerra), and the 2 new tyrosine kinase inhibitors, ibrutinib (Imbruvica) and idelalisib (Zydelig).

“Over a merely 1-year period, patients with CLL gained 4 new treatment options. This marks an unprecedented pace of progress for any single type of cancer. The new therapies have filled an unmet clinical need for those with newly diagnosed or resistant disease, making treatment—and remission—possible for more patients than ever before,” Dr Yu told VBCC.

Advances in Treatment, Prevention, and Screening

The report highlights advances in combination therapies and targeted therapies for cancer. Of special note are the new combination therapies for patients with brain cancer and those with prostate cancer. The combination of chemotherapy and radiotherapy in patients with low-grade gliomas extended patients’ life span by 5 years compared with radiotherapy alone. For patients with advanced prostate cancer, first-line chemotherapy combined with hormone therapy showed improved patient survival.

The new targeted therapies became available for non–small-cell lung cancer, advanced stomach cancer, and ­radioiodine-resistant differentiated ­thyroid cancer.

Immunotherapies are a main advance in cancer therapy, and many new drugs are targeting rare types of cancer.

Two major advances in cancer screening and prevention include the oral drug anastrozole (Arimidex), which showed an almost 50% decrease in the risk for breast cancer in a large study of postmenopausal women at risk for breast cancer. And the new Medicare reimbursement for lung cancer screening with low-dose computed tomography may help to diagnose lung cancer at an early stage and reduce deaths.

There has also been exciting progress in understanding tumor biology. “Large-scale cancer genome analyses have provided a wealth of new information that may help identify new targets for cancer therapy. This new information may also help identify biomarkers for use in monitoring disease progression, assessing the risk for relapse, and selecting the optimal therapy for each individual patient,” explained Dr Yu.

The Challenge of Value-Based Care

The importance of value-based cancer care remains a continuing challenge. “Healthcare has become increasingly unaffordable to patients and their families and to society at large, both of whom bear the costs of care. As this happens, increasing numbers of patients face the threat that they will be left behind the advances in cancer care. Disparities in healthcare will widen,” Dr Yu told VBCC.

“To prevent that from happening, it is critical that patients and physicians understand the value of treatment options. In any treatment situation, the health and individual needs of the patient are paramount, and determining the value of any particular cancer treatments is a highly personalized process that must be determined between a physician and patient,” Dr Yu emphasizes.

He added that ASCO is developing ­a framework for value-based care that will provide a “physician-guided decision-making tool to help physicians discuss with their patients the value of any particular treatment and will support patient-centered care.”

The Next 10 Years

The report predicts the trends likely to shape the next 10 years of cancer care. Dr Yu said that faster and less expensive genomic testing (eg, next-generation sequencing) “is poised to revolutionize personalized medicine, both as a diagnostic tool and a way to tailor targeted treatments to individual patients.”

He also noted that nanotechnology is another area that has broad potential for improving cancer treatments. “Nanoparticles ‘loaded’ with cancer drugs can be designed to release their cargo only upon docking onto or entering cancer cells. This feature spares healthy tissue of toxic side effects, allowing delivery of higher doses of cancer drugs to the tumor.”

The use of liquid biopsies to diagnose cancers from circulating tumor cells and DNA can determine the cancer subtype, estimate how fast the tumor is growing, monitor response to therapy, and detect relapse. “Cancers evolve over time, often becoming resistant to therapies. This will allow us to be more agile in responding by changing our therapeutic strategies. However, it is unknown yet whether such approaches truly translate into improved outcomes for patients,” said Dr Yu.

Important advances in health information technology will further improve quality care and outcomes, Dr Yu concluded. “New big-data health information technology will delve into the massive and rapidly growing array of cancer research data and guidelines to help physicians deliver care that is personalized to the unique characteristics of patients and individual tumors,” he said.