[ad_1]
Trends in the treatment of cancer patients are shifting towards earlier intervention, with effective therapies such as immunotherapy moving to neoadjuvant stages to improve outcomes. However, Geoffrey D. Moorer, MD, believes challenges remain in ensuring broader access to sequencing and overcoming data complexity.
While the future holds immense potential for artificial intelligence to revolutionize treatment planning, for now the focus is on maximizing access to existing advances and prioritizing comprehensive diagnosis for all patients with advanced cancer.
In an interview with Targeted OncologyM.T.Geoffrey D. Moorer, MD, medical oncologist at Virginia Cancer Specialists, discussed recent trending topics in the field of oncology among hospital tumor boards and committees.
Targeted Oncology: Can you share some thoughts on the latest developments among tumor boards and committees that have been discussed?
Moorer: Some of the emerging issues in cancer care that tumor boards and committees are discussing are our continued efforts to find the right treatment for the right patient at the right time, which essentially involves personalized medicine. This typically includes next-generation sequencing of patients, either in their tumor sample or in the patient’s serum. Ideally, that will allow us to find the right treatment for the right patient, whether it’s a small molecule inhibitor, whether it’s immunotherapy, whether it’s endocrine therapy, whether it’s traditional chemotherapy or some combination of those things. .
What emerging therapies or treatments have been hot topics in the oncology space?
While checkpoint inhibitor immunotherapy has been a hot topic over the past 5 to 10 years, there remain prior approvals for a variety of checkpoint inhibitors. I think a trend is that we are advancing those treatments in our treatment of cancer patients. There is more emerging data on neoadjuvant therapy, primarily in the lung space, but also in the breast cancer space. There are still many approvals for patients with advanced disease, who are extending their lives and improving their symptoms. Basically, these drugs work very well, which is why it has been one of the hottest topics in the last 5 to 10 years.
It would also include small molecule inhibitors, which are things that can be detected in next-generation sequencing or molecular testing. They continue to be used in a variety of tumor types, again in our well-known breast cancers and also in lung cancer. Small molecule inhibitors also have the advantage of being largely oral. That provides not only efficacy for patients but also some convenience in terms of being able to take those medications at home and not have the added burden of coming to our infusion clinics and requiring infusions.
Have there been any notable changes in multidisciplinary approaches to cancer treatment?
We are advancing systemic therapies in the treatments of our patients. There is now a lot of evidence emerging that new adjuvant therapy, with immunotherapy, checkpoint inhibitors, and chemotherapy combinations, leads to better patient outcomes in the lung cancer setting. There is also more data in the breast cancer space. Furthermore, other areas, such as [genitourinary] tumors. I think those would be the top 3 where we have some emerging data on how to advance those treatments earlier in the neoadjuvant space before surgery, but also in the adjuvant space, improving your chances of care or patients with advanced disease receiving those treatments. Earlier treatments have been shown to extend overall survival, which is the goal in patients with stage IV metastatic disease that is generally not curable but treatable.
What challenges are being addressed in terms of personalized medicine and targeted therapies?
This is a recurring theme: patients must be the right patient. [and get] the right treatment at the right time. All patients should receive next-generation sequencing testing, either on their tumor sample or serum. There are a lot of different companies, a lot of different players in that space, so I think the biggest challenge is ensuring that patients get the right diagnostic study and the right pathology study with next-generation sequencing.
There are currently studies analyzing the rates of patients receiving next generation sequencing and they should be 100%. Any patient with metastatic disease who is undergoing treatment should undergo next-generation sequencing. Many patients have early disease, as I mentioned, because we are finding more uses for these drugs in the neoadjuvant and curative-intent curative space. I think we are rapidly approaching a space where almost all patients diagnosed with cancer will receive some type of molecular testing and next-generation sequencing. I’m sure there will be data to support that patients who get tested have better outcomes than those who don’t.
Many times that can be financial. In my experience, our partners in that diagnostic space have been filling the gap for patients who may have some gaps in terms of their insurance coverage. But it is essential that, as doctors and providers, we order those tests.
Have there been discussions about incorporating genomics and precision medicine into cancer care?
Absolutely. Genomics and precision medicine allow the right patient to receive the right treatment at the right time. By performing next-generation sequencing testing, we will be able to find approved therapies for which they are eligible, but also clinical trials. Many of these clinical trials that we are doing now are tumor agnostic. They are not for lung cancer, nor for breast cancer, nor for colon cancer, but for patients with certain mutations, a KRAS mutation, MET amplifications. The only way to detect them is with next generation sequencing. That is a recurring theme and I think it will be the bread and butter of all cancer treatment in the future.
Are there any collaborative research projects or clinical trials that you can discuss in this space?
In my practice here at Virginia Cancer Specialists, our goal is to conduct a trial for every patient who is healthy enough to participate in clinical trials. But we certainly have clinical trials and [of] all our major tumor types, our largest portfolio[s are] probably in the lung and breast. For example, right now we have a trial on lung cancer in patients with MET amplifications where they obtain neoadjuvant MET inhibitors, such as capmatinib [Tabrecta], and then they go on to surgery and then they also receive adjuvant treatment with capmatinib. This is a mutation that will only be detected with next-generation sequencing, so it is a perfect example.
Otherwise, in the past, that patient would have gone straight to surgery and perhaps received adjuvant systemic therapy in the form of chemotherapy or immunotherapy. Now we know that with that mutation, those patients will most likely do better. Research has shown that they do better in advanced space. We are hopeful and early. Preliminary results are that they do better in the neoadjuvant space, as expected.
How are artificial intelligence and machine learning used in cancer diagnosis or treatment planning?
AI is a hot topic in everything from medicine to finance, urban planning and everything in between. I have not seen any examples in my own practice of the direct impact of artificial intelligence. What I would predict is that as all these massive amounts of data come in, patients get next generation sequencing, we will find more targets, more mutations, other biomarkers that tell us which treatments may work for which patient, but then you also have the additional complexity of sequencing these treatments, as well as the comorbidities that patients may have. Therefore, certain patients may not be eligible for certain treatments due to toxicities or risk of toxicities or interactions with other medications.
I see it as a space where artificial intelligence is collecting all of those different factors, patient factors, disease factors, etc. and predicting which treatments will be most effective for which patient and at what time. I think that’s certainly on the horizon, but it hasn’t entered clinical practice yet. As far as I know, it’s not even in the advanced or mature research space yet, but I certainly think there will be more to come very quickly in the coming months or years.
What are the key points a community oncologist should take away from this discussion?
The bottom line is that all patients diagnosed with cancer, especially advanced disease, should receive next-generation sequencing from their serum or nearby tissue. As a cancer treatment community, our goal must be 100% and make sure that all of those patients receive the correct pathology and diagnosis.