Expanding Access to NSCLC Innovations: Challenges and Opportunities

Principal topics addressed during the panel discussion, “Immunology Advancements in NSCLC” at the Institute for Value-Based Medicine^® event in Boston included how to connect patients who have non–small cell lung cancer (NSCLC) with the newest treatment advancements, such as molecular testing and combination therapies; ensuring equitable access to all eligible patients; and prioritizing ensuring that clinical trials are seeking to answer clinical dilemmas and not just get a drug approved.

Umit Tapan, MD, thoracic oncologist, Boston Medical Center, and an assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine, participated on this panel, and in this interview with The American Journal of Managed Care^® addresses these topics, as well as potential solutions to increasing clinical trial diversity, such as addressing next-generation sequencing disparities and lack of adequate language resources.

This transcript has been lightly edited for clarity.

Transcript

What key topics were addressed in the panel discussion, “Immunology Advancements in NSCLC”?

It was great to see several of my colleagues. We discussed about the latest developments in lung cancer treatments. We discussed about antibody-drug conjugates and new combination therapies, such as drugs that combine PD-1 and VEGF [vascular endothelial growth factor] pathways, which is important in lung cancer care.

The discussion during the panel was that, yes, there are these advancements that could lead to more effective and personalized treatments, but of course, we would need to be able to integrate these into clinical practice, potentially improve survival of lung cancer patients, and enhance their quality of life. But at the same time, we need to make sure that these treatments are accessible to all eligible patients and that clinical trials should be focusing on how we could answer true real-life clinical questions.

We talked about the importance of molecular testing, which determines if a patient is a candidate for targeted treatment, and if not, then we would evaluate the patients for immunotherapy-related treatments. So, the molecular testing comes first.

So these are great advancements, but only if they are accessible to all patients. We discussed about disparities in cancer care and making sure that patients are able to get the treatments they need regardless of their socioeconomic status or geographic location.

We also discussed about clinical trial enrollment. We all know that it is very difficult to conduct a clinical trial, to be able to find correct patients for these trials. But we also need to acknowledge that the focus of a clinical trial should not really be just to get a drug approval. We should prioritize clinical trials that would address the most important clinical questions in oncology, and make it possible for the clinicians, like myself, when we are facing a patient, to be able to make the best decision for the patient based on the clinical trial results.

What are some ways to increase clinical trial enrollment diversity?

This is actually a very important question, and it is one of the areas that I am focusing on when I mentioned about the disparities in lung cancer care. So, when clinical trial enrollment starts, for lung cancer at least, a very important aspect of clinical trial enrollment is actually next-generation sequencing. Because studies have shown if a patient has next-generation sequencing—which is the best molecular testing to understand the genomics of the cancer—having this done prior to initiation of first-line therapy increases a patient's chance to participate in a clinical trial by more than 50%. And we know that there is disparity in next-generation sequencing testing. Studies have shown less than 40% of the patients actually who are African American get the testing done, whereas it’s about 50% or a bit more for White patients. So there is disparity in next-generation sequencing, which impacts clinical trial enrollment.

Of course, this is not the only factor for clinical trial enrollment. There are language-related barriers. You could have a clinical trial which will allow only certain patients who speak a certain language. So being at Boston Medical, we have 30% to 40% of patients who are non-English speakers, and if a clinical trial does not have a consent [form] for that language, this will be a barrier. And geographic location is also important for clinical trial enrollment. If a patient lives in an area where they don't have access to the hospitals that provide clinical trials, then they won't be able to be involved. All of these are contributing factors for clinical trial enrollment.