Keeping Up With Evolving Data to Better Cancer Care

With all the practice-changing data coming out at major conferences, it’s getting harder for physicians to keep up and practice medicine, said Davey B. Daniel, MD, chief medical officer (CMO), OneOncology, to kick off the second fireside chat on day 2 of the annual Patient Centered-Oncology Care^® meeting.

Davey B. Daniel, MD

Image Credit: Tennessee Oncology

Stephen "Fred" Divers, MD

Image Credit: American Oncology Network

Daniel was joined on stage by a fellow CMO, Stephen “Fred” Divers, MD, of American Oncology Network. The depth and breadth of data analytics and knowledge a practicing oncologist has to have is “insurmountable,” Divers said. “It's also a Sisyphus project, right? It never ends.”

Both CMOs are grappling with the challenge of assisting oncologists to do the job with the best data, but there’s only so much they can manage at the point of care in a 15- to 20-minute time window with the patient, Divers said.

Daniel admitted that he got a “panicky feeling” at the American Society of Clinical Oncology (ASCO) meeting, listening to all the presentations on the latest data and updates to practice. He was wondering which patients had finished what line of therapy and if the adequate testing had been done “because now everything has changed.”

Health care is a “living, breathing thing,” Divers agreed. There has to be a good system to integrate clinical decision support, because physicians make the best decisions when they have access to the best data. With precision medicine, there are more and more cancers where clinicians can make a huge difference.

Strategic arrangement and alliances are becoming more important to access, curate, and operationalize data, he said. There are a lot of data out there, but unless it’s operationalized, it’s meaningless.

“If you can't get the data to the hands of people making a decision at the point of care, then you're not doing the job,” Divers said. The job isn’t even done then, because real-world evidence will help clinicians continually learn, which is an area where artificial intelligence may have a role.

He expressed excitement that real-world evidence might get the industry to a place where patient data is continuously being curated and updated for physicians to learn from. It isn’t possible to do a clinical trial for everything, but real-world evidence can help them understand how to treat the next patient.

With all the new clinical trial data coming out, there is a struggle to find the inflection point, he added. At what point are the data still too early and when do they become something that is actionable? For instance, his organization debated the use of polatuzumab in the diffuse large B-cell space when there was progression-free survival data but not overall survival data. Another example is minimal residual disease (MRD. Currently, it’s not clear what to do when a patient has positive MRD, because the knowledge is still evolving about when to intervene.

There can also be debate over when a mutation is actionable, such as HER2, which can be amplified or mutated in a variety of cancers, but there is also HER2-low and even ultra-low, and it’s not always clear how that should be interpreted for actionable decisions. This information needs to be recorded properly so it’s meaningful, and practices need good data partners and next-generation sequencing test partners to help find the areas of meaningful impact, he said.

Finally, Divers pointed to the challenges with interoperability. Although health information exchanges have been in place for a decade, they aren’t where they need to be to create real connectivity.

“Figuring out how we create interoperability of all [these] precision tests to follow a patient through their journey is key,” Divers said.

Daniel agreed, adding that there is a knowledge gap that needs to improve not just between organizations, but within organizations. There is a lot of work to be done, they both said.

“But I think these are the things that change the outcomes and allow the Matthews [advocate and survivor Matthew Zachary, the keynote speaker at PCOC] of the world to be here, ultimately,” Divers said. “So, it’s work that’s well worth the effort.”