Other problems include the sparsity of available care, and the ability of large cancer centers to effectively pool genomic data. Precision medicine “just isn’t available to everyone,” said Dr Wolchok. Greater collaboration across the country, however, will improve cancer care among all centers nationally, not only for the larger hospitals.
The panel members were reluctant to discuss cost of care. Enrollment on clinical protocols, an important goal for the Cancer Moonshot program, may be one way for patients without extensive financial resources to receive the care they need. But these protocols are not available everywhere in the United States, and experimental regimens, by definition, are not right for every patient. “I can’t speak to the cost,” said one panel member. Precision therapy may “lower and justify the cost,” said another.
Former US President Jimmy Carter’s remission from stage IV melanoma was a frequently-cited topic, though oncologists cannot attribute that success in treatment to immunotherapy. The cost of the former President’s cancer treatment was not discussed.
When asked how many patients respond to immunotherapy, the panelists’ answers ranged from 5% to 50%, though all members agreed that the correct answer depends on the area of treatment. Lung cancers with KRAS mutations, for example, are notoriously difficult to treat with immunotherapy, though pediatric cancers, as noted before, are frequently responsive.
Panelists were also asked about the expected advancements of precision medicine. Combination therapies in targeted settings were agreed to be promising, though extensive understanding of tumor genetics is required to effectively implement these combinations. Communication, both internationally and nationally, was agreed to be of vital importance to advancements in treatment. One panelist added inconsequently that “we are closer [to a cure] than previous generations have been.”
Another panelist answered this last question by addressing education: oncologists are needed in the US, and for cancer to be treated effectively, there needs to be a larger oncology workforce.
There is likely no single correct answer, and, as the panelists agreed, collaboration and effective communication are vitally important. Just as combinations of treatment are important in cancer care, so is communication among researchers, medical oncologists, and care centers important to learn more about treating cancer effectively.
- Precision medicine in cancer research. 2016 Concordia Summit; September 19, 2016; New York, NY.