I would like to see that every cancer center in America provides all patients with the opportunity to have their tumor extensively characterized for mutations and other molecular abnormalities, so treatment is based on those molecular abnormalities. Only then will precision medicine truly become a reality.— Bruce E. Johnson, MD, FASCO
Ensuring that all patients with cancer have access to the potential benefits of precision medicine regardless of where they are treated has been a primary goal of Bruce E. Johnson, MD, FASCO, since the concept was first introduced following completion of the Human Genome Project in 2003. Dr. Johnson is so determined to make personalized medicine a reality for all patients with cancer, he has made individualizing care based on the molecular characteristics of a patient’s tumor the central theme of his term as President of ASCO in 2017 to 2018.
As Dr. Johnson prepares to take office as President of ASCO during the ASCO Annual Meeting, June 3–7, in Chicago, he is already focused on putting in place the tenets of the theme of his Presidential year: Delivering Discoveries and Expanding the Reach of Precision Medicine. An ASCO member since 1986, Dr. Johnson has served the Society in a variety of capacities, including as a member of the Board of Directors from 2008 to 2011 and Chair of the Audit, Cancer Education, and Cancer Communications Committees, among others. In 2008, Dr. Johnson was awarded the Translational Research Professorship from the Conquer Cancer Foundation of ASCO.
The ASCO Post talked with Dr. Johnson, Chief Clinical Research Officer and Institute Physician at Dana-Farber Cancer Institute; Professor of Medicine at Harvard Medical School; and Director of the Dana-Farber/Harvard Cancer Center Lung Cancer Program, about the goals he hopes to accomplish during his year as President of ASCO.
Personalized Care for All
Precision medicine has been a field of interest of yours for a long time. How will that interest impact your term as ASCO President?
I would like to see the benefits of precision medicine reach a greater number of patients with cancer than they do currently. Although the majority of our patients are cared for in community hospitals and private oncology practices, personalized care that takes into account the molecular information about a patient’s tumor to identify the most effective treatment is still more commonly performed at academic medical centers. That has to change. We want to make sure that the scientific advances taking place within the academic cancer centers continue to make their way to community practices.
Earlier this year, ASCO launched a free online course on “The Future of Genomics and Precision Medicine,” which was designed to help oncologists understand the evolution of precision medicine and how big data analytics can improve the care of patients. The course also provided a glimpse at how CancerLinQ™ incorporates data from patients’ medical records to analyze patterns in patient characteristics, treatments, and outcomes and provides physicians with guidance on matching targeted treatments based on the biology of each patient’s cancer.
We would like to continue our educational process both in the multiplex genotyping of tumors and in the meaningful reports generated from that sequencing to show actionable mutations in each patient’s tumor and what specific drug or clinical trial would be appropriate for that patient. We want to make certain that the education we provide keeps pace with the ever-changing knowledge in oncology care. Our current method of using a set of slides to teach new medical concepts isn’t a format that will continue to work indefinitely in this fast-paced technologic era, so we will be working on changing the way we present educational programs.
Expanding the Reach of Personalized Care
How do you plan to expand precision medicine in community practice settings?
We are planning a multipronged approach. First, we want to make certain that the cost associated with next-generation sequencing is reimbursable by third-party payers.
The U.S. Food and Drug Administration’s (FDA) Oncology Center of Excellence has launched a podcast series called the “FDA Drug Information Soundcast in Clinical Oncology,” referred to as D.I.S.C.O. The series was inspired by meetings with community oncologists, who indicated a need for easy-to-access information about new drug approvals and other topics.
Richard Pazdur, MD, Director of the Oncology Center of Excellence, explains in an introductory podcast that the initiative is part of FDA’s effort to provide concise, timely information to patients with cancer and their treating physicians. The podcast is hosted by two FDA oncologists, Dr. Abhilasha Nair and Dr. Sanjeeve Bala.
The podcast is available on the Oncology Center of Excellence website at www.FDA.gov/OCE and also on iTunes, and the OCE will announce new installments on its Twitter account @FDAOncology. Watch for more on D.I.S.C.O. in future issues of The ASCO Post.
Second, we want more community oncology practices to participate in ASCO’s Targeted Agent and Profiling Utilization Registry (TAPUR) Study (tapur.org) in which targeted therapies are made available by participating pharmaceutical companies at no cost to patients enrolled in the study. Oncology practices can sign up for the study and obtain access to drugs for patients with advanced cancers that have a potentially actionable genomic variant. We want to continue the program so these drugs become more widely available not only in academic cancer centers but in private practices and community cancer centers as well.
Third, we plan to continue the development of CancerLinQ and extend its reach to more community oncology centers to help guide our members to the most effective treatments tailored to each patient’s tumor types. I am planning on working with ASCO members of the CancerLinQ LLC Board of Governors, the ASCO Institute for Quality, the ASCO Board, the Advisory Groups, ASCO staff, and volunteers to continue to expand and streamline the clinical practice guidelines process, make the health information technology resources available for delivering care to our patients, and integrate the performance measures as part of oncology practice.
What are the issues of greatest concern confronting ASCO members over the next year, and how will ASCO tackle those challenges?
Our main concern is that our patients continue to obtain high-quality, affordable cancer care and that our members are paid well enough to afford continuing to treat patients. There have been proposals on Capitol Hill to change the Affordable Care Act, and we do not yet know what our health-care system will look like in the future.
ASCO operates on a set of principles that no patient should be denied care because of preexisting health conditions and that no patient should be denied care or have treatments interrupted because of cost. We do not control the prices of drugs, but we can use evidence-based approaches to prescribe the best value-based care for -patients.
ASCO’s Value in Cancer Care Task Force developed the ASCO Value Framework, which assesses the value of new cancer therapies based on clinical benefit, side effects, and improvements in the patient’s quality of life in the context of cost, and oncologists can use it in shared decision-making with patients. And through ASCO’s Advocacy & Policy Group, we are able to advocate on Capitol Hill for increased federal funding for research, greater health-care access for patients, and payment reform.
We know that health-care costs are among the leading causes of financial distress and anxiety for patients, and we believe that patients will have better outcomes if they worry less about having adequate resources to receive the best care for their malignancies. We stand for our patients having access to affordable health care and not having excessive insurance co-pays, which put them in a difficult financial situation. So another one of my goals is to ensure that patients with cancer have the financial support they need to get the best care.
A Lasting Legacy
What lasting imprint would you like to have on the Society?
I would like to see that every cancer center in America, both in the academic and community settings, provides all patients with the opportunity to have their tumor extensively characterized for mutations and other molecular abnormalities, so treatment is based on those molecular abnormalities. Only then will precision medicine truly become a reality. ■
Disclosure: Dr. Johnson has received postmarketing royalties for EGFR mutation testing (owned by Dana-Farber Cancer Institute) and institutional research funding from Novartis.