In Cancer, Process Drives Progress - Pharmaceutical Executive


In Cancer, Process Drives Progress

Pharmaceutical Executive

It was noted that increased collaboration among stakeholders will be required to keep these standards fresh and relevant, with a pertinent example being the joint Value Pathways project just launched between McKesson Oncology Research and the leading independent source of physician-led guidelines, the National Comprehensive Cancer Care Network (NCCN). The Value Pathways are designed to assist oncologists in managing care for 19 cancer tumor types, but their real novelty is in addressing head on the complex, sensitivity-laden notion of "value"—by building in a peer reviewed evidence rationale for every cost incurred.

While the growing sophistication of guidelines and pathways is a welcome trend, there are institutional challenges that threaten to impair their effectiveness. These include the difficulty of compiling convincing clinical data on outcomes for many cancers; reconciling the standardized protocol approach against the growing scientific capacity to deliver treatments tailored to an individual's unique genetic profile; contradictory regulations, as represented by the actions of many US states to limit the legality and scope of privately-sponsored guidelines; and the sheer proliferation of activity around guidelines, which ultimately poses a redundancy problem. Again, the cancer community may be best positioned to resolve these roadblocks, since historically it has moved further and faster than other specialties in relying on guidelines and other evidence-based tools to set the standard of care for patients.

Such optimism is underscored by the group's conviction that many cancers are going to be not just treatable—but beatable—within the next decade or so. Scientists are learning more about the special characteristics of cancerous stem cells, promising over time a new way of avoiding tumor metastases. The fight against HIV is producing insights that may yield new immunotherapy treatments for cancer, and there is a small but budding research agenda around cancer prevention, which could accelerate if issues around securing a better return from investments in prevention are resolved.

Finally, the old adage that perception drives reality was reinforced through a survey conducted by Eli Lilly & Co. that found more than half of patients today believe cancer is one disease—and thus can be defeated with one cure. Is it just a coincidence that regulators still tend to address the approval process in the same way, with little if any focus on devising enhanced registration benchmarks for very small drug indications? Cliché or not, the future of cancer is not macro, but micro.

William Looney

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