Transforming Cancer Care: Lessons from ASCO's 2023 Annual Meeting

Two weeks ago, many of us returned home from ASCO’s annual meeting with hoarse voices, 10K+ steps daily average, and “poor recovery” from biometrics as a result of the 6 AM to 10 PM days.

For a Californian suburbanite like me, ASCO is the New York City of conferences where the collective energy drives me to burn bright and hard for 4-5 days in Chicago. This year’s ASCO felt like pre-pandemic meetings with more than 36,000 in-person attendees and non-stop posters and presentations, hallway meetings, cross-town treks, and conversation-rich dinners.

In full disclosure, I was exhausted and needed some time before putting my thoughts together for this post.

This year’s theme – partnering with patients – was timely and important. The pandemic has taken a toll on cancer care across the patient journey; only through working with our patients will we be able to get back on track toward meaningful reductions in the suffering cause by cancer.

Across the research lifecycle from discovery to survivorship, the scientific program was rich with the promise of improved and continuing care as we apply these breakthrough technologies and medicines into the clinic. There is a lot to be excited about and it is incumbent on all of us to engage and partner with patients, so they share in the excitement and benefit of advances in cancer care.

From the perspective of Illumina’s chief medical officer, a few key observations stood out to me:

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1.????Evidence shows that comprehensive genomic profiling can significantly improve outcomes for cancer patients. CGP is a next-generation sequencing approach that uses a single test to assess hundreds of genes, including relevant cancer biomarkers for solid tumor therapy guidance.

My colleague Kevin Keegan, VP and general manager of oncology at Illumina, spoke to an abstract from Illumina that highlighted how the application of CGP-guided therapy led to significantly higher survival in a reflex testing population. The study, which was done in partnership with Providence Health Network, was designed to automatically order no-cost CGP testing for patients as soon as they were diagnosed with advanced cases of cancer. Of the more than 1,400 patients who were included in the study, the tests found actionable biomarkers in almost half of them. The study also found that the group treated with targeted therapies had one-year survival rates of over 70%, compared to less than 63% for patients treated with just chemotherapy.

While the evidence for making CGP a standard of care is clear to researchers, we must find ways to make it practical for physicians. I was encouraged by the high level of interest in applying this technology at the Illumina booth, where we invited attendees to play an education game called Comprehensive Genomic Protector, designed for providers to practice connecting variants with targeting drugs. While the game is a lighthearted exercise, it gets to a bigger point: for CGP to be effective, we must create greater clarity for physicians on how the technology can be applied, especially given the lack of testing we are seeing today.

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2.????With 50% - 80% of eligible insured patients not receiving the tests they need in some studies, there is an urgent need to democratize genomic profiling in cancer care. While we’ve seen great progress in expanding access from a few payers like United Healthcare and Cigna who insured whole genome sequencing, an alarming number of patients do not receive genomic profiling when they are diagnosed. ?

I strongly agree with Weill Cornell Medicine’s Dr. Pashtoon Murtaza Kasi, who shared in a panel discussion that “we can’t justify not testing our patients” to find out their actionable markers. While it may be confusing at first why this isn’t happening at scale already, we must consider how resource and time constricted many healthcare providers are right now. Unless we integrate these new technologies into their workflow, it’s just not going to be information that’s utilized, harming the ability for these life-saving treatments to be made more accessible and affordable for patients over time.

This is an unfortunate reality identified in one of Illumina’s abstracts accepted to ASCO, which demonstrated how using small panels causes us to miss many markers. This not only limits our understanding of different populations and the treatments that may be viable, but it makes care even less equitable.

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3.????To translate research and technological advancements into better care for patients, we must work together. This was a major theme of a panel discussion Kevin and I had with Weill Cornell Medicine’s Dr. Pashtoon Murtaza Kasi, Allegheny Health Network’s Dr. John Nakayama, and Florida Cancer Specialists & Research Institute’s Dr. Lucio Gordan. If we’re missing any piece of the puzzle from reimbursement to physician training, the incredible progress we’ve made could be lost before it gets to our patients.

In our discussion, Dr. Gordon shared how his practice is pioneering innovations in community oncology that simply could not be done without Illumina’s support.

I’m particularly excited about our recently-announced collaboration with Dr. Nakayama at Allegheny Health to evaluate whether blood-based testing can inform oncology providers of targetable genetic variations within a patient's cancer. Earlier in the year, we also launched the?first companion diagnostic claim for the TruSightTM?Oncology Comprehensive (EU) test with Bayer, which is enabling targeted therapy for patients with NTRK fusion cancer. These are just two examples of how we can use partnerships to bring innovations directly to patients.

This research and these ideas shared by leaders across the healthcare ecosystem at ASCO demonstrated that we can leverage widespread adoption of innovation and transform biological insights into better care for patients.

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Of course, we also must admit that our care still fails our patients too often.

After ASCO, I spent time with a friend and colleague whose cancer was progressing despite the best of molecular oncology. Even when we know a cancer’s whole genome, when we have CAR-T cell therapies, combination chemotherapy, targeted small molecule-based therapies, and antibody-based therapies, cancer can be unrelenting. All our knowledge, technologies, and treatments, remain inadequate for too many friends, family, and colleagues who are diagnosed with cancer.

We must continue to partner with patients to improve care and continue our collective efforts to eliminate the suffering caused by cancer. We have a full year ahead to make meaningful progress so that we can return to Chicago in 2024 and hear of additional breakthroughs.