Decision making in an increasingly complex treatment environment

The last 50 years over which the ASCO has existed has seen huge advances in our understanding of cancer, and therefore also in how we can treat the disease. While this is obviously overwhelmingly positive for patients and physicians, this has also meant that treatment decisions are getting ever-more complex.

We asked Niko Andre, Head of Global Medical Affairs Oncology at Roche, for his perspective on how decision-making by physicians has become complicated these days, and how this can be addressed.

How is the oncology treatment landscape changing?

I think the oncology treatment environment has changed substantially over the last couple of years. We have always seen evolution of treatment options, with some smaller incremental improvements and other bigger advances. From my oncologist perspective, I feel that there has never been a time of more opportunity to bring better treatments to patients – and even to achieve cure in certain diseases. On the other hand, I think there has never been a time of more complexity and of challenges to overcome to ensure that we can translate these benefits from our development programmes into tangible improvements for patients.

We must not forget that cancer represents the major healthcare burden for the globe in the decades to come. While today we talk about fantastic scientific advancements, we also have to admit that there are millions of patients who do not even have access to standard best supportive care. I really think we need to commit ourselves to ensuring that access to meaningful cancer treatment is made possible for these patients, particularly in those countries where the latest standards of care are not yet available.

To reflect on how today’s cancer treatment has gotten more complex, probably it is best to step back fifteen years and think “what were my options as a treating oncologist back then?” For several cancers – in particular solid tumours – there were not that many. Looking at the options that you have today – from how many molecules you can pick, and how many different diagnostic tests you can run to identify a subset of patients who could benefit from choosing a particular targeted drug – it is an immense richness on the one hand, but on the other hand it is really getting complicated. So if I would be a community oncologist these days it would be difficult to basically maintain oversight.

This is where it is very important that we, as key drivers of advancing cancer care, also ensure that our communication towards healthcare professionals, our medical education efforts, really are state-of-the-art to ensure that the great promise offered by this multitude of molecules and diagnostic tests actually reaches them.

What is your view on how oncology drugs should be best used in the future?

There is enormous promise out there with regards to identifying an individual patient’s condition and then being able to choose, from a whole catalogue of potential treatments, the very right one at this very time point. Then we can check again at a later stage of the disease whether it has changed its genomic background and whether you need to pick another drug because you have encountered resistance to the initial therapy, and so on.

This is all great on paper, and we have already seen some areas where it also works in clinical practice, and that is very impressive. The big question for me is: how is all this going to reach the broader group of the “everyday” patient? Right now we are looking at patients who are participating in very sophisticated, very expensive, very tailor-made clinical trials, and I think that the most important goal that we need to have is to ensure that we make these treatments available for the broader oncology patient community.

What information do physicians need in order to make treatment decisions, and how should Pharma address these needs?

I think it is very important that physicians have instant access to state-of-the-art, peer-reviewed scientific data. Ensuring that our data are communicated to the scientific community and also made available in the public domain, and that the most accurate, highest quality standards are maintained, are therefore things that we are very committed to.

The second thing is that medical societies will play an even bigger role in the future in determining which treatments are most beneficial for patients. They will continue to develop treatment guidelines, which are absolutely essential in these days of ever-growing numbers of available treatment options. The societies maintain oversight and ensure that patients receive the best possible treatment when there are so many choices out there.

Roche is extremely committed to ensuring that data publications are of high-quality and meet the needs of the medical community. In addition, we have been a major supporter of the data transparency initiative, which I think is a great step towards enhancing even further how scientifically valid data are distributed within the scientific community. We are ensuring that we maintain the appropriate transparency, for example through timely reporting of clinical data whether it is positive or negative, as we will learn from every piece of data that is there.

How do you see the oncology environment looking in five years' time?

Personally I am most interested to see how we are going to answer the question on access – not only to treatment, but also access to diagnostics. Diagnostics are absolutely essential for many cancers these days, because they basically decide which treatment to use and which treatments not to use.

We are quite active in working with several different partners not only to ensure that we can play a role in providing these diagnostic solutions, but also in ensuring that access to diagnostics for the individual patient becomes a reality – not only in the very advanced and sophisticated high-tech areas, but also on a much broader scale.