For this article, Alight talked with Dr. John Strickler, a Medical Oncologist at Duke, to share the second part of this series on precision medicine. We reviewed the growing opportunities for precision medicine in cancer treatment and how organizations can approach advances in this area.
Earlier we spoke with Dr. Gerry Blobe, a Professor at Duke University, about the promising role of precision medicine in cancer detection and prevention.
The idea that the immune system could play a role in fighting cancer was once only whispered about in the medical community. But today, targeted therapies designed to attack harmful genetic mutations are leading the way. What has changed, and how should employers respond to ensure their employees have access to these new treatments?
(This interview was edited for clarity.)
Alight: Can you tell us about biomarkers? What are they and why do we test for them?
Dr. Strickler: A biomarker is something we measure to see what’s happening inside a cell. It can be a protein on the cell’s surface or a genetic change that helps identify a particular cancer cell. In precision medicine, we use biomarkers to help give patients the right treatment at the right time.
Alight: What’s the difference between prognostic and predictive biomarkers?
Dr. Strickler: Prognostic biomarkers tell us how aggressive a cancer is. A good prognostic marker indicates that a patient will do well no matter what treatment is given, while a bad one suggests a shorter survival. Predictive biomarkers help us decide which treatments to give based on the protein or genetic mutation of the cancer cell. Some mutations make a tumor very sensitive to a certain therapy, while others can make it resistant.
With a prognostic biomarker, the outcome is the same no matter the treatment. With a predictive biomarker, we can change treatments to get a different result.
Alight: How has the approval process for drugs changed because of biomarkers?
Dr. Strickler: The benefits of some biomarkers in precision medicine are so clear that it’s not ethical to do a trial where some people get a placebo. The FDA doesn’t require a placebo control trial for biomarkers anymore because the effect of the treatment is so significant.
Alight: Is there a demand for precision medicine in cancer treatment? Are patients asking for it by name?
Dr. Strickler: Yes, more people are asking for precision medicine thanks to media and the Internet. But not every patient is a candidate for these therapies, and the healthcare system has trouble keeping up with the demand. Physicians spend a lot of time explaining why certain therapies are given or not given, which can be confusing for patients. And while there are successes, cancer is not always curable.
Alight: What challenges should employers be aware of when considering coverage for these new treatments?
Dr. Strickler: Since precision medicine is evolving quickly, healthcare plans must adapt. Employers need to support their employees, even if it means offering help at the point of their treatment journey. Precision medicine offers exciting possibilities, but support is needed from all angles, not just treatment administration.
In many cases, insurance plans haven’t caught up yet, so employers face a dilemma. They have the power to help speed access to targeted therapies. As a physician, I rely on those in the “business” of medicine to help patients navigate the system when they’re already scared.
(End of interview.)
Many thanks to Dr. Strickler for his time and knowledge on precision medicine for cancer treatment.
Through our benefits support services, Alight can help employees and advocate on their behalf in challenging healthcare situations.
Alight Cancer Guidance combines the best of our clinical guidance and navigation services to provide targeted support and proactive outreach to those diagnosed. Participants and families can:
- Connect to the nation’s top oncologists who can confirm the right treatment pathway for a particular disease and answer questions around precision medicine options.
- Receive unlimited guidance and compassionate support from a dedicated Nurse Ally, including pre-appointment prep with questions to ask the oncologist, post-appointment debriefs to improve education and literacy, help with next steps and more.
- Locate the highest quality oncologists for in-person treatment.
- Get help with billing issues and the financially toxic aspects of cancer treatment.
- Connect to community-based resources.
- Receive guidance on clinical trials.
Alight Cancer Guidance
Deep oncology expertise and personalized support for every diagnosis
With cancer now being the number one cost driver, it’s important to have something on the employer-side of benefit design that meets the needs of the employee population. When we think about how any newer technology, and in particular, precision medicine is evolving and affecting the medical spend for an employer, it’s crucial to have a partner that can help find high-quality, cost-saving care that enables the best possible outcomes.
