Mello Abrams Lecture: Research in Ovarian Cancer, Where Are We Now?, Michael Seiden, MD, PhD

The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Ovarian Cancer, Where are We Now?
2016 Mello Abrams Lecture
Michael Seiden M.D. Ph.D.
Chief Medical Officer, The US Oncology Network

Focusing on the Patient

Triple Aim: A Patient-Centered Approach to Care
Better Care
Better Value
Better Outcome

Triple Aim – Better Care
Better Care
Better Value
Better Outcome

Better Care - Elements
• Cancer Journey
• Navigation
• Rehab
• Survivorship
• Family Risk
• Palliative Care
• Advance Care Planning

Navigation Survivorship
Advance
Care
Planning
Palliative
Care
End of Life
Care
CANCER JOURNEY
The Cancer Journey

Communicating with Patients
• What should the patient know about their disease?
• How should this information be delivered?
• When should this information be delivered?

Most Cancer Patients are Poorly Informed
Only 5% of patients could answer “yes” to all four questions:
Study by Holly Pigerson, Weil Cornell
1 Do you know the stage of your cancer?
•2 Do you know your current health status?
3 Do you know your expected life expectancy?
4 Have you had an end of life discussion with your physician?

Triple Aim – Better Value
Better Care
Better Value
Better Outcome

QUALITY
• Achieve better outcomes
• Increase safety
• Improve satisfaction
COST
• Reduce avoidable medical
spending
• Decrease total cost of care
A Market Shift Towards Redefining Value
VALUE =
$

Oncology Care Model (OCM)
Clinical Components:
• Treatment Plan
• Prognosis
• Intent of Therapy
Adoption of Value Base Care:
• Patient Navigation
• Access to Care 24/7
• Psychosocial Screening
• Advance Care Planning
• Financial Counseling
• Self & Claims Based Measures
• Eligibility & Enrollment
• July 2016 Start
• 5 yr. OCM Pilot
Medicare Patients
National Scope
~3200 physicians
~120,000 patients/year

Transferring Risk and Reward
Who Pays the Bill
Present
Employer
Government
Insurance Company
Patient
Physician
Past
Employer
Government
Insurance Company
Patient

Potential Benefits
• More incentive for clinics to handle urgent issues
• Extended hours in some offices
• More incentive to minimize chances of hospitalization or emergency
room visits
• More attention on eliminating duplicate or wasteful tests or
procedures
• More decision making in the hands of physicians instead of
insurance companies

Challenges
• New payment models place physicians at risk for how they
use resources
• How do we support innovation and new technology that
might be expensive?
• How do we move forward with more “authentic
conversation” with our patients?
– Late line chemotherapy
– Palliative care and hospice

Better Outcome
• Science
• Clinical Research
Better Care
Better Value
Better Outcome

The Human Genome

High Grade Serous Carcinomas
1 2 3
4 5
6 7 8
9 10 11
12 13 14 15
16 17 18
19 20
21 22 X
1 2 3
4 5
6 7 8
9 10 11
12 13 14 15
16 17 18
19 20
21 22 X
1 2 3
4 5
6 7 8
9 10 11
12 13 14 15
16 17 18
19 20
21 22 X
1 2
3 4 5
6 7 8
9 10 11
12 13 14 15
16 17 18
19 20
21 22 X
1 2 3
4 5
6 7 8 9
10 11 12
13 14 15
16 17 18
19 20 21
22 X
1 2 3
4 5
6 7 8
9 10 11
12 13 14 15
16 17 18
19 20
21 22 X
A B
C D
E F
Ahmed et al J path 2010 Press et al BMC Cancer 2008

1 2 3 4 5
6 7 8 9 10
11
12 13 14 15 16 17
18
19 20 21 22 X
1 2 3 4 5
6 7 8 9 10
11
12 13 14 15 16 17
18
19 20 21 22
X
1 2 3 4 5
6 7 8 9 10
11
12 13 14 15 16 17
18
19 20 21 22
X
1 2 3 4
5
6 7 8 9 10
11
12 13 14 15 16 17
18
19 20 21 22 X
1 2 3 4
5
6 7 8 9 10 11
12
13 14 15 16 17
18
19 20 21 22
X
1 2 3 4 5
6 7 8 9 10
11
12 13 14 15 16 17
18
19 20 21 22
X
A B
C D
E F
Ahmed et al J path 2010 Press et al BMC Cancer 2008

Fixing Damaged DNA
Patients with defective BRCA-1,
BRCA-2, PALPB2, or other DNA
repair genes prefer PARP
assisted repair.

NOVA Trial
Niraparib
Placebo
Women with
platinum sensitive
disease with
response to
platinum therapy
500 Patients

Patient Groups and Results
Patient Group Placebo
Time to
Disease
Worsening
Niraparib
Time to
Disease
Worsening
No mutation in gBRCA 3.9 months 9.3 months
Abnormal “My Choice HRD Test”
with normal (non mutation)
BRCA genes
3.9 months 12.9 months
Mutation in BRCA 1 or 2 5.5 months 21 months

Immuno-oncology
Activating your immune system to destroy your cancer

Immuno-oncology
Tumors have mechanisms to silence the immune system

Immuno-oncology
New drugs (PD1 Inhibitors) remove the “immune silencer”

Science: Tumor Microenvironment

Science: Stem Cells

Challenges in Science
Complexity of genetics
Intra-tumoral variability
Genetic evolution

Gene Mutations in Serous Cancer

Improving the Patient Journey Together
The
Patient
Better
Care
Better
Value
Better
Outcome
The
Ovarian
Cancer
Survivor

Mello Abrams Lecture: Research in Ovarian Cancer, Where Are We Now?, Michael Seiden, MD, PhD

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Mello Abrams Lecture: Research in Ovarian Cancer, Where Are We Now?, Michael Seiden, MD, PhD