ASCO Connection

July 2017

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(TAPUR) trial. The TAPUR trial is prag- matic: any type of assay, as long as it is performed in a CLIA-certified labora- tory, can be used to identify a relevant genetic change that matches a drug already approved by the FDA for one type of cancer, but not for the one in which the biomarker has been found in the respective patient. Currently, ASCO has partnered with seven companies who have provided 17 drugs, and as of this meeting, 65 practices and institu- tions have already accrued 301 patients. We are anticipating 36 additional sites being activated for a total of 101 partici- pating sites by the end of the year. We owe it to our patients to not just assume the strategy of precision medi- cine is appropriate, but to prove it! ASCO is also pioneering big data observational research through Can- cerLinQ ® . CancerLinQ was designed to be a rapid learning system to improve quality of care for patients with cancer. In addition, it will become the largest and most granular clinical cancer out- comes database in the world. To date, CancerLinQ has enlisted more than 85 practices, encompassing 2,000 doc- tors representing a broad cross-section of cancer care delivery settings from around the U.S. We now have well over 1 million individual patient records in the database. We expect to be able to make these data available for obser- vational research very soon, enabling what should be the most comprehen- sive source of real-world cancer data ever assembled. Our next challenge is the delivery of high-quality care to everyone who needs it, when they need it. My friend John Cleland was lucky, not just by timing, but by geographic loca- tion. He happened to be in the right place, at the right time, with the right doctor, to be cured, and frankly, he had the right insurance to pay for it. How many other "Johns" are out there now who do not receive the proper diagno- sis and treatment, just because they are geographically or economically in the wrong place? As our treatments become even more complex, this issue becomes even more acute. All the advances in the world will do no good if they are not applied properly —or at all. Medicine does no good in the bottle, it only works in the patient! Cancer mortality in the United States has declined by as much as 20% over the last 20 years. However, a disturb- ing figure, taken from a recent paper by Dr. Ali Mokdad and colleagues, shows that this decline is geographical- ly disparate across our country. These disparities are not due to differences in cancer incidence. They are related to differences in cancer treatment. I find this unacceptable. When you are diagnosed with cancer, where you live should not dictate whether you live. ASCO is addressing practice hetero- geneity in two ways: by advocating for support of delivery of high-quality care, and by generating guidelines and improving practice pathways. In order to advance this fundamental goal of making sure the right treatment at the right time is available to every patient, ASCO is actively engaged in shaping Medicare's change from a fee- for-service model to the new Quality Payment Program. This change has grown out of the Medicare Access and CHIP Reauthorization Act (MACRA). Although it will be difficult, this change in our reimbursement model is the right thing to do. For years, I personally have felt that we should be paid for doing the right things for, and not just to, our patients, but the incentives have been against us. We Left: Fig. 1 "shows the remarkable increase in expected overall survival and subsequent cure rates in cohorts of children with acute lymphoblastic leukemia from 1968 to 2008." Right: "Cancer mortality in the U.S. has declined by as much as 20% over the last 20 years. However, [Fig. 2] shows that this decline is geographically disparate across our country." 30 I 07.2017 FEATURES

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