Markman Shares Hopes for 2024, Underscoring Need for Meaningful Decision Support Across Oncology

Maurie Markman, MD

In an interview with OncLive®, Maurie Markman, MD, president of Medicine & Science at City of Hope, Atlanta, Chicago, Phoenix, discussed current challenges faced with developing robust decision support tools for oncologists. He also projected additional research efforts dedicated to finding a way to leverage CAR T-cell therapies in solid tumors to improve patient outcomes.

OncLive: What would you say are some of your hopes and wishes as it relates to oncology for 2024?

Markman: I just hope that we can come up with a strategy. I, for one, struggle with a strategy of how we are going to develop meaningful decision support. Everybody knows it’s important, but it is not any group’s responsibility. Surely, pharma cares about the use of their products on label and they obviously want to educate the oncology community as it relates to their products. Fine. But that’s not the broad band approval I’m talking about. The insurance companies have a vested interest in making sure that drugs are used wisely. But again, their perspective is controlling costs, not necessarily the overriding concern about how we can educate oncologists. The National Cancer Institute’s major goal is developing new strategies, new drugs, new approaches, and [focusing on] things like cancer prevention and screening, so their whole world is not just treatment. If you then were to ask the question, whose responsibility is it to develop these robust decision support tools? I would say, no one’s.

As such, I think we’ve got to figure out as a society, and certainly, as a community of oncologists, how we’re going to approach this. Perhaps [we can address this] through foundations [or] put together think tanks [to figure out] how we can have pharma, the insurance industry, the academic medical centers, and the patient advocacy groups work together to develop very robust decision support tools. I would also note that the world of artificial intelligence is coming along. One could certainly envision a situation where there is a major effort to put together strategies through the variety of these approaches to effectively...help the oncologist in their very busy practice take care of very complex patients, with literally hundreds and hundreds of options that may not have anything to do with an individual tumor type. When I say hundreds and hundreds, I’m envisioning the future.

You have a 15-minute visit, and you’re trying to figure out what to do, what tests to order, how to get these drugs to patients, and how to get them paid for. We’ve got to come up with a strategy. So, my hope for the future is that we figure out a way to begin to tackle this problem of meaningful decision support for the oncology community.

Are there other agents that are in the pipeline that you think have the potential to have practice-changing amplifications next year?

The antibody-drug conjugates are really a broad class [of agents]; you can have lots of different types of antibodies. Outside the realm of solid tumors, there are a variety of CAR T-type approaches and bispecific antibodies. Certainly, they will move forward. I should mention [with regard to] CAR T, that, in some ways the holy grail for that type of an approach [would be] to figure out how to use that type of technology in the solid tumor space. Clearly, [that approach has had a] major impact in hematologic malignancies and [data have] been very exciting. But we’ve yet to crack this from a point of view of anything remotely related to standard of care in solid tumors with these T-cell manipulations, and certainly not in the gynecologic cancer space. Although again, there’s research. Yes, we’re using checkpoint inhibitors, but the idea of actually manipulating the immune system within a patient, that has not been successful yet at a clinical level in the solid tumor space. Once we see that happening, I can see this occurring in many solid tumor types.

Is there anything else that you would like to say in reflection of 2023 as we move forward into 2024?

I think the major thing I would say is that 2023 has been revolutionary; I stick by my term. [There has been] incredible excitement with new drugs and new strategies as well as understanding of the molecular biology of cancer and understanding of mutations. Obviously, the whole world of diagnostics is increasingly moving to blood-based [tests] from tissue based, which allows for the potential of monitoring on a regular basis. Obviously, this has been done in hematologic malignancies for multiple decades, [where you can look at] either the blood or the bone marrow and see how a patient is doing. We don’t have that in the solid tumors yet, regularly. But with circulating tumor DNA and a variety of other approaches, the idea that you can monitor—hopefully at a reasonable cost—pick up new mutations, anticipate that, and then potentially change the therapeutics, is just overwhelming. How we do all that?

But that’s what I would see for the future, this blood-based monitoring of solid tumors, and potentially being ahead of the game. [Getting to a place where we are not giving] drugs to patients that are not working or have stopped working and figuring out a way [that we can get] ahead of the tumor.