Cancer therapy is becoming increasingly complex and more treatment options for cancer are available than ever before. Recent ground-breaking treatments, such as gene and cell-targeted therapies, have shifted the standard of care away from traditional chemotherapies towards individualised journeys involving multiple therapeutic approaches. The past decade has seen an explosion in targeted treatments coming to market across a range of cancer subtypes, and immunotherapy has become an established pillar of cancer management. Such breakthroughs have led to an improved prognosis and increased survival among patients and have empowered healthcare professionals (HCPs) by providing treatment options that can offer clinically meaningful benefit to patients across many cancer types. Despite the promise offered by these recent advances, they also often present an entirely new set of challenges in implementing the therapies into routine clinical practice within a hospital setting. Through a partnership between HCPs, pharma and medical communications (med comms) specialists, these challenges can be met to raise awareness of treatment options, both in terms of their potential and limitations.
Immune surveillance is the process by which aberrant cells are removed by the immune system. When immune surveillance fails, a person’s risk of developing cancer increases. A number of drugs, so called ‘immunotherapies’, have been developed to address the failure of immune surveillance; among the approved immunotherapies for cancer treatment, the two main pillars are checkpoint inhibitors (CPIs) and chimeric antigen receptor (CAR) T cells. CPIs work by allowing an individual’s own immune system to become active against cancer. CPIs have now been integrated within the treatment regimens of many solid and haematological cancers and are under development for use in many more tumour types. CAR-T cell therapy involves genetically engineering the cancer patient’s own immune cells, by making the T cells express a protein to recognise and target the cancer cells (anti-CD19 CAR-T cells). Following chemotherapy, the anti-CD19 CAR-T cells are re-infused into the patient to allow them to multiply and target the haematological cancer cells. The successes of CAR-T cells in the treatment of acute lymphoblastic leukaemia and diffuse large B cell lymphoma have led to further investigation in numerous follow-up trials, as well as some future strategies focusing on their efficacy in the treatment of solid cancers. This means that the adoptive T cell therapy portfolio, and thus the range of cancer treatment options, might increase drastically over time, which is becoming especially evident as the principle of targeting CD19 is now being explored even further with other immune cell types beyond T cells, such as natural killer (NK) cells.
With numerous, fast-paced advances in immunotherapy and their positive impact on patient prognosis, both HCPs and treating hospitals must also comprehend the challenges and limitations associated with this treatment revolution. Although CPI treatments and CAR-T cells are very effective for some patients, immune-related adverse events (AEs) are a reality of therapy; they can be life-threatening and represent a significant concern for HCPs, in terms of their unpredictability. In addition, the integration of numerous new immunotherapies into the cancer treatment pathway has increased the complexity of the decision-making process; for example, with the large number of both inline and pipeline immunomodulatory drugs, there is an almost infinite number of combinatorial regimens for further clinical evaluation.
As the therapeutic pathway becomes more complex, so does the patient’s journey. Consider CAR-T therapy, which presents a unique challenge; patients who are eligible must go through an elaborate process, from the collection of the cells to their infusion once the cells are re-programmed. Each step then involves multiple transfers between primary care and specialists over an extensive period of time, requiring the involvement of treating physicians, apheresis and infusion staff, plus pharmacists for any complementary treatment, to mention just a few. Elsewhere in oncology, CPI immunotherapy has yielded promising results for patients with triple-negative breast cancer alongside the use of precision and personalised medicine (PPM). However, this comes with its own challenges, given the genetic diagnostic tests and unique AE management required. Again, several stakeholders are involved in PPM, and the interpretation of genetic data into actionable information involves complex processes between HCPs and geneticists. Regardless of the chosen immuno-oncology therapies, communication is, therefore, essential for treatment compliance, lowering error and complication risks, as well as handling comorbidities. To that end, hospitals organise their coordinated care through multidisciplinary teams (MDTs). Although some centres of excellence and teaching hospitals have well-established MDTs, achieving coordinated care for patients with complex cases of cancer is a real challenge in many hospitals globally. Hospital teams need to be aware of these intricate treatment journeys, in order to ensure a smooth and coordinated process and guarantee the best treatment outcomes. Of course, another important factor to consider is time: the treatment process needs to be completed in a short timeframe to maximise the opportunity of a positive clinical outcome.
Beyond HCP and hospital education around the treatment journey and outcome, efforts must be made to demystify these new immunotherapies to patients. How can HCPs engage patients in the treatment decision-making process and set clear and realistic expectations about side effects and efficacy? Patients require a sensitive approach to learning about new AEs, including how these are monitored. Importantly, the wealth of information now accessible online and through social networks can be overwhelming or, worse, misleading. Where can patients turn to for accurate and reliable information?
Pharma, therefore, faces three specific challenges: first, educate HCPs to help them understand and use immunotherapies appropriately; second, provide education for patients to help them understand the treatment journey and set expectations around its outcome; and third, facilitate the development of structured support networks needed to ensure that the right patients are getting the right treatment as quickly and efficiently as possible. What would the role of med comms agencies be in this already complex setting? Partners. Med comms agencies are working together with pharma to decipher the unmet needs, build programmes and tools to address them, coordinate the delivery of the tactics and expand the breadth of knowledge through carefully selected channels. In recent decades, pharma and med comms agencies have successfully provided support in establishing education tools to raise awareness of the complexity of the treatments, and to manage patients’ and doctors’ expectations. However, med comms is currently at a turning point; as the treatments and technologies are evolving, so too is the way we can spread education across clinical and patient groups. The portfolio of immunotherapies will increase drastically over the coming years, being one of the key elements of pharma pipelines and academic research. These advances will eventually involve new mechanisms of action that will need to be unravelled to both HCP communities and patients. The immuno-oncology revolution requires a powerful and well organised communication setting: while the responsibility for getting this right sits with all stakeholder groups, pharma companies play a critical role and med comms agencies must support them in this endeavour, by acting as collaborators and partners.