Evolving Oncology Pathways, CLL Treatment Advances, and the Role of Multidisciplinary Care Teams
Shaffee Bacchus, PharmD, FASN, Oncology Access Lead for Value and Access at AbbVie, attended the Clinical Pathways Congress + Cancer Care Business Exchange (CPC+CBEx) to emphasize the importance of pathways in ensuring patient access to oncology treatments (Figure). In this exclusive interview, Dr Bacchus highlights the evolution of treatment for chronic lymphocytic leukemia (CLL) and provides context regarding the complex needs of patients with CLL. The following is an edited excerpt from the video interview for clarity and brevity.
Disclaimer:
The views expressed in this interview are solely those of Dr Shaffee Bacchus and do not represent AbbVie Inc.
Dr Shaffee Bacchus: My name is Shaffee Bacchus. I'm the Oncology Access Lead for Value and Access at AbbVie, and I'm here at the Clinical Pathways Congress because we believe that pathways are a critical access channel for oncology. We need to be aware of how pathways are evolving to ensure that we have continual access of oncology products to our patients. To tell you a little bit about myself, I'm trained as a pharmacist, and I'm very fortunate to have always had opportunities to be a patient advocate for my early career. I started in nephrology, where I did outcomes research, essentially trying to understand medication-related problems in complex patients with kidney disease. Then I spent some time with a GPO connected to Premier, and that exposed me to the supply chain of medications and how they traverse the health care landscape. After a few years of that, I joined Janssen where I got my first introduction to hematology-oncology, and for the last 3 or 4 years I've been at AbbVie in the oncology space, primarily in the hematology space here.
What are some of the most common treatments for patients with chronic lymphocytic leukemia (CLL)?
Dr Bacchus: Chronic lymphocytic leukemia (CLL), as you know, is a complex disease state. Initially we had chemo-immunotherapies, which were a broad-based approach to CLL treatment using agents within the alkylating agents and so forth. However, over the last 10 years we've had targeted therapies like BTK inhibitors and Bcl-2 inhibitors, and these drugs are incredibly effective, prolonging the 5-year survival for patients up to as much as 88%. We also see that there could be combination therapies of BTKI and Bcl-2 inhibitors, and we have CAR T therapies on the horizon.
Given the advanced age of patients with CLL and their complex medical needs, how can a holistic approach to care address comorbidities, concomitant medications and socioeconomic conditions to optimize outcomes?
Dr Bacchus: That's a great question because the average age of diagnosis for CLL is 70 years of age and usually occurs in white males. By that time, these patients have developed different comorbidities. Usually they have underlying cardiovascular comorbidities, diabetes, they might have kidney disease, they might even have other cancers. Both diabetes and kidney disease are independent risk factors for cardiovascular disease as well. In addition, they're treating multiple other comorbidities, so taking multiple medications multiple times a day. That in itself is challenging for these patients. What we need to do is ensure that there's a very strong multidisciplinary team that could provide the type of support that these patients need throughout their care. Survival is improved, so you have to have a system that can provide that care over a long period of time. We have 10-year data showing that patients do well in overall survival. What we need in terms of this care team are oncologists. Of course, you may need cardio-oncologists, pharmacists, nurse navigators, and you do want to engage the patient's caregivers as well.
The last thing I'll say is that shared decision-making is very important because you want to elevate that patient voice and understand their experience. If a patient is going to live that long on a therapy, that is great, but you want to make sure that they have the quality of life that they need to have as well. You really do want to listen to them. In fact, there are many programs here and even by the FDA that are elevating the patient voice into the early research process.
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