Introduction

Targeted therapies are reshaping the oncology treatment paradigms, with significant growth projected in the coming years. According to publicly available data presented by Anton Yarovoy, Group Product Director of Precision Medicine at Johnson & Johnson Innovative Medicines, these therapies are expected to grow by 50% in revenue over the course of ten years through 2032, while maintaining their proportion as approximately 30% of the oncology market.

"Targeted therapies are an important aspect of oncology treatment across various disease states," explained Yarovoy, describing that more products are in pharmaceutical pipelines for coming years.

This approach represents a fundamental shift in treatment practice, from the broad-based approaches of 10-15 years ago to highly specific treatments based on patients' genomic mutations. Using an analogy from Star Wars, Yarovoy compared previous cancer treatments to broad-based attacks on the Death Star, where limited damage was done. Targeted therapies, however, focus on the mechanism of action and can lead to a chain reaction that results in the cancer being destroyed, similar to targeting the Death Start’s weak point which ultimately destroyed the weapon.

Practice Gaps to Implementation: The Testing Challenge

Targeted therapies face practice gap challenges as testing processes take time to be implemented. A key study revealed that two-thirds of patients with metastatic non-small cell lung cancer did not receive appropriate targeted treatment because of various identified practice gaps.

The testing process itself presents numerous challenges. Healthcare providers must navigate a tissue stewardship processes, varying testing capabilities across hospital systems, and insurance barriers that can lead to health inequities in testing access.

"For many practitioners, a Next Generation Sequencing (NGS) report can be challenging to interpret. The reports can be lengthy, up to 20 pages long, listing lots of treatment options and clinical trial recommendations, which can be daunting," Yarovoy noted. These reports then also need to be considered in parallel with other testing that the patient may have undergone in order to decide on the optimal treatment for the patient.

This level of testing complexity necessitates extensive collaboration between the entire Multi-Disciplinary Team (MDT), including oncologists, pathologist, nurse navigators, and interventionalists, as well as improved education for providers on test interpretation.

The Educational Shift

Education has emerged as a critical need in the precision medicine space. Healthcare providers are actively seeking information about guidelines, decision tools, and emerging trends to help navigate the complex landscape of targeted therapies.

"The more we learn, the more we discover how much we do not know," said Yarovoy, noting that a session on testing interpretation at World Lung was standing-room only, demonstrating the need for knowledge in this area.

Several pharmaceutical companies have responded with educational initiatives, including education around biomarker testing and awareness. These initiatives are built to bridge knowledge gaps and improve testing practices.

Balancing Brand and Testing State Education initiatives

Yarovoy discussed the need for a rebalance in pharmaceutical commercial activities, shifting from a predominantly brand-focused content to a more equal mix of branded product and completely unbranded testing state education.

"Content needs to be balanced with a larger breakdown between brand and testing education," he advised, suggesting a move from the current model of approximately 85% branded content to a more equal 50-50 split.

This approach better aligns with what healthcare providers and patients are requesting: accessible, unbiased educational content that helps them navigate the complex world of precision medicine. It also addresses the need that many Medical Science Liaisons (MSLs) often do not have specific training in diagnostics, creating a need for specialized precision medicine teams.

Key Takeaways

1) Targeted therapies impact everyone in the oncology space, with lung being a at the forefront, having over 50% of metastatic mutations with a targetable mutation.
2) Testing barriers remain significant, with complex reports, varying hospital protocols, and access barriers that impact patient treatment journeys.
3) Education is critical for healthcare providers to interpret complex diagnostic reports and stay current with rapidly evolving treatment options.
4) Balance branded and testing state awareness educational content to better meet the needs of healthcare providers who are seeking guidance on testing and treatment pathways.

"Medical and commercial will always have their separate roles. They will always be distinct in what they need to do. But there is no reason why you cannot have a single objective or single set of objectives what you're trying to accomplish,"

she explains.

The solution isn't about breaking down regulatory boundaries but aligning on common goals: "If you can align on the goal, it's not about the activities, it's not about the details of the road, it's about, are you trying to move in the same direction?"

Fostering Innovation Through the 90/10 Rule

To drive meaningful innovation, Gopal advocates for the "90/10 rule"—dedicating 90% of resources to essential activities while reserving 10% for creative exploration. She cites Google's approach of allowing employees to spend 20% of their time on creative projects, which led to innovations like Gmail and Google News.

However, she cautions that once an innovation shows promise, it requires full commitment: "They cannot be side projects once you choose to do something with them. If you decide you're going to do something coming out of that 10%, you have to be all in."

Implementing Change

Gopal outlines three key principles for implementing change:

1. Establish clear objectives and stay committed: "Pick a lane, get alignment and stay committed. You cannot have a different plan every six months."

2. Involve the right stakeholders early: "Get the right people around the table to say, okay, this is the idea. How are we going to make this happen? Not do I have permission to make it happen."

3. Proceed with determination: "You have to be enthusiastic when you're trying to make change. You have to believe and you have to commit. And you can't back down."

"Agility in pharma is not a contradiction. It is absolutely possible," Gopal concludes. "We are nimble when we need to be. How are we going to be nimble when we want to be?"

Key Takeaways

1) Shift from reactive to proactive change: "Imagine if you could turn that around and make it about, I see a need, I see an opportunity, and I want to change something. That's what creates agility."

2) Align medical and commercial objectives: "If you can align on the goal, it's not about the activities, it's not about the details of the road, it's about, are you trying to move in the same direction?"

3) Implement the 90/10 rule for innovation: "Let's dedicate 90% of our budget to things that need to happen... But let's leave 10% to think about things that we normally wouldn't think about."

4) Prepare concrete action plans, not just scenarios: "Being competitive means preparing for the pivot and having a plan in place that we can use immediately."

5) Learn from cross-industry approaches: "We need to be curious. I learn a lot from other industries. I don't think any industry is better or worse at moving with speed than pharma is."

"That's one of my big missions in my team – that people are getting a flavor and a taste of all of the different components of this ecosystem between the data, the digital and the operations,"

she says. "The more we are thinking of that holistically across this whole area, the better off we're going to be anticipating and seeing around corners."

Key Takeaways

1) Start with the customer experience: "A big part of it is really starting with our customer as the first point. How do we think about that person's experience? The things that are making them frustrated or standing in their way."

2) Embrace difficult change management: "Standing true to the notion that ultimately, on the other side of those tough decisions, there's a better future for the organization and maybe even for those individuals who are impacted."

3) Adapt to the digital-native clinician: "Our clinicians are changing and that inherently means that the way we engage with those clinicians has to evolve with them."

4) Maximize each interaction: "The number of times we get in front of these clinicians nowadays is going to be a lot fewer per time period, so each one of those conversations needs to be that much better and that much more planned out."

5) Foster cross-functional thinking: "I want the entire team to be thinking about data, thinking about digital and thinking about operations, regardless of which place you are in your function."

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