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Clarified Precision Medicine, VieCure Platform Supports Community Oncologists in Alabama

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NEW YORK – A pilot program at Alabama Cancer Care (ALCC), within which oncologists receive expert support when deciding which treatments to give patients based on genomic test results, is improving the community-based institution's ability to deliver precision care.

In May, ALCC implemented Clarified Precision Medicine's somatic and germline testing clinical consultation process within VieCure's artificial intelligence-based informatics and clinical decision support platform. In the pilot program, four providers at ALCC's Gadsden, Alabama, site are testing out Clarified's consultation process through VieCure's platform.

VieCure and Clarified partnered two years ago to make the virtual molecular tumor board (MTB) company's precision oncology expertise more accessible to healthcare organizations. Oncologists at ALCC are skilled in general oncology but lack expertise in precision cancer care, which makes this health network an ideal place to test the impact of the VieCure-Clarified collaboration, said Howard McLeod, cofounder and managing director of Clarified.

Community oncologists are often generalists because they must see patients with so many different types of cancers, which, in turn, places greater demands on their time and stretches limited resources. This can make it more difficult for these physicians to keep up with the latest treatment recommendations and guidelines, which are changing quickly as more precision oncology treatments come to market.

In the 2023 Precision Oncology News annual survey, for example, when asked about the biggest institutional challenge to implementing precision oncology, 20 percent of oncologists in both academic and community settings surveyed said it was difficult to keep up with the latest guidelines on actionable biomarkers for personalizing treatment. Another 15 percent cited the lack of integration of biomarker results into their electronic medical record (EMR) systems, and 5 percent cited a lack of clinical decision support software or automated tools.

Clarified CEO Rajni Natesan said many oncologists, not just community practitioners, are struggling to keep up with rapid advances in genomics and precision oncology. "If you put yourself in a busy generalist oncologist's shoes, seeing 20 to 30 patients a day with three minutes in between patients, it can be difficult to figure out what treatment the patient needs [when you're] working across so many different cancer types," Natesan said. "Keeping up with that patient volume and with the genomics space is very challenging [for these oncologists]."

VieCure's collaborative platform is designed to streamline the use of precision medicine in oncology. It allows oncologists to order a molecular test for their patients from different genomic testing providers, and once the test results are in, the integration with Clarified's consultation service provides expert reviews of the test results in a report, called ClarifiedSelect, within 48 hours. If oncologists have questions after seeing this report, they can use the platform to connect and discuss the information with one of Clarified's clinical experts.

The ClarifiedSelect report includes a ranked list of treatment recommendations based on the patient's genomic test results, including biomarkers associated with response to immunotherapies and targeted drugs, and factoring in patients' clinical information, US Food and Drug Administration-approved drugs, guidelines, and the peer-reviewed literature.

Clarified partnered with VieCure because its platform combines patient data usually contained in electronic medical records with clinical decision support tools. "I refer to them as an electronic medical record that actually works for oncologists," said McLeod. "Some of the other [platforms] are good for billing and scheduling, but they're just not that great for clinical care. We realized we could embed within their electronic medical record-type system and make it super easy [for oncologists] to identify who needs a test in the first place, and then get a consult that is more focused on the therapeutics."

The VieCure-Clarified collaboration, according to Natesan, integrates virtual MTB access into oncologists' workflow. "For the first time, we have the ability to take a [MTB-type] review right to the point of care with VieCure," she said.

Typically, community oncology networks have had to partner with academic cancer centers to have patients' molecular tests reviewed by an MTB. For example, Duke Cancer Institute has partnered with community care sites affiliated with the Duke Cancer Network with the goal of improving MTB access to patients in rural counties in North Carolina, and the University of Kentucky Markey Cancer Center is similarly making its MTB available to community affiliate sites. Studies have shown that programs promoting molecular profiling or implementing MTBs in rural, community oncology settings have led to more patients joining clinical trials or receiving precision therapies.

The Clarified team has done a preliminary analysis of the impact its expert reviews have had in the first few months of the pilot at ALCC and found that Clarified's reports within the VieCure platform led to a treatment change in about a third of cases, Natesan said. Clarified and VieCure are still gathering data for the impact analysis, so Natesan declined to share further details on the data, including how many patient cases have undergone expert reviews.

Before the pilot, McLeod said that ALCC doctors "were already batting above average" among community practices in determining which patients needed molecular testing and using the results to guide treatment, "and now, we're helping them to get to the point where they're having results that are similar to any academic center."

So far, the four oncologists who participated in the pilot program have said they felt their recommendations and their decision making across all patient cases were supported by the VieCure platform and the Clarified team, according to Natesan.

"The number one thing that Clarified does is provide a voice of authority on every single patient," she said. "That can reassure [oncologists] about whether they're choosing the right therapy or if a clinical trial should be considered. The physician on the ground can hang their hat on the recommendation from folks on our clinical team that have done [precision oncology] for their entire career."

Clarified and VieCure plan to publish a detailed impact analysis from this pilot in the future. They are also hoping that the initial learnings from the program will spur ALCC to make these point-of-care expert reviews available to oncologists at more sites across its health network. McLeod added that the Clarified team is also looking to add pharmacogenomics-based treatment guidance to its reports to ALCC oncologists. The PGx insights are included in another Clarified report, called OncoGuardian, aimed at helping physicians manage treatment-related toxicities.

"This is the new standard that we'd like to see, where every single patient anywhere has the benefit of this kind of expertise at the point of care and in a seamless workflow for their oncologist," Natesan said.