NEW YORK – Research and development of precision medicines usually happens faster than community oncologists can keep up.
It wasn't that long ago that Dong Kim was in medical school using next-generation sequencing for research. In the decade since, Kim has become an oncologist at Maryland Oncology Hematology in Silver Spring, molecular testing and NGS has become cheaper and more accessible, and new treatment options have proliferated. His practice is even in the process of starting its own NGS lab.
When Kim entered a clinical setting, he knew that inevitably, there would be new testing and treatment guidance that he'd miss. "One of the issues is that there's so much data now," Kim said. "You can follow some of the bigger topics, but when things start to get very complicated, and you have very unique [patient] situations, it's really tough to be on top of that."
Drug and medical supplier McKesson said it can help busy community oncologists bridge that knowledge gap by connecting their practices to a consortium of experts who can guide them on test ordering and targeted therapy decisions. It's not the only one — recently, competitors Cencora and Cardinal Health have formed their own networks to offer similar services as they expand their oncology focus.
Through McKesson's initiative, called Precision Care Companion (PCC), providers will have access to workshops, a helpline, and molecular tumor boards. A designated "champion" at each practice communicates any feedback and questions to the PCC team monthly.
Kim enrolled in PCC just a couple months ago, and he's already used the molecular tumor board, which helped him identify a mutation in one of his patients that signaled resistance to a targeted therapy. He hasn't used the helpline yet but foresees creating a reference database of answers he gets from it that he can use for future cases. The goal, he said, isn't to know about every precision medicine development there is but rather to know all the options and caveats for a single patient's condition.
McKesson has rolled out this program in 12 practices in its US Oncology Network, comprising 2,750 community-based providers who treat more than 1.4 million patients each year. Over the next year, McKesson hopes to enroll 10 more clinics in the PCC.
"Precision Care Companion was really born out of a need that we've seen emerge over the last several years, with community oncologists really struggling to keep pace with the almost continuous change that we see in the industry as it relates to new biomarker tests coming to market and new targeted therapies being approved," said Regina Murphy, VP of precision medicine, genetics, and lab services for McKesson's US Oncology Network.
The US Food and Drug Administration approved 48 precision medicine treatments last year by Precision Medicine Online's count, up from 28 in 2023. A rapidly accelerating industry can leave many providers feeling behind, said Howard McLeod, director for the Center for Precision Medicine and Functional Genomics at Utah Tech University.
"Most of the oncologists I work with, even at the biggest academic centers, when they're in the clinic, they just want to know what to do," he said. "Academic curiosity is sometimes an obstacle to better clinical care."
Roughly 80 percent of cancer patients in the US are treated in a community setting. That number could be even higher, since some patients who visit academic institutions are often referred there by oncologists they initially saw at a local practice. Many of those providers are generalists by necessity since they are more likely to encounter patients who have the most common tumor types. Meanwhile, genomics researchers are rapidly uncovering molecular abnormalities that drive a subset of these common tumors, and drugmakers are designing drugs to target them.
Genomic abnormalities like NTRK fusions show up in less than 1 percent of solid tumors and can make rare cases out of patients that may otherwise have common tumors. A community oncologist may be experienced in treating colorectal cancer patients but not be up to date on how to treat a colorectal cancer patient with an NTRK fusion. And if they haven't treated a lot of rare cancers, like cholangiocarcinoma, then figuring out how to treat a patient with a rare cancer and a rare molecular driver can be particularly challenging.
In such cases, doctors require simple clinical translations of research findings. "The problem is only getting worse," said McLeod, who also cofounded Clarified Precision Medicine, an expert consultation service for community oncologists. "Nearly every new drug that gets approved has a new molecular finding to it."
Which is why making "amazing advances easy to use" should be a priority for the precision medicine industry, he said.
Recently, McKesson has grown its oncology segment through strategic partnerships and acquisitions of genomic data companies. Its main competitors, Cardinal Health and Cencora, have also expanded in the community oncology space. Cardinal Health made its foray late last year when it acquired the Integrated Oncology Network for $1.12 billion, while Cencora in 2023 acquired a similar network, OneOncology, which is also focused on bringing precision oncology to community practitioners.
Lisa Gill, an analyst at JP Morgan who covers McKesson and its competitors, expected McKesson's stock to overperform following its third quarter earnings announcement in early February, driven by a "positive tailwind" from "differentiated strategy around oncology and biopharma services," she wrote in a note. She also has predicted a 21 percent year-over-year increase in operating profits for McKesson in an April 23 industry supply chain note. McKesson is slated to report fourth quarter and fiscal-year 2025 financial results in early May.
McKesson's stock is up around 13 percent since it reported its Q3 results on Feb. 5, closing Thursday at $688.43 on the New York Stock Exchange. Its shares touched a 52-week high of $728.32 in early April.
While Precision Care Companion is McKesson's latest offering for community cancer medicine, the firm has built up its data infrastructure in recent years to enable delivery of precision oncology. In 2020, the company launched Ontada, a technology business that hosts a variety of data and analytics tools that provide clinical data to life sciences companies, including Amgen, Merck, and BeiGene. Likewise, the tools allow clinicians to more easily use that data in evidence-based care.
In 2021, McKesson also launched a separate consortium called MYLUNG (Molecularly Informed Lung Cancer Treatment in a Community Cancer Network), with the goal of standardizing best practices for molecular testing and personalized treatment for lung cancer patients in community practices. Precision Care Companion has a vaster scope, with the network advising oncologists on many types of cancer.
"We want to increase testing rates, get patients on the right therapies, and ultimately help them lead the highest quality lives that that they can," Murphy said.
These developments are a net positive for practitioners and patients, McLeod said, as long as McKesson commits to not only helping select the molecular tests patients should receive but also providing doctors guidance and support through the full spectrum of patients' care, including accessing the right treatments. Getting the treatments identified through molecular testing to patients, in McLeod's view, is the "last mile" problem in precision medicine. "And that's the part that is often missing," he said.
For Kim, PCC has already become not only a way to give patients more options in clinical testing but also a resource to learn about clinical trials and backup options if the patient develops resistance to the selected treatment. Testing is an ongoing process, he said, and PCC experts can offer guidance on how often to take biopsies and what to do if he sees clonal evolution.
"When I have people around me that I can talk with about these spaces and can make multidisciplinary or collaborative decisions, it really helps," Kim said. "Not only is it better care, but it does give me more reassurance."