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Innovation in Cancer Treatment
Author(s)
Sara Ahmed, PhD, and Michael Kelley, MD

Click to view more from Cancer Data Trends 2023.

References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
Author and Disclosure Information

Sara Ahmed, PhD
Director of Precision Oncology, National Oncology Program
Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
Executive Director, National Oncology Program
Veterans Health Administration
Durham, NC

Publications
Federal Practitioner
Topics
Cancer
Author(s)
Sara Ahmed, PhD, and Michael Kelley, MD
Author(s)
Sara Ahmed, PhD, and Michael Kelley, MD
Author and Disclosure Information

Sara Ahmed, PhD
Director of Precision Oncology, National Oncology Program
Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
Executive Director, National Oncology Program
Veterans Health Administration
Durham, NC

Author and Disclosure Information

Sara Ahmed, PhD
Director of Precision Oncology, National Oncology Program
Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
Executive Director, National Oncology Program
Veterans Health Administration
Durham, NC

Click to view more from Cancer Data Trends 2023.

Click to view more from Cancer Data Trends 2023.

References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
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Cancer treatment in the VA has been advancing for years, moving toward the use of targeted therapies and immunotherapies guided by comprehensive genomic profiling.1 Initiatives like NPOP, established in 2016, have contributed to these efforts, with more than 52,000 samples tested and 35,000 veterans having care guided by these molecular tests as of February 2023.2,3 NPOP has been generally well received by VA oncologists eager to provide personalized, cutting-edge cancer care for veterans.4 However, several challenges still need to be overcome to ensure the full adoption of precision medicine at the VA, no different from challenges faced in the private sector.5 For example, in advanced lung cancer, many patients may not have access to personalized treatment due to various clinical practice gaps that prevent the full integration of this technology into clinical care.6

In assessing cancer treatment innovation, it is important to consider the changes in treatment approaches based on a molecular understanding of individual patient tumors.5 The treatment process for many late-stage cancers now starts with, or at least includes, NGS to see if immunotherapies or other targeted therapies can be used in place of past methods such as chemotherapy.5 In lung cancer, for example, chemotherapy is still used, combined with immunotherapy or later in the process, but often after other treatments are ruled out.5 This innovation in the cancer treatment process has led to longer survival and better quality of life for patients with lung cancer and other advanced-stage cancers.5,7 NGS is used for many cancers, including lung, prostate, colorectal, hematologic, breast, brain, pancreatic, and bladder.3,8,9 Genetic sequencing and targeted therapies are changing the cancer treatment field dramatically, in both the general and veteran populations with programs like NPOP, the Lung Precision Oncology Program (LPOP), and Precision Oncology Program for Cancers of the Prostate/Genitourinary cancers (POPCaP/GU) making this possible.1,10-13

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