Howard A. â€œSkipâ€ Burris III, MD, offers his views on key developments in the oncology field.
Howard A. “Skip” Burris III, MD
For more than 20 years, Howard A. “Skip” Burris III, MD, has been at the forefront of early-stage clinical development of many novel agents. As president of clinical operations at Sarah Cannon and executive director of drug development at the Sarah Cannon Research Institute, Burris has helped design and lead scores of clinical trials. Indeed, he has coauthored more than 450 abstracts presented at oncology conferences.
Burris was honored in the Drug Development category with a 2014 Giants of Cancer Care® award, an OncLive program to recognize leaders in the field. In this interview with OncologyLive, Burris offers his views on key developments in the oncology field.The coming year will see further developments in the field of immunotherapy, including combination strategies and expanded indications, as we began to understand which patients will most benefit from these treatment approaches.
The use of next-generation sequencing in the study of small-molecule biologics will continue to evolve, including blood-based testing. The initiation of broad basket /molecularly matched clinical trials will shed light on the potential of such agents to benefit individual patients. Additionally, we should see further work emerge in the area of antibody—drug conjugates, with unique targets and new payloads, further improving their role as the future of cytotoxics. The approval of the immunotherapeutics /checkpoint antibodies for the treatment of non—small cell lung cancer and melanoma is clearly the year’s biggest story. After decades of attempting to harness the immune system to fight cancer, the scientific breakthroughs leading to these reasonably well tolerated and effective therapies have forever altered our perspective on what the future will bring.
Small-molecule biologics remain promising with marked benefits seen with agents as varied as the CDK 4/6 inhibitors in hormone receptor—positive breast cancer, the T790M inhibitors in lung cancer, and the IDH inhibitors against refractory acute myelogenous leukemia.
Blood-based genetic testing and molecular profiling offers great hope and a more practical approach for better understanding the prescribing and the effectiveness of cancer therapies. Community oncologists will continue to be affected by a variety of economic pressures, ranging from the cost of new therapies, serving the poorly insured, the scarcity of professional staff—particularly nurses—and lower reimbursement. Piled onto these issues are the need to remain educated and aware of the rapidly changing science, the emergence of unique new therapies, and the explosion of molecular diagnostics as critical information to practice best medicine. A top oncology priority will be the need for oncologists to understand and establish the practice of value-based care. Getting the right therapy to the right patient at the right time will move from an aspiration to being a critical piece of this paradigm shift. With 85% of cancer patients being cared for in community settings, a continued emphasis on education and awareness of treatment advances, use of multidisciplinary teams and conferences, and participation in clinical trials will all be key to our success in cancer care. Rulings around the use and reimbursement of next-generation sequencing tests are needed to help clarify their role—an important one in my mind—in treating cancer patients. Pricing strategies and payer reimbursement in the area of combination regimens with these new, and expensive, [drugs] will be an area of great interest.
Pivotal registration trials with a variety of agents, ranging from small molecules to antibodies, in cancers as diverse as chronic lymphocytic leukemia and ovarian cancer, are nearing completion with results eagerly awaited. A variety of new drugs are making their way through the approval process as this interview is being conducted. Almost every type of cancer has a promising therapy either in late-stage development or with remarkable early-phase results. Multiple more indications will be added to the list for the approved immunotherapies over the coming year. In addition, several mutationally targeted small molecules should be on the fast track to approval, particularly in the field of blood cancers.
The future has never been more promising for cancer patients, and my colleagues have never been more excited about the clinical results being observed.