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NCCN Academy Welcomes Expert Deliberation on Hot Topics in Cancer Care

On March 30, 2016, in conjunction with the National Comprehensive Caner Network® (NCCN®) 21st Annual Conference, NCCN hosted its Academy for Excellence & Leadership in Oncology: School of Pharmaceutical & Biotech Business at The Diplomat in Hollywood, Florida.

Hot Topics in Cancer Care: Biosimilars, Specialty Pharmacy, Molecular Testing, Diagnostics, and Value

The day’s first module, moderated by Clifford Goodman, PhD, The Lewin Group, brought together the following experts to discuss Hot Topics in Cancer Care: Matthew C. Fontana, MD, Health Care Service Corporation; Andrew Krueger, MD, Accordant Health Services, A CVS Caremark Company; Lee N. Newcomer, MD, UnitedHealthcare; Mark Oldroyd, JD, Foundation Medicine; William Yoon, PharmD, MBA, Sandoz, Inc.; and Martin J. Zagari, MD, Amgen.

Dr. Goodman opened the first session by asking Dr. Newcomer to discuss how he perceives value as multiple value frameworks are introduced to the market.

Dr. Newcomer, Senior Vice President, Oncology and Genetics at UnitedHealthcare, described and challenged the current notion of value in which society is paying for minimal benefit from a drug. For instance, he described a situation in which a patient is given a drug costing $100K per year and is cured, allowing him to reenter the workforce at $52K per year. That patient, explained Dr. Newcomer, is putting $52K back into the economy; however, that means that the market wants three years’ value for one life-year gained.

Moreover, he said, with current pricing models there are two scenarios—one where the gain is so large that we are willing to bankrupt the patient, and another in which we make society pay too much for minimal benefit.

Dr. Zagari, Vice President, Global Health Economics, Amgen, agreed with Dr. Newcomer that the systems ought to begin looking at value from a societal standpoint, noting the importance of considering long-term gains from innovation in oncology. However, he added that the conversation must go beyond just drug cost and consider the total cost of care. As a health economist, Dr. Zagari said he must look at the societal view, as well as the cost of all the resources for cancer care.

We need to have a balanced discussion of the benefits and costs from the societal system—every group is trying to hide their costs and the frameworks make the costs more transparent, said Dr. Zagari.

Dr. Krueger is Medical Director for Accordant Health Services, a company that supports patients through nurse care management in order to optimize patient care and provide value in order to reduce cost of care. There are pressures that are real for payers and employers, and it’s hard to sustain double-digit increases year over year, he said.

Looking at statistics in The ASCO Post, said Mr. Yoon, since 2000, the five-year survival rate has increased 39%. More than 80% of that increase is attributed to innovation in therapy—drugs are part of the problem, but they are also part of the solution, said Mr. Yoon, National Director, US Clinical Development and Medical Affairs at Sandoz.

Mark Oldroyd, JD, Senior Director of Payer Relations & Reimbursement with Foundation Medicine added that once reimbursement models are implemented for molecular testing and patient access is improved, the data gathered from this testing will lead to improved value through administration of appropriate targeted therapies.

Introductory cost of a new drug has taken off, though the clinical gain has not been realized—are you getting the bang for the buck, Dr. Goodman asked Dr. Fontana.

The overall return on the investment is not keeping pace with the increasing cost, answered Dr. Fontana, Vice President and Chief Medical Officer, Pharmacy with Health Service Corporation. I don’t know what the solution to that is, but I do know that it’s unsustainable, he added.

Dr. Goodman asked Dr. Zagari how the value equation is considered when setting the price of a drug.

Dr. Zagari replied that there is no one price for a drug and explained that, because of pricing discounts given to government and Veterans Affairs (VA) programs, managed care organizations and private insurers are paying more for the same drugs. Different people are paying different prices and that is often hidden, he said.

When developing pricing strategy at Amgen, we look at the effect of the disease as well as the long-term benefits to society and the patients, and we begin with a value-based price that starts with a global value benchmark, Dr. Zagari added. Then, he said, we look at gains—marginal or great—in comparison with the market’s benchmarks and price accordingly.

Mr. Yoon, recalling experiences with his father’s own cancer diagnosis, explained that there are, indeed, scientific and economic reasoning behind the pricing structure of innovation; however, he said, value must be defined by the patient and the circumstances.

I certainly consent that there are cost issues throughout the total cost of care and there are perversities around physician incentives, said Dr. Krueger. Patients cannot afford their co-pays and health insurance is going to high-deductible plans, he added.

Dr. Newcomer expounded that in 42 states it is mandatory for payers to reimburse for FDA-approved drugs. The seller sets the price and the payer must pay it…that is not a market, he said. One of the payers—the federal government—cannot look at cost at all and to call this a market is wrong, he added.

Let’s give the patient the average that we spend on these cancers—say $100K, suggested Dr. Newcomer. And, let the patient spend it as they please—that’s where we have the market, he said. Dr. Newcomer explained a study, which looked at a similar scenario and noted that in such circumstances patient satisfaction and survival improved. Then, value is truly defined by the patient, he said.

If we want to recalibrate our framework…if we want pharma to do well and keep innovating, what would work, Dr. Goodman asked Dr. Fontana.

Dr. Fontana noted that the purpose of Health Care Service Corporation is to make health care more affordable for its members, allowing them to live better and longer. However, he noted, the wellbeing of pharma and bio is important because they enable innovation. Where I would start is transparency—we need to put aside the argument that the cost is solely research and development and have the conversation about what is the proper margin for the industry, he said.

Today, it takes about 10 – 12 years of investment to bring a biologic to market and 95 percent of drugs in clinical trials fail, explained Mr. Yoon. We cannot disregard the cost of innovation, he said.

In order to move the needle from a fee-for-service reimbursement model toward a value-based model, Dr. Newcomer described ongoing UnitedHealthcare prior authorization and episode-based payment pilots that are gathering patient data and identifying patients via characteristic cohorts in order to know what treatments are chosen, and tracking performance by claims data. Basically, winners—physicians who chose the optimal treatment for patients with the most value—will be reimbursed and providers who did not meet those criteria will not be reimbursed, he explained. 

Now that payers can have access to very long, real-world data sets they use to make decisions about what works in practice, this could change the dynamics, said Dr. Goodman.

Mr. Oldroyd added that the data does create a road map. We can look at genomic markers and see that a drug will be effective, and if we do not do that we are missing an opportunity to impact what the utilization of drugs are, he said.

Dr. Goodman asked Dr. Fontana to explain specialty pharmacy and its place in the current market.

Dr. Fontana explained that specialty pharmacy was borne from older treatments with compounds that required specialty handling but has since morphed into new products that tend to be higher costs, like those used in oncology. Orphan drug development has become a niche in economics and inflation in older branded products as well as generics has driven the pharmacy benefit trend, he said.

We are seeing inflation on proven products year after year as well as sudden pricing increases in generally common products that have been on the market for years for no particular reason—increases absent of innovation, said Dr. Fontana.

Moving to the subject of clinical trials, the panelists called for collaboration among all stakeholders—pharma, physicians, academic and community centers, and payers—to jumpstart a system in which patients are encouraged to enroll in clinical trials.

Especially for those with known genetic markers, said Dr. Newcomer, clinical trials certainly can lead to optimal outcomes while forging innovation.

Will this effect cost, asked Dr. Goodman.

We are stuck in a setting where these drugs are going from no cure to a little bit more of a cure, said Dr. Krueger. Costs will need to be determined based on expectations relative to expectations and progression-free survival, he said.

Dr. Goodman asked the panelists to discuss biosimilars and whether their introduction to the market can trend the cost curve in oncology.

I think that biosimilars certainly can help with equivalent outcomes at lower cost, said Dr. Fontana.

Mr. Yoon added that success of biosimilars is based on a competitive market and collaborative development, as well as physician decision-making.

We are looking a few years down the road until biosimilars come to fruition in oncology, said Dr. Kruger. Our payers and clients are eager to have access and we are looking to a 15-30% savings in those areas, he added.

In closing, Dr. Goodman asked the panelists to discuss one thing they could champion in order to generate more value in the system.

Across the board, the panelists noted that collaboration among all oncology stakeholders is key. The panelists noted the importance of capturing and sharing data in order to accomplish better health care costs, as well as identifying areas for increased patient access to care.  

Meet the Guidelines Panel Experts

The second session of the day, Meet the Guidelines Panel Experts, included the following esteemed NCCN leaders: Robert W. Carlson, MD, NCCN; William J. Gradishar, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University; M. Dror Michaelson, MD, PhD, Massachusetts General Hospital Cancer Center; Jerald P. Radich, MD, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; and Lee S. Schwartzberg, MD, FACP, St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center.

Dr. Goodman opened the panel with a discussion about what is coming down the pipeline for the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panels.

One of the challenges that the panels are undertaking is reevaluating current recommendations to eliminate redundancy within the Guidelines, said Dr. Gradishar, Chair of the NCCN Guidelines® Panel for Breast Cancer. In a disease such as Breast Cancer, he said, there are 10 options for adjuvant therapy, and the panel must determine preferences.

Dr. Gradishar noted that the panels are also tasked with development of new Guidelines resources, in particular the NCCN Guidelines with NCCN Evidence Blocks™ and the NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework™). New to the Guidelines panel members in the last year is the consideration of affordability in development of the NCCN Evidence Blocks™.

Right now the Guidelines for Chronic Myelogenous Leukemia (CML) are looking like a novel and we need to clarify the footnotes and instill consistent terminology, said Dr. Radich, Chair of the NCCN Guidelines Panel for CML.

Being part of an NCCN Guidelines Panel is a very rewarding experience, said Dr. Michaelson, noting the evolution of the Guidelines for Kidney Cancer since he joined the panel. The challenge—and reward—lies in the process of taking the primary literature and translating it into standard of practice for the rest of the country and ourselves, he said. Dr. Michaelson noted, in particular, the importance of interpreting literature on targeted therapy and putting it into a usable framework.

There has been a dramatic evolution in the NCCN Guidelines for CML for which the standard therapy was once bone marrow transplant—a treatment that is unheard of today, said Dr. Radich. Today, he explained, physicians know who will respond to certain treatment in a matter of just three months, and consistently work to alter the clock on temporary decision-making.

Echoing Dr. Gradishar, Dr. Radich later added that the panels make recommendations using high-level evidence based on NCCN Categories of Evidence; however, panelists face a difficult challenge in deciding which preference to give older drugs once new therapies are approved and added to the algorithm.

Dr. Goodman asked Dr. Schwartzberg to discuss the NCCN Guidelines Steering Committee, which comprises representatives from each NCCN Member Institution. Dr. Schwartzberg is a member of the committee. The Guidelines Steering Committee is charged with finding the proper representatives for each panel, as well as suggesting new Guidelines panels and new Guidelines derivatives for consideration, said Dr. Schwartzberg, who is also a member of the NCCN Guidelines Panels for Breast Cancer and Myeloid Growth Factors. The Guidelines Steering committee also coordinates the work of the panels—each panel has a different personality and we want to preserve this uniqueness while maintaining consistency across the panels, he explained.

One priority alteration to the Guidelines that was instituted this year was the stratification of myeloid growth factors within the NCCN Guidelines, he said. The growth factors are stratified by risk factor—high-, medium-, and low-risk—and then sorted by curative, life prolonging, or palliative therapy, Dr. Schwartzberg explained.

In describing the Guidelines development process and transparency measures, Dr. Schwartzberg added that the Guidelines panel members do accept packages from industry through a fully transparent process for consideration of a new agent of therapy within the Guidelines. However, he added, editorializing that content does not help in having a new agent added to the Guidelines. In general, he said, unless such packages are peer reviewed, panels have not been very willing to review the information. We wouldn’t consider something without analytical and clinical validity, he said.

Dr. Radich added that, as a Guidelines Panel member for CML, he does not recall ever reviewing a package for industry, explaining that the panel strictly reviews clinical trial data.

The Guidelines development process is incredibly efficient, added Dr. Carlson. Typically, he said, there is a 10-day turnaround for the NCCN Guidelines once a new agent is approved. We track PDUFA dates and we lag just days behind FDA approvals, he added.

Dr. Goodman asked the panelists to discuss the NCCN Guidelines with NCCN Evidence Blocks™ that were publicly released in October 2015.

Dr. Carlson, Chief Executive Officer, NCCN, and former Chair of the NCCN Guidelines Panel for Breast Cancer, discussed the challenge that the panelists face in developing the NCCN Guidelines versus the NCCN Evidence Blocks™, noting panelists must ignore drug cost in constructing the Guidelines due to NCCN’s strict firewall policy with industry. It is only in the development of the NCCN Evidence Blocks™—a separate Guidelines derivative—that the panel considers cost, he said. Dr. Carlson expounded that the Evidence Blocks do not illustrate a metric of “cost”, but that they are meant to inform the decision-making in the clinic with information that is optimal for a specific individual using five measures of value—efficacy, safety, consistency of evidence, quality and quantity of evidence, and affordability.

The development of the Evidence Blocks is an evolving and laborious process, added Dr. Gradishar. Each panel member must analyze each regimen within the Guidelines and make opinions based on evidence and personal experience, he said.

The process is evolving, said Dr. Carlson. Today, he explained, final score is an aggregate of the responses from the panelists on each regimen and there is very tight clustering on the surveys thus far, illustrating that the panel members are in very close agreement on the value measurements.

He also added that the panelists making the decisions about affordability of therapeutic regimens in the Guidelines are sub-specialists in their respective diseases who are exposed to these agents on a daily basis. The affordability scores are based on overall administration of a drug, not direct cost to the patient, he added.

Insurance companies and doctors have a good idea about what chemotherapy costs—the people who do not know the cost are the patients, and the NCCN Evidence Blocks™ provide information on costs of a particular regimen that they may need to think about, he explained.

Dr. Goodman asked if the affordability measure within the NCCN Evidence Blocks™ will have a direct effect on drug cost in the market.

Dr. Carlson explained that NCCN’s financial firewall prohibits the panelists from discussing cost with industry. However, he noted, there are other NCCN programs outside the firewall that can focus on cost of care, including items like episode-based insurance models and best practices.

The conversation then turned to the subject of biomarkers within the Guidelines.

Dr. Schwartzberg said that there are ongoing discussions among panelists regarding molecular testing for diagnostics versus therapeutics, noting that historically payers have been reluctant to reimburse for diagnostic molecular testing.

Dr. Goodman asked if the panels have the bandwidth to handle the inclusion of the biomarkers within the recommendations.

Dr. Radich said the CML panel has enough molecular biologists to interpret the data accurately.

Speaking for the Guidelines Panel for Kidney Cancer, Dr. Michaelson added that they can handle the workload, but said that there is not the plethora of genetic markers in their disease type as seen in other cancers.

Three years from now, if you could do something to augment or improve the NCCN Guidelines, what would it be, asked Dr. Goodman in closing.

Dr. Schwartzberg noted that the Guidelines Panels will need to integrate molecular profiling into the Guidelines in a consistent fashion.

We will need to make the Guidelines as portable as possible to community physicians and patients—communication with patients is the gap that we have, said Dr. Radich.

Dr. Michaelson said that panelists must adhere to their specialties and not make decisions on subject that they are not experts in. 

NCCN must continue its process to digitize the NCCN Guidelines for easier integration into health information technology (HIT) systems to increase access within electronic health records, education, and other support systems in oncology, said Dr. Carlson.

Going forward, precision medicine is not only going to guide systemic therapy, but also local therapy—at least in Breast Cancer, said Dr. Gradishar. I think we do a very good job, he said.

Ensuring Access to Innovation

The third session of the day, Ensuring Access to Innovation, featured the following industry, patient advocacy, and payer representatives: Joel W. Beetsch, PhD, Celgene Corporation; Briana Garofolo, Patient Alliances, LLC; Joan Levy, PhD, Multiple Myeloma Research Foundation (MMRF); Christine MacCracken, MSHEd, BSN, Janssen Pharmaceutical Companies of Johnson & Johnson; Lee N. Newcomer, MD, MHA, UnitedHealthcare; and Michael Ybarra, MD, PhRMA.

Dr. Goodman opened the discussion by asking how successful early access programs have been thus far in the United States.

Ms. MacCracken, Director of Patient Support, Janssen Office of the Chief Medical Officer, noted that success is relative to the lens through which one looks. Compassionate use has faced a large number of challenges from patient, provider, and government perspectives, and demand for transparency and process has increased, she said.

No one is against it, but there are challenges, echoed Dr. Goodman.

We believe that clinical trials are the gold standard for patients; however, once patients have exhausted all available treatment options, we want to make sure that something else is available for them, said Dr. Ybarra, Senior Director at PhRMA.

According to Dr. Beetsch, Vice President of Patient Advocacy and Corporate Affairs at Celgene, there are a number of challenges to weigh when considering innovation, clinical trials, and early access. He said that industry must balance the criticality of the phased trial program initiated by FDA, noting that expanded access programs can jeopardize clinical trial innovation if the wrong patient is put on the wrong drug. At the same time, he said, properly executed expanded access programs can help bring agents to patients earlier and faster and essentially can help with the approval process. Moreover, the early access patient population represents a real-world use case as opposed to a homogeneous clinical trial, said Dr. Beetsch.

Because of the smaller sample size, is there more of a hesitation to participate in early access within rare conditions, asked Dr. Goodman.

Early access complements what we are trying to do, said Dr. Levy, who is Vice President of Research at MMRF. In Multiple Myeloma, there have been 10 new drugs approved in the past 12 years; however, patients are still relapsing aggressively and they are looking for alternative treatments, she said. Dr. Levy discussed a recent project in which MMRF collaborated with Janssen, saying that it offered a lot of opportunity for patients who desperately required therapy.

The best way to ensure access to innovation is to get a clinical trial approved, said Mr. Garofolo, Managing Partner at Patient Alliances. However, there is a time and a place for early access—if you have the correct partners at the time, you can initiate a controlled, measureable, expanded access program to benefit patients, he said.

From the payer perspective, Dr. Goodman asked Dr. Newcomer whether he is in favor of early access programs.

In our world, there is no uniform process for incidents of early access, said Dr. Newcomer, Senior Vice President of Oncology and Genetics, at UnitedHealthcare. What I would like to see is a uniform process for expanded access where patients can enter into a phase III trial, he said. Dr. Newcomer reminded the audience that the payer ultimately does not make the decision to allow early or expanded access—the pharmaceutical manufacturer makes the decision based on certain criteria.

Delving further into the systematic approach to compassionate use and early access, Dr. Goodman asked Ms. MacCracken to expound on Janssen’s recent collaboration with New York University (NYU) to create the pilot initiative—Compassionate Use Advisory Committee, that comprises medical experts, bioethicists, and patient representatives who consider compassionate use requests that fall outside of clinical trials or expanded access programs through FDA. This advisory committee recommends to Janssen whether a patient is eligible for an investigational drug under certain parameters. Ms. MacCracken cited a February 2016 paper in The Journal of the American Medical Association for further background (Caplan AL, Ray A. The Ethical Challenges of Compassionate Use. JAMA. 2016;315(10):979-980. doi:10.1001/jama.2016.0416).

The pilot, said Ms. MacCracken, exists to learn a few lessons. Some of the lessons are not without challenge—no process is without criticism no matter how fair and well-rounded—but we welcome this challenge because it’s the right thing to do for patients, she said.

Other hurdles to innovation access lie outside of compassionate use, early access, and expanded access. In a time where the price of therapy is increasing exponentially, a major barrier to access is cost of treatment.

Dr. Goodman asked the panel to discuss assistance programs that help guarantee that patients have access to the drugs they need.

Dr. Ybarra noted that, in the United States, patients indeed experience higher health care costs, noting that PhRMA members have allowed patients more standardization in payment structures to help with the out-of-pocket costs.

There are a number of resources available for co-pay assistance, said Mr. Garofolo. He added that each year the Association of Community Cancer Centers (ACCC) publishes a list of resources that provide a safety net for patients who cannot afford treatment or who experience financial distress.

Is there enough assistance to go around, asked Dr. Goodman. The panel noted that there are several outlets for assistance—manufacturer assistance programs versus Foundation assistance—and a major challenge is making patients aware that help is available.

With regard to commercial co-pay assistance, health care stakeholders have to do a better job of getting the information for these programs into the hands of the health care providers, said Dr. Beetsch. On the Foundation side, there is enough assistance if a patient is eligible—especially for patients who are on Medicare and have low incomes, he explained.

If patients know about assistance programs, they will reach out, said Dr. Levy. She described how MMRF receives calls about payment assistance and their representatives are able to connect patients with customer service professionals at the manufacturers. Companies are very responsive in providing information back to patients, she said.

Dr. Goodman asked Dr. Newcomer to discuss value-based reimbursement and how such a model could affect treatment cost.

Dr. Newcomer described a system in which there is zero co-payment for therapy that provides unquestionable benefit, i.e. asthma medication or insulin. Another addition, he said, would be first-line therapy for Non-Hodgkin’s Lymphomas (NHL). In the same system, fourth-line therapy would be reimbursed at 50%, he said. These value-based systems will help steer patients toward therapy that is most likely to lead to optimal outcomes. The consideration of benefits along with their level of effectiveness will also have a positive effect on use of societal resources, said Dr. Newcomer.

With UnitedHealthcare’s new prior authorization tool, there is performance data available for certain regimens, he added. What is inevitable is that we will get more and more data on particular regimens and at that point, we can discuss the price of a product based on performance, he added.

Dr. Beetsch said a move toward value-based insurance would be a step in the right direction.

In a value-based system, cost equals opportunity to benefit, said Dr. Goodman. Is that something that PhRMA would favor, he asked Dr. Ybarra.

What’s more important to patients is that doctors are having conversations with them about what they want, he responded. Sharing data, sharing information, allowing a patient to make an informed decision—that’s great, he said.

In moving to a value-based system, added Dr. Ybarra, adherence to medication is very important. We need to make sure that patients are taking their medication, particularly if we are on the hook for value.

If you have a co-pay of $0, adherence goes up and outcomes are better because patients can afford their medications, added Dr. Beetsch.

When we talk about ensuring access to innovation, said Dr. Goodman, we know that when people do gain access, we still leave out certain disadvantaged populations and these groups are underserved. He asked the panelists to discuss whether or not barriers still exist for these patient groups.

Speaking about the Myeloma population, Dr. Levy described COMPASS data that showed that the African-American community was two- to three-times more likely to be diagnosed with the disease. Originally, she explained, the community thought this was caused by a genetic predisposition; but, the data have shown that, when given access to the standard of care, the African-American patients have similar outcomes to other patient populations. It’s essential to have more outreach programs to ensure that newly diagnosed patients in certain populations have access to the standard of care and education, said Dr. Levy.

There is a lot of funding from many partners that goes into these awareness campaigns, said Mr. Garofolo. What I would like to see is more collaboration among manufacturers to create more targeted awareness campaigns instead of working separately, he added. These programs work better when we partner together, he said.

Dr. Beetsch added that education is not only important at the patient level, but also among caregivers and physicians.

As part of a patient support program, inherent in the title is to reach out to patient support groups—we must focus on what the patient needs and not what we perceive the patient needs, said Ms. MacCracken. We must listen to the words of the patients to understand what they need, she added.

In closing, the panel discussed collaboration among the multitude of stakeholders who are responsible for ensuring patient access to innovation in oncology.

Dr. Beetsch and Mr. Garofolo expressed that stakeholders must collectively define value, expressing the importance for patient advocates to be a part of the conversation surrounding innovation, value, and access.

We must figure out how to collectively get big data sets together for use in defining appropriate care for complicated diseases, said Dr. Levy. Approval is also needed to release those data, she said.

Dr. Newcomer added that such transparent data will be available publicly next spring through the UnitedHealthcare prior authorization tool, providing the ability to bring real data to the conversation.

Manufacturers must work with patients and providers while also collaborating with payers to determine how we will find a common ground, said Dr. Ybarra.

To ensure access, we must collaborate with any stakeholder that is required—organizations, industry, payers—in order to put the patient’s needs first, said Ms. MacCracken. We must do more and try less, she added.

About NCCN Academy

NCCN Academy for Excellence & Leadership in Oncology™: School of Pharmaceutical & Biotech Business provides pharmaceutical and biotechnology professionals with the significant opportunity to view the oncology space, its future and its current operational issues from the provider and payer perspective. Participants will improve their working knowledge of key business, policy, coverage, reimbursement, informational, and operational issues in oncology and will gather valuable insights into developing effective strategies for navigating the various constituencies in cancer care. Through this interactive program, pharmaceutical and biotech professionals will learn from key stakeholders what they view to be the most pressing issues in oncology today and how to apply this knowledge to create mutually-successful working relationships. Further, they will hear thought leaders discuss how their decisions and programs are shaped by certain types of information and data.

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