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Q&A With BS&W Oncology Leader on Cancer Costs and Research

By Christopher Cheney  
   June 12, 2019

An oncologist who pioneered immunotherapy cancer treatments at Johns Hopkins Medicine is now pursuing novel cancer care at Baylor Scott & White in Texas.

Ronan Kelly, MD, MBA, is right where he wants to be—on the cutting edge of cancer care.

Kelly recently joined Baylor Scott & White (BS&W) as the chief of oncology for the Dallas-based health system's North Texas division and director of oncology for the Charles A. Sammons Cancer Center.

He came to BS&W from Baltimore-based Johns Hopkins Medicine, where Kelly served as director of the Gastroesophageal Cancer Therapeutics Program and medical director of Global Oncology Johns Hopkins International.

At Johns Hopkins, Kelly worked closely with the Bloomberg~Kimmel Institute for Cancer Immunotherapy—a leader in the field of first-generation immunotherapy treatments with PD-1 inhibitors.

"I was there at the ground level when we were determining why patients were responding to PD-1 inhibitors, and why some patients whose tumors possessed more mutations were responding better than patients who had less mutations," he says.

HealthLeaders recently spoke with Kelly to discuss his new role at BS&W and the advances and challenges in cancer care. Following is a lightly edited transcript of that conversation.

HL: Why did you choose oncology as your specialty?

No. 1, I felt I had the right makeup as a doctor to be able to help cancer patients, not just in the short term but over a long period of time and to act as their primary physician for many months or years.  No. 2, I was interested in the huge scientific and technological breakthroughs that I knew were going to emerge over the lifetime of my career as a cancer doctor.

When I was coming out of medical school in the late 1990s, the Human Genome Project was coming to a close, and I knew we had reached a new era in cancer treatment because the Human Genome Project was unraveling who we are as human beings. By unraveling the human genome, we can understand what normal DNA should look like; and, as a result of that, we can identify where the mutations are developing that cause people to have cancer.

The first whole genome sequencing cost $2.7 billion in 2003. In 2006, the cost to sequence a human genome dropped to about $300,000. In 2016, we were down to $1,000, which is an example of the huge technological advances that we have made in the past 15 to 20 years that today are improving our understanding of why patients develop cancer and why they develop resistance to some of the medications we prescribe. I wanted to be involved right from the start of this new era of cutting edge human science, where we can develop new molecular and immunotherapeutics to help cancer patients in a much more meaningful way than ever before.

HL: Can you provide examples of novel cancer treatments that you hope to pursue at BS&W?

BS&W's Baylor University Medical Center is one of the largest cancer centers in the United States. If you look across the whole family of Baylor Scott & White cancer hospitals, we have 16 Charles A. Sammons Cancer Centers located throughout Texas. So, I am looking at harnessing the power of population medicine by inviting the thousands of men and women who are receiving FDA-approved immunotherapy drugs every day in our clinics to help us improve our understanding of what is happening in their immune cells throughout the duration of their journey with cancer. By utilizing biosamples from real-world patients, we will gain a greater understanding of mechanisms of resistance so that more patients can benefit in the future.

My hope for Baylor Scott & White oncology is that we can position ourselves not just as an immunotherapy center of excellence in Dallas but also the whole Baylor Scott & White health system will become an immunotherapy system of excellence. We want to learn from every patient who comes in for treatment. We will be taking samples of blood and other biospecimens from patients during their whole journey with cancer to try to understand at every step of the way what's happening to their immune system. We want to understand why some people stop responding and why some people have a phenomenal response rate.

The other thing we are looking to do is to continue to grow our immunotherapy clinical trial portfolios. We have a huge volume of novel and exciting immuno-oncology trials here at the Baylor University Medical Center. We have some of the most novel cellular therapy trials in the country. We have numerous CAR T-cell, T cell receptor gene therapies, bi-specific T-cell engager, and Natural Killer cell studies. Some of these trials are first in humans and not available anywhere else in the world. By utilizing our good manufacturing practice (GMP) laboratory, which is located at the Baylor University Medical Center campus, we can take blood from a patient, isolate the strongest tumor fighting immune cells, and genetically alter those cells prior to growing them in huge numbers in our lab. Then we give the cells back to the patient as an infusion of their own "supercharged" immune cells in an attempt to overwhelm a tumor.

HL: Based on the advances in cancer care over the past 15 years, what kind of advances do you expect over the next 15 years?

Every person who develops cancer has within them the ability to control cancer. We have an immune system that should be programmed to kill cancer cells. However, cancer has a series of defensive mechanisms that can protect itself from immunological attack. Now, most of the emphasis in cancer research is turning on the patient's inherent cancer-fighting ability by overcoming a tumor's ability to resist immunological attack.

We have seen incredible advances in the past five to 10 years with the PD-1 inhibitors; but now, we have a whole new generation of immunotherapies emerging from cellular therapies or so called “living drugs” to new checkpoint inhibitor combinations. We need to understand how to personalize immunotherapy so that every patient can benefit. Our ambition is to turn cancer into a chronic disease, it's going to be based on turning on the patient's immune system to wage a war between the bad cells and the good cells at the microscopic level.

HL: What is the biggest barrier in cancer care and how can it be overcome?

On a macro level, the biggest challenge now is the escalating cost of cancer care. The cost of cancer care is increasing at a faster rate than many other areas in medicine.

One of the most important things that we have to do as doctors is to become involved in national organizations that are tackling this challenge. I am involved with several task forces at the American Society of Clinical Oncology that are looking at how we can improve quality of care and bend the cost curve. I'm also involved in the International Association for the Study of Lung Cancer, where I chair the quality and value task force to make sure that we can continue to improve the quality of care given to all lung cancer patients in the world while also improving the value and the cost effectiveness of our care.

There's only so much that individual doctors can do, but we can come together in large organizations like ASCO to work with government to ensure that we can continue to not only help every patient who gets cancer but also do it in the most cost-effective manner for our country.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

On a macro level, the biggest barrier in cancer care is cost, says Baylor Scott & White oncology leader Ronan Kelly, MD.

One of the most important things that doctors must do is become involved in national organizations working to bend the cancer care cost curve, Kelly says.

In terms of cancer research advancement, he says "most of the emphasis … is turning on the patient's inherent cancer-fighting ability."

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