CHICAGO (GenomeWeb) – For four years, Dana-Farber Cancer Institute has been developing dozens of series of best practices in both medical and radiation oncology.
The organization had been automating these protocols, called Dana-Farber Clinical Pathways, in partnership with Via Oncology, a former subsidiary of the University of Pittsburgh Medical Center that is now owned by Elsevier. Dana-Farber created its own content on the Via Pathways web-based informatics infrastructure, but it was strictly for use by its employed and affiliated oncologists.
Now, Dana-Farber is looking to commercialize its Clinical Pathways protocols through a month-old, exclusive partnership with Royal Philips.
Philips used the occasion of the 2018 American Society of Clinical Oncology meeting held last month in Chicago to announce that it would partner with the cancer center to deploy Dana-Farber Clinical Pathways through the Philips IntelliSpace Oncology platform. According to the Dutch industrial conglomerate, IntelliSpace would deliver genomic- and diagnostic-centric clinical decision support to clinicians through electronic health records, following best practices developed at Dana-Farber.
Philips said it would incorporate Dana-Farber Clinical Pathways into its IntelliSpace Oncology to direct cancer patients and their doctors to the most appropriate treatments, relying on integrated digital pathology, genomics, and oncology informatics. Â
David Jackman, medical director of the Clinical Pathways program at Dana-Farber, said that Philips offers a "more dynamic platform" and wider reach for protocols developed at the cancer center than the previous partner, Via Oncology, did.
"Other providers would be able to, as they are seeing their own patients, say, 'What would a doc at Dana-Farber do?' This platform will provide that kind of information," Jackman said.
The Clinical Pathways set of protocols dates to 2014, when Dana-Farber piloted best practices with lung and breast cancer. "We now have over 30 medical oncology pathways and a similarly robust portfolio in radiation oncology," Jackman said. Those have been deployed throughout the Boston institution, as well as across its local and regional network of community oncologists.
"When we started this process, we tried to identify the cancers with the greatest need in terms of the volume that we see and the community oncologists see," Jackman said. A secondary consideration was whether there was enough patient information to build a data-driven pathway.
The collection is broad and still growing. "The pathways that we have cover about 93 to 95 percent of what we see, and what I imagine an even greater percentage of what a typical oncology office would see," Jackman said. "It's a very broad portfolio, but we don't have every single cancer. I don't have something for some rare sarcoma yet."
He expects IntelliSpace to help Dana-Farber capture, collate, and present these findings and recommendations to clinicians in a manner that can improve both decision-making and multidisciplinary communication, the latter through tumor boards.
"At the end of all that, once you've gathered all that information, we hope that our clinical pathways will be a welcome solution to try to support decision-making," Jackman said.
For example, according to Philips, Clinical Pathways can help physicians seeing a case of chronic myelogenous leukemia that is still progressing after first-line therapy to find a suitable treatment by comparing more than a dozen known resistance-related mutations to a range of potential targeted therapies.
The Clinical Pathways collection is broader than genomics. "It's for overall treatments of patients, and genomics is an important part of that, but it's certainly not the only part of that," Jackman said.
But he noted that genomics does inform the protocols in two main ways.
"We recognize that there are known targetable mutations for which there are approved and ready therapies, so if you've got a lung cancer with an EGFR mutation, we wanted patients to recognize that they should be getting an EGFR inhibitor, and, in fact, here's the one that we would recommend, and here's why," Jackman said.
"On the second level, depending on someone's genomic profile, a provider should be able to know for their patient if there are any clinical trials that are pertinent to this patient," either at Data-Farber or a community clinic, Jackman said. "We're trying to create a robust clinical trial system within that so that someone at any given institution would be able to look at someone's genomics" and find suitable treatments and clinical trials.
"There's the standard therapies for which there is a genomically based therapy, there are clinical trials for which there is a genomically targeted agent in trial," Jackman said.
"We need to look at this as a chance to study our own data and for other organizations to study their own data for patients with certain gene signatures," he continued. Dana-Farber is, however, being careful not to recommend treatments that have not either been approved by the US Food and Drug Administration or are in a registered clinical trial.
"We're really focusing on the approved things, the clinical trials, and how we can use genomics in that way right now, and then with an aspirational hope of [embedding] genomics in a way that creates a rapid learning system for the future," Jackman said.
In an email, Louis Culot, general manager for genomics at Philips, said that the partners have not announced a launch date but indicated that the IntelliSpace integration with Dana-Farber Clinical Pathways would "become available in the coming months."
He said that Philips is integrating Clinical Pathways into both the genomics and oncology modules of IntelliSpace. "[We] are looking at all the clinical touchpoints we have to see where the embedding of pathways can contribute to the 'quadruple aim' [of] better outcomes, lower cost, better experience for clinicians, and better experience for patients," Culot added.