Types of Blood Disorders

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JOHN WHYTE: Facing a cancer

diagnosis is something no one

wants to experience even

with all the remarkable advances

in treatment.

Today, I'm joined by Dr. Sunil

Verma, AstraZeneca's Senior Vice

President and global head

of the oncology franchise, who's

at the forefront of transforming

cancer care.

Dr. Verma is not only driving

the development of more

personalized treatments

but also championing

the importance

of early detection.

We recently sat down

and discussed his vision

for the future of cancer care,

including the role

of artificial intelligence,

the need to clarify often

confusing screening guidelines,

and how exactly we enhance

the patient experience.

If cancer has touched your life,

you will want to watch

this conversation.

Dr. Verma, thanks for

joining me.

SUNIL VERMA: It's great to be

here, John.

Thank you.

JOHN WHYTE: Well, let's start

off and get right at it

because you talk about the need

to transform oncology care.

So if we need to transform it,

what do we need to change

that we're currently doing?

SUNIL VERMA: So there are

some important elements that we

have to consider as we think

about what are those challenges.

So one is the complexity

of care.

When we think about the options

patients have, clinicians have,

even 5, 10 years ago, we really

had chemotherapy, radiation

therapy, surgery,

and targeted treatments.

Then, of course, came

immune therapy, which has really

helped many patients.

But thinking about the next 10,

15, 20 years with antibody drug

conjugates, cell therapies,

radio conjugates, the complexity

of care

is going to be substantially

more complex.

And I think we need to make sure

that we are partnering

effectively to simplify

care and not make it

more complex.

So an important element of how

we think about partnership,

how we think

about the future state,

is how do we make sure that we

simplify the care decision

making so that patients are

able to access the right therapy

at the right time in a more

meaningful manner.

JOHN WHYTE: I mentioned to you

before we went on that I follow

you on LinkedIn

and like your profile.

You talk a lot on LinkedIn

about the need

for these partnerships.

Who do we need to be

partnering with?

Is it the patient community?

Is it regulators?

And they don't think

of partnership in the same way.

Where are those partnerships

in your mind

that we need to be more

focused on?

SUNIL VERMA: As a clinician

and thinking and delivering

about cancer care

and through my academic and

clinical care,

you tend to be very focused

right on the patient in front

of you.

How do we bring

the right therapies and the best

therapies to that patient?

But I think being in industry

and being

in pharmaceutical companies

over the last few years,

it has really given me

an appreciation that the health

ecosystem is very broad,

and the partners who are part

of that ecosystem

need to be much

better integrated.

And these partnerships include

from diagnostic companies

to make sure we have

the right biomarker information,

from data companies who are

able to assimilate information

and provide information

to the clinicians,

to the health systems, and maybe

the patients in the future.

We have to think

about the health

tech companies who are also

involved in thinking about how

do we make sure

that the patients have

the right information

on their hands.

But we are collecting

the right information

from patients to make

the clinical journey much

better, much smoother.

We're thinking about also how do

we leverage the new emerging

technologies, such as AI,

into the mix and also

the education companies-- of how

do we make sure the information

is disseminated

to the clinicians

and to patients along the way.

So that whole health ecosystem

requires partnerships.

JOHN WHYTE: We can't talk

about transforming oncology care

and not talk specifically

about AI.

So you've mentioned it a couple

of times.

And I'd want to know where you

kind of sit on that continuum

where there are some folks that

are saying, "You know what?

We haven't even scratched

the surface of the power of AI."

And there's others that will

say, "You know what?

It's never going to replace

a physician and make that

cancer diagnosis."

And there's others over here

that will say, "Everyone should

have a second opinion

that's generated by AI."

So where does Dr. Verma stand

on the role of AI

in transforming cancer care?

SUNIL VERMA: I think, John, AI

is here to stay and will improve

cancer care decision-making.

So to share a couple of examples

and also where we see the future

of AI in the

decision-making process--

so as a breast cancer

clinician 20, 25 years ago

when I started

my clinical career,

a patient with hormone receptor

positive breast cancer who would

come and see me, I would have

an option.

I can give

this patient chemotherapy,

or I can give

this patient

endocrine treatment.

Those were the two options

Ten years ago, 5 years ago, we

may have five different options:

endocrine therapy,

endocrine plus

targeted chemotherapy.

If you think about the next 5

to 10 years, there may be 10,

15 different options

for that specific patient.

Now, there's a multitude

of factors that can determine

what is the right option

for that patient.

It could be how they responded

to prior therapies.

What is their disease status?

What is their

biomarker information?

What is the cancer treatment

resistance pathway that

has evolved?

All of that element and all

of that information

is really

difficult for a clinician

to track, measure, comprehend,

to provide a specific

treatment decision.

JOHN WHYTE: And everyone's not

a specialist as you are

that's treating.

SUNIL VERMA: Absolutely not

everybody is a specialist.

And maybe at an esteemed

cancer center

and an academic institution,

you're able to assimilate

and there is a structure.

But we need to make sure

that the information is

available, accessible, scalable,

and to make an informed decision

irrespective of where

the patient is going to go.

And so AI machine learning has

a critical role in taking a look

at all of those information

streams to be able to augment,

to be able to support

the clinical

decision-making process.

So I do feel that in the next 5

to 10 years,

a clinician who is sitting

in front of a patient will say,

"Based on my experience,

here's a recommendation.

Based on the guidelines,

here's a recommendation.

And based on data and informed

decision-making, which is

powered by AI and machine

learning, here is

a recommendation that is

specific to you."

And that information will lead

to a better decision-making

for the individual patient.

But also, and just as

importantly, it will also lead

to less disparity in care

between different institutions.

Because what you're doing is

you're really trying

to personalize the care

for that patient.

And irrespective of where

the patient goes,

that information

is accessible to make sure

that that individual patient

will have the right

treatment decision.

So that element is, I

think, critical.

And I think AI is going to have

a significant role.

And just as importantly, where

we're talking about patient

experience, imagine a patient

who can also learn as to what

their experience could be

on a specific medicine, using

AI-based content to say, "What

would be my experience look like

on this medicine versus

this medicine?"

JOHN WHYTE: Let's just even look

at breast cancer

and colorectal cancer screening

where we have guidelines.

We talk about guidelines.

But then the guidelines

sometimes are

different between different

professional societies,

and that can be

confusing to clinicians.

What's the right age?

What's the right methodology?

And then it can also

be confusing to patients.

Am I at average risk?

Can I do this test

versus that test?

How do we help

educate clinicians

about these changing guidelines,

which can be different based

on different medical groups?

It can really be frustrating.

What's your counsel to them?

SUNIL VERMA: So first of all, I

am a strong advocate

for guideline-based care.

I think the literature

and the evidence clearly

points out

that following guideline-based

care leads to better and more

improved patient outcomes.

I think where there may

be inconsistencies

or maybe

different interpretations

is really what is the endpoint

that is being measured in some

of the studies

or some of the guidelines.

And that endpoint can vary

from earlier diagnosis.

And are we diagnosing patients

at an early-stage setting

to an endpoint?

Are we truly improving survival

for patients by doing that?

Or is it leading to better

value-based health care

decisions from a

payer perspective?

So there's different endpoints

that are potentially why

these different guidelines may

have different outcomes

or different measures.

So what we can do,

and I think what we can

facilitate, is to connect some

of those critical endpoints

to say what really matters.

What really makes the biggest,

most impactful impact

from a health system perspective

or from a patient perspective?

And I think as a clinician,

I remember--

I recall having

those discussions with patients

to say yes, on a health system

level, the guidelines

recommendation is this

because it looks at

resource utilization.

It looks at if we were to not

spend the money on screening

guideline A, where you were

to shift resources--

JOHN WHYTE: But ages could

be different.

Some people could say start

mammograms at this age

versus another age.

One year we're supposed to do

shared decision-making

on prostate cancer screening.

SUNIL VERMA: Yeah.

JOHN WHYTE: Now we're supposed

to talk more

aggressively about--

SUNIL VERMA: Absolutely, John.

JOHN WHYTE: Folks can just

be like, I'm not sure what I

should be doing.

But patients aren't sure.

SUNIL VERMA: But that is really

where the clinicians

and a patient to say,

"Here is what the guideline

recommendation is.

Here is what the evidence

suggests for you

as an individual patient.

Here is the recommendation,

and here is the value

proposition based

on the recommendation."

So I think the guidelines'

audience is very different when

we're thinking about age, when

we think about resources.

But that clinician-patient

interface on individualizing

those guidelines is really where

the decision-making happens.

So I think that it's

good to have

those different guidelines,

but we have to also recognize

who the audience is

for those guidelines.

At the end of the day,

the patient and the clinician

needs to be able to

personalize and--

the term, our personalized risk

identification-- and have

those guidelines

really personalized

to that specific patient based

on their risk criteria

and applying those skills.

But I think to your point,

we need to simplify and help

and support

our oncology community so

that the value of their work

is realized and

greatly appreciated.

JOHN WHYTE: We started off

with transformation.

So I want to come back and end

with transformation.

I want to be very practical

or have you be very practical

and kind of walk our viewers

through what you envision

that workflow might look

like in 5 years from now.

Or maybe it's 10 years from now

in the sense, will people

be getting more care at home?

Will there be much more targeted

therapies with fewer

side effects?

Will we be at a point

where cancer won't be

in the top three causes of death

in the next 5 to 10 years?

What's your vision

of that transformation?

What does it look

like practically?

SUNIL VERMA: John,

it's such a great thing

to sort of imagine, because I

do think--

JOHN WHYTE: And I'm going

to play it back to you

in 5 years.

SUNIL VERMA: I hope all

of these elements come true.

I do think cancer is going to

be cured.

I do think cancer is going to be

a much more chronic condition.

And I do think that patients

will have a much stronger voice

in their decision-making

than they do today.

So let's walk through what

that future state is going

to look like.

So I think care will be closer

to home.

I think patients will have

access to medicines

and resources closer to home.

I think there will be a greater

emphasis on data that

we're collecting from patients

directly-- whether it's through

variables or other tools--

that we are able to predict

before a patient gets a side

effect on the medicine

or we're able to predict

before the patient's

disease progresses.

And we're able to predict

before a patient gets

into trouble so that we are

really proactively managing

the patients rather

than patients coming

to us with a symptom.

I think we'll be able

to personalize and individualize

that care and decision for that

specific patient, not just based

on a cancer biomarker report

but based on all the other

factors that we discussed-- how

they responded to prior

therapies, what and how

their cancer has progressed,

where has it progressed, what is

the composite information

related to wherever the cancer

is present--

so that diagnostic element

and that cancer informatics

element can be blended together

to be able to individualize.

I think the patients will have

a greater say based

on multiple modalities

of therapy

to say, "Yes, this therapy gives

me this value.

This therapy gives me this

value, but here is the patient

experience or here is what I

would want my life to be like."

So they'll be able to have

that shared decision-making that

is based

on their own individual

value system.

So we will have that certainty.

And finally, I think we will

have a more equitable system

where irrespective of patients

where they are with zip codes

they live in,

the access and the type

of therapy and their outcomes

will be much similar.

And I think if we reach

that state in the next 5 to

10 years,

we're looking at a much better

overall health system, a much

more value-based outcome,

and, more importantly, a system

that is more

equitable and accessible.

JOHN WHYTE: And that will be

a transformation

of our current system.

Well, Dr. Verma, I want to thank

you for taking the time today.

SUNIL VERMA: It's

wonderful to have

this discussion.

Thank you, John.

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