New science could turn some health sys­tems into ‘di­nosaurs’

Modern Healthcare - - Q & A -

Dr. Pa­trick Soon-Shiong is the founder and CEO of Cul­ver City, Calif.-based Nan­tHealth, which seeks to use big data to de­liver per­son­al­ized medicine. Last week, Allscripts Healthcare So­lu­tions dis­closed that it would pay $200 mil­lion for a 10% stake in Nan­tHealth; Soon-Shiong said he plans a public stock of­fer­ing by year-end. Soon-Shiong, who in­vented the block­buster can­cer drug Abrax­ane, founded drug com­pa­nies Abraxis and Amer­i­can Phar­ma­ceu­ti­cal Part­ners, which he sold for a com­bined $9.1 bil­lion. He also has served as global di­rec­tor of can­cer ser­vices and bioin­for­mat­ics at Providence Health & Ser­vices. Mod­ern Healthcare re­porter Beth Kutscher re­cently spoke with Soon-Shiong about how Nan­tHealth will work with re­searchers, clin­i­cians and pay­ers to trans­form healthcare. This is an edited tran­script.

Mod­ern Healthcare: What does Nan­tHealth do?

Dr. Pa­trick Soon-Shiong: Nan­tHealth is cre­at­ing a knowl­edge en­gine on be­half of the pa­tient. If a pa­tient is deathly ill, the best thing is to fig­ure out the right treat­ment in the 21st cen­tury of molec­u­lar medicine. There was no in­fra­struc­ture to cap­ture big data in real time across the con­tin­uum for one sin­gle pa­tient. So we set up this in­fra­struc­ture to do that.

The pa­tient is em­pow­ered be­cause we now have dis­cov­ered that can­cer is a slew of rare dis­eases at the molec­u­lar level. The goal is to bring this break­through science to the de­liv­ery and pay­ment sides. Then we have an op­por­tu­nity to trans­form healthcare.

MH: Can you de­scribe specif­i­cally how this will work?

Soon-Shiong: Let’s say you find out through whole genome se­quenc­ing that this pa­tient with lung can­cer had this molec­u­lar fin­ger­print and a drug was avail­able and the pa­tient was com­pletely cured. The next week, you find a breast can­cer pa­tient who has the ex­act same molec­u­lar fin­ger­print. So the power of that sin­gle pa­tient in­formed 5,000 breast can­cer pa­tients about the op­por­tu­nity to treat them with that drug that’s been ap­proved for a dif­fer­ent in­di­ca­tion.

This pa­tient is unique in terms of the can­cer. How do we find a treat­ment uniquely for that pa­tient? That op­por­tu­nity is here now, by be­ing able to in­ter­ro­gate a pa­tient’s molec­u­lar pro­file and find a unique anti­gen on the sur­face of the tu­mor cell of that pa­tient. Then you have the abil­ity to iden­tify an an­ti­body that might match that anti­gen and tar­get that tu­mor.

MH: You be­lieve we’re too fo­cused on tis­sue and where (can­cer) is in the body, as op­posed to the molec­u­lar foot­print?

Soon-Shiong: Yes. We should treat the bi­ol­ogy, not the anatomy. The can­cer doesn’t un­der­stand that it hap­pens to be in the breast when the bi­o­log­i­cal path­way is the same for the ovary, uterus, lung or brain. We’ve been stuck and happy that a treat­ment works in 20% of the pa­tients. We need to trans­form our en­tire think­ing to treat the bi­ol­ogy, and get a 90% or 100% re­sponse.

The dif­fi­culty for the phar­ma­ceu­ti­cal in­dus­try is that the bi­ol­ogy is so rare be­tween dif­fer­ent types. How does any one in­sti­tu­tion ac­tu­ally cap­ture the pa­tient with that same bi­ol­ogy? With Nan­tHealth, we’ve cre­ated the in­fra­struc­ture to cap­ture the bi­ol­ogy of mul­ti­ple rare dis­eases in real time so we can treat that bi­ol­ogy.

MH: When did you first re­al­ize that the way we were treat­ing can­cer was wrong?

Soon-Shiong: When we de­vel­oped Abrax­ane in 2001. Abrax­ane is pa­cli­taxel. What we dis­cov­ered is that by en­cod­ing it with an al­bu­min drug, it in­ter­acts with a pro­tein in the blood ves­sel called gp60 and that all tu­mors feed on this pro­tein, re­gard­less of tu­mor type. There was a dance of pro­teins and if we could dance with them, we could kill the tu­mor by hav­ing the tu­mor feed rather than starve.

MH: What do you mean by “a dance of pro­teins”?

Soon-Shiong: What drives the cell in both a nor­mal state and in a dis­ease state are pro­teins in­side the cell. The pro­teins dance and talk to each other and cause the cell to ei­ther grow or die. In can­cer, it’s not that the cells just grow; it’s that these pro­teins pre­vent the cells from dy­ing. So the dance of pro­teins is chang­ing all the time and we need to cap­ture and find them. We want to drive that to an ev­i­dence­based de­ci­sion-sup­port sys­tem for doc­tors.

MH: How is your op­er­at­ing sys­tem pro­gress­ing to­ward

“If a pa­tient is deathly ill, the best thing is to fig­ure out the right treat­ment in the 21st cen­tury of molec­u­lar medicine.”

shar­ing in­for­ma­tion with elec­tronic health records?

Soon-Shiong: It’s launched across the coun­try. The de­vice con­nec­tiv­ity is in 250 hos­pi­tals. It’s in 80% of the on­col­ogy prac­tices. By next year, the de­ci­sion-sup­port en­gine is go­ing to cover 40 mil­lion cov­ered lives. It’s about to be launched through­out the Na­tional Health Ser­vice in the U.K.

MH: How is it chang­ing the way clin­i­cians op­er­ate?

Soon-Shiong: A pa­tient di­ag­nosed with breast can­cer en­ters an on­col­ogy prac­tice. The doc­tor goes on the sys­tem and finds there are a hun­dred pro­to­cols for breast can­cer. The pa­tient’s molec­u­lar pro­file is in­serted. The data would rule out pro­to­cols in terms of over­all sur­vival and cost. The doc­tor chooses a pro­to­col and the in­sur­ance com­pany im­me­di­ately ad­ju­di­cates cov­er­age. Then the pa­tient en­ters a mon­i­tor­ing phase. A clin­i­cal trial en­gine then opens, and the pa­tient knows by her lo­ca­tion which clin­i­cal trial is avail­able.

MH: Have in­sur­ers said they’ve saved money by us­ing this?

Soon-Shiong: Many. An­them Blue Cross has adopted this. It’s re­im­burs­ing the doc­tor $350 per pa­tient per month over and above the stan­dard re­im­burse­ment to use this sys­tem be­cause it’s im­prov­ing care and sav­ing money.

MH: How are you part­ner­ing with com­pa­nies such as Black­berry?

Soon-Shiong: With Black­berry, we will launch a can­cer genome browser that ev­ery physi­cian could ac­cess in real time. The other B2B piece we’re about to launch is called the Nan­tTrans­porter. That takes ge­nomic data from any se­quenc­ing ma­chine. We stream that data to our su­per­com­puter so that the bioin­for­mat­ics and re­port could be put in the hands of the doc­tor that same day.

MH: What healthcare or­ga­ni­za­tions will you be work­ing with?

Soon-Shiong: You need the knowl­edge do­main tied in­ti­mately to the de­liv­ery do­main. While Providence has an ex­cel­lent hos­pi­tal de­liv­ery sys­tem, I have not yet seen any demon­stra­tion that it’s tied to the knowl­edge do­main.

I’ve con­cluded I re­ally need to work with or­ga­ni­za­tions with in-depth knowl­edge of the bioin­for­mat­ics and molec­u­lar medicine, as well as the hos­pi­tal-based de­liv­ery sys­tem. So we will be mov­ing on from Providence and look­ing for in­te­grated health sys­tems in Cal­i­for­nia, Ore­gon and Washington. This is a very im­por­tant de­ci­sion for my wife and me as we start look­ing to see where we will put our ac­tive phi­lan­thropy. We want to com­mit $1 bil­lion, with $100 mil­lion for each of the par­tic­i­pat­ing in­sti­tu­tions.

MH: What’s your timeline?

Soon-Shiong: Now. We re­cently were in six cities in eight days. I’m look­ing in Nashville and Pittsburgh. I’m go­ing back to Los An­ge­les and I’ll be dis­cussing this with or­ga­ni­za­tions there.

These or­ga­ni­za­tions need to have lead­ers and sci­en­tists who un­der­stand 21st cen­tury science but also have the scale and ca­pac­ity to man­age clin­i­cal care with ex­cel­lence. Science is mov­ing so fast. Un­less or­ga­ni­za­tions tie clin­i­cal care to the move­ment of new science, they will be­come di­nosaurs.

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