Story Topic: Advocacy

In recognition of Colorectal Cancer Awareness Month in the month of March, Linh Alejandro, Director of Medical Affairs Strategy interviewed Rona Yaeger, MD, of Memorial Sloan Kettering to elevate education and research on this devastating disease.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in men and women in the United States, according to the American Cancer Society. While the incidence rate of colorectal cancer has dropped overall since the mid-1980’s, the average age of diagnosis is getting younger (American Cancer Society 2023).

Q: Why were you motivated to focus your professional efforts on treating colorectal cancer?

A: I am interested in the science of how cancers develop. Colorectal cancer was one of the first cancers where the genetic steps for cancer development were mapped out, as polyps could be removed and analyzed. Beyond my scientific interest, I find the close relationship oncologists develop with patients, often spanning over years, especially rewarding. This is particularly true for colorectal cancer, where treatment of advanced disease requires consideration of local interventions, such as surgery or ablations where possible, and sequencing multiple treatments.

Q: During this colorectal cancer awareness month, what do you think is important for people living with colorectal cancer to know?

A: It’s important for everyone to be aware of the rising incidence of colorectal cancer among young people.  While we don’t understand the cause, colorectal cancer is rising rapidly among people in their 30’s and 40’s, particularly low colon or rectal tumors. Symptoms such as change in bowel habits or rectal bleeding that persist should be evaluated. Many of our young patients describe feeling that something wasn’t right for a while and their difficulty getting a colonoscopy. With increased awareness that even young people can get colorectal cancer, there’s hope that we will catch these cancers earlier, when they are more curable.

Q: Do you have any perspectives to offer other physicians treating colorectal cancer?

A: I have been fortunate to be involved in recent clinical trials of targeted therapies against BRAF V600E and KRAS^G12C mutated colorectal cancers. I have learned from this experience that it is important to consider both the mutation and the cancer type. Matched therapies can lead to dramatic responses in patients who have a specific mutation in their cancer. But these treatments can’t be applied the same across cancers, so physicians need to think of both factors, particularly for colorectal cancer, where combination therapy can be needed to sufficiently block the target.

Q: Looking at the horizon of colorectal cancer clinical research, is there anything exciting that gives you hope?

A: We’ve seen in past years that colorectal cancer can be a particularly challenging disease for which to develop new therapies; targeted therapies and immunotherapies that showed high efficacy in other cancers were not effective against colorectal cancer. We are now in an exciting time with many targeted therapy combinations and immunotherapy combinations being tested and advancing quickly in clinical trials. I am hopeful that there will be new treatments for patients with advanced colorectal cancer in the near future.

Q: Are there any resources you recommend to people living with colorectal cancer or their caregivers?

A: Patient networks on social media, such as COLONTOWN or KRAS Kickers, provide support and help patients and their families navigate treatments and clinical trials. Organizations such as ASCO have patient resources that can also provide information on disease-specific treatment options and what to expect with treatment. I have found that patients are now very well-informed and that information can be empowering.

Key Statistics for Colorectal Cancer American Cancer Society. 2023.

Q: Describe your role at Mirati.

A: At Mirati, I lead our regional medical affairs team, which encompasses our regional medical affairs directors, regional health outcomes directors, and our medical patient advocacy function. From a medical perspective, we engage with various external stakeholders such as key opinion leaders, healthcare providers, payers and population health decision makers, and patient advocacy groups in various capacities of scientific exchange such as providing education, determining potential collaborations, and other clinical and scientific support.

Q: Describe the journey that brought you to Mirati to do what you do today.

A: I started my industry career doing traditional discovery biology work, identifying and validating novel cancer targets for a small biotech company. I eventually shifted from R&D to medical affairs, moving through various roles and leadership responsibilities in both big pharma and medium-sized companies. After spending several years in the bigger pharma world, going back to a smaller biotech setting and being a part of a best-in-industry medical affairs team was attractive to me and led me here to Mirati. Although I’m a cancer biologist by training, a development opportunity afforded me the ability to get additional training in public health and has since inspired me to be an advocate for Health Equity in everything I do.

Q: What is ‘health equity’?

A: As defined by the Centers for Disease Control and Prevention (CDC), ‘health equity’ is when everyone has an equal opportunity to be as healthy as possible. There are many examples of health disparities that exist between different populations of people. Health disparities exist specifically within cancer as well, as certain communities such as Black, Latino, Native American, LGBTQ+, and people with disabilities have been disproportionately burdened by cancer and can experience greater barriers to cancer prevention, treatment and survival.

Q: What are the biggest barriers to health equity, specifically for cancer patients?

A: At Mirati we’re helping to address unmet needs in cancer patients with specific oncogenic drivers, but we also need to think about the non-genetic drivers of health outcomes that may influence a patient’s ability to receive appropriate health care. These issues are complex and have many social, economic, and cultural dimensions. Racism, poverty, limited access to insurance coverage, and earning a non-livable wage can all intersect to determine if one can receive adequate cancer care. Zip code and location of patients also matter; for example, for cancer patients living in a rural setting, transportation and accommodation may be an issue if they are referred to a treatment facility outside of their local community or even their state – especially if the patient doesn’t have the means to travel or afford lodging.

In addition, clinical trials are an important consideration in a cancer patient’s treatment repertoire and as a clinical development company, clinical trials is a large focus here at Mirati. However, it’s been well documented that minority groups, such as Black, Latino, Native American and others are underrepresented in the majority of clinical trials across the country. Race and genetics are both important components of how someone with cancer responds to treatment. Therefore, if we’re not accounting for diverse populations in our clinical trials, any drug once approved, may not be effective as proposed, if the drug has not been robustly tested in specific populations. Indeed, we have seen in the oncology setting more aggressive cancers associated with Black populations where approved treatments are not as effective as they are in their white counterparts.

Q: Why is it important to have a thoughtful DE&I strategy when working towards closing the healthy equity gap for cancer patients?

A: It’s important for all of us at Mirati to be aware of what impacts our patients’ health outcomes. I wish it were as simple as developing a drug and then putting it out there for people who need it. Educating ourselves on these complex issues is key for us to be able to collectively contribute to patient centered solutions. In particular, understanding that a subset of patients may not be receiving appropriate care simply because of the color of their skin or where they happen to live, should inspire us all to want to do more for these patients. There isn’t necessarily a ‘one size fits all’ solution for improving cancer health outcomes, so Mirati must be intentional, thoughtful, and inclusive in our strategic approach if we want to make a true impact on all of the patients we serve.

Q: Share 5 ways to bridge the healthy equity gap for cancer patients.

1. Educate yourself on the core issues that drive health inequities.
   Learn more about the social determinants of health. Think about the everyday challenges a cancer patient goes through and put yourself in the shoes of someone who may have additional burdens on top of dealing with a deadly illness.
2. Support Mirati efforts in the outreach and recruitment of diverse patients for our clinical trials.
   Keep marginalized patients and the patient voice top of mind when considering clinical trial strategy and operations. If in a role directly applicable, work collaboratively and cross-functionally to determine appropriate trial sites capable of recruiting a diverse population. Take marginalized populations into consideration earlier in the design process of a study.
3. Formalize partnerships with organizations and institutions that work with communities impacted by health disparities.
   Mirati regularly partners, sponsors, and engages with multiple patient advocacy organizations. If you are in a role that is involved in such decision making, be intentional when selecting new organizations to partner with. Ensure such partnerships and sponsorships at least in part support marginalized communities.
4. Volunteer your time with an organization advocating for marginalized patient populations.
   Use your volunteer time to directly support advocacy groups and the diverse patients they serve. Try to learn more directly about patient hardship in the community. Be an active participant and do your part to make an impact.
5. Support STEM initiatives designed to increase the future number of diverse healthcare providers in the workforce.
   Serve as a mentor (either formal or informal) to STEM students, be a guest speaker at a career fair or a judge at a local science fair, participate in STEM activities through your alma mater. Support and nurture the development of future healthcare providers with diverse backgrounds.