Abstract
Abstract Background: The advent of Next-Generation Sequencing (NGS), and other diagnostic technologies, has enabled the use of genomic information to guide targeted treatment in cancer patients. Utilizing these technologies, we established a precision medicine program within a large, integrated healthcare delivery system. We then monitored the outcomes, including progression free survival and treatment delivery costs, associated with the delivery of precision medicine for patients with advanced cancer. We report the structure of our program and an analysis of the clinical outcomes associated with precision cancer medicine. Methods: We conducted a matched cohort study of 72 patients from July 01, 2013 to December 31, 2014, with metastatic cancer of diverse subtypes. The outcomes of 36 patients treated with precision cancer medicine were compared to 36 historical control patients who received standard chemotherapy. Study and control patients were matched according to age, gender, histological diagnosis, and number of previous treatment lines. Progression free survival was compared between the two groups using a Cox Proportional Hazard model for survival and accounting for potential confounders. Costs included subsequent ED visits, hospitalizations, NGS costs, and costs for targeted treatment or standard therapy. Results: Establishing a precision cancer medicine program for advanced cancer patients was feasible and scalable. Evaluation of the outcomes revealed that progression free survival was 22.9 weeks for the treatment group and 12.0 weeks for the historical control group (p = 0.002). Patients receiving precision cancer medicine compared to conventional treatment patients had a hazard ratio of 0.47 (95% confidence interval of 0.29-0.75) when adjusting for age, gender, histological diagnosis and previous treatment lines. Cost per week was $3,204 in the treatment group and $3501 in the historical control group, p = 0.22 Conclusions: Precision cancer medicine appears to significantly improve survival for patients with advanced cancer when compared to control patients who received conventional chemotherapy. The additional survival is not associated with increased health care costs. While the results of this study warrant further investigation, this genomics-based approach appears to be a viable, and perhaps superior, option for patients with advanced or metastatic cancer. This abstract is also presented as Poster 16. Citation Format: Lincoln D. Nadauld, Burke Van Norman, Gail Fulde, David newman, Allison Butler, Brian Tudor, Heather Gilbert, Karen Lin, Gary Stone, Anish Konde, Iva Petrovchich, James M. Ford, Derrick Haslem. Precision genomic medicine improves clinical outcomes in advanced cancer patients. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr PR07.
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