Abstract
PurposeComprehensive genomic profiling (CGP) detects several classes of genomic alterations across numerous genes simultaneously and can match more patients with genomically targeted therapies than conventional molecular profiling. The current study estimated the costs of anticancer drugs and overall survival (OS) for patients who were treated with matched and unmatched therapy.MethodsCosts were estimated for patients with complete data (188 of 500 patients) from a prospective, nonrandomized study of patients with diverse refractory cancers who underwent CGP and were treated with matched or unmatched therapy. We assessed mean time to treatment failure (TTF) and mean observed OS. Patient-specific drug and administration costs were imputed for the first regimen after CGP on the basis of drug classes, unit costs, and time on treatment.ResultsPatients on matched (n = 122) versus unmatched (n = 66) therapy had longer mean TTF (+1.5 months) and observed OS (+2.4 months) and higher drug costs (+$38,065; all P < .01). Increased drug costs were largely attributable to the longer duration of therapy associated with extended TTF (66.3%) rather than higher monthly drug costs (33.7%). Incremental increases in TTF (+1.9 months v +1.2 months) and observed OS (+2.5 months v +2.1 months) between matched and unmatched therapies were larger for those who underwent CGP in earlier- versus later-line therapy. Incremental increases in drug costs between matched and unmatched therapies were lower for earlier- compared with later-line therapy (+$27,000 v +$43,000, respectively).ConclusionMatched therapy was associated with longer TTF, increased OS, and manageable incremental cost increases compared with unmatched therapy. Most of these increased costs were a result of the longer duration of therapy rather than higher monthly drug costs. The benefits of matching were numerically greater in earlier versus later lines of therapy, which is consistent with the value of early use of CGP.
Highlights
Patients with metastatic cancer who have experienced failure with standard therapy often have few therapeutic options remaining; in recent years, the development of personalized medicine has shifted the oncology treatment landscape
Increased drug costs were largely attributable to the longer duration of therapy associated with extended treatment failure (TTF) (66.3%) rather than higher monthly drug costs (33.7%)
Matched therapy was associated with longer TTF, increased overall survival (OS), and manageable incremental cost increases compared with unmatched therapy
Summary
Patients with metastatic cancer who have experienced failure with standard therapy often have few therapeutic options remaining; in recent years, the development of personalized medicine has shifted the oncology treatment landscape. This includes the use of next-generation sequencing (NGS) platforms that vastly improve DNA sequencing efficiency by allowing millions of reactions to occur in parallel.[1,2,3,4] Many cancers have been shown to contain genomic alterations that can be targeted by specific therapies. Several prospective pantumor studies using comprehensive genomic profiling (CGP) have demonstrated improvements in clinical outcomes for patients who were treated with genomically matched therapy compared with those who received unmatched therapy.[7,12,13,21] Recent evidence has suggested that genomic testing at the time of diagnosis of metastatic disease, rather than after one or more lines of systemic therapy, may improve the chances for patients to receive clinically beneficial matched treatment before they undergo a rapid functional decline as they experience disease progression.[22]
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