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Measuring the Value of Matched Therapy

Broad molecular tumor profiling can offer clinical benefits to many cancer patients. This is further supported by the addition of broad genomic profiling to oncology practice guidelines, like the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) in melanoma and non-small cell lung cancer (NSCLC). Now, studies are beginning to suggest that improvements in patient outcomes attributed to genomically-matched treatment regimens may help to balance the financial investment for cancer treatment. These studies are positive indicators that a comprehensive genomic profiling (CGP) approach in advanced cancer patients will be a key part in achieving ‘value-based oncology.

In new research recently published in JCO Precision Oncology1, we quantified the costs and benefits of genomically matching patients with metastatic cancer to therapy. This cost overlay study is the first to report anticancer drug costs and associated cost drivers for matched and unmatched therapies in these types of patients.

We found that the estimated mean anticancer drug cost for patients matched to targeted therapies was $68,729, compared to $30,664 for patients who were not matched to targeted therapies. Importantly, the increased drug treatment costs were largely attributable to a longer duration of therapy which was associated with longer time to treatment failure (TTF), rather than higher monthly drug costs. Additionally, patients receiving CGP early in their treatment journey trended towards improved outcomes and lower drug costs.

Improving Outcomes

The impact of genomically matched therapies on outcomes was based on a recent study2 which looked at 188 patients who were participants in a clinical study performed at M.D. Anderson Cancer Center in Houston, Texas. Of those patients, 122 were matched to a treatment based on a genomic alteration found by the FoundationOne® CGP test; 66 did not have a treatment match and received a therapy based on standard practice. In the study, patients who were matched with a targeted therapy experienced a mean TTF of 3.9 months, compared to 2.4 months for patients who were not matched with a therapy. Patients who were matched with a targeted therapy experienced a mean overall survival of 8.2 months. Patients who were not matched to a targeted therapy experienced a mean overall survival of 5.9 months. While these numbers may seem minimal at face value, for a patient battling cancer, two more months can mean more time spent with loved ones, seeing another birthday, or the opportunity to achieve an important life milestone.

These are encouraging results that we believe highlight the potential value of and need for genomic testing to match patients with the targeted therapy to which they’re likely to respond based on their individual tumor profile. CGP also has the potential to help prevent patients from receiving costly treatments to which they may not respond; although this study was not set up to measure this outcome.

Other studies have also demonstrated a favorable cost-benefit relationship for cancer therapies guided by genomic profiling. In a study published earlier this year3, patients receiving targeted therapy experienced mean progression-free survival (PFS) of 22.9 weeks, relative to 12 weeks for a control group, at a weekly cost that did not differ significantly between the groups.

Modeling Costs

The budget impact to commercial United States health plans was also considered in a recent publication in the Journal of Medical Economics4. This study compared the cost of an increase in CGP testing versus non-CGP testing, including a combination of both “hotspot” panels and single gene testing approaches, in advanced NSCLC patients. The study found that increasing the utilization of CGP tests within this patient group was associated with $0.02 per member per month budget impact to the payer model. Of that, $0.005 was attributable to testing cost and $0.013 to costs of prolonged drug treatment and survival, similar to the study out of M.D. Anderson Cancer Center mentioned above.

This economic analysis supports broader use of CGP in advanced NSCLC to maximize patients’ opportunities for being matched to effective treatments at manageable cost. These findings also indicate that the budget impact of CGP adoption is driven primarily by the clinical value generated in terms of longer treatment and survival and should not be viewed as a barrier to CGP access.

All of these results help provide a foundation for future research to further our collective understanding of the clinical and economic value of CGP. As the precision medicine treatment landscape continues to evolve, we believe that the role and value of genomic testing will continue to be at the forefront of advancing patient care.

Notes

1 Chawla, A., Janku, F., Wheler, J., et al. Estimated cost of anticancer therapy directed by comprehensive genomic profiling in a single-center study [published online November 2, 2018]. JCO Precis Oncol. doi: 10.1200/PO.18.00074

2 Wheler JJ, Janku F, Naing A, et al. Cancer therapy directed by comprehensive genomic profiling: a single center study. Cancer Res. 2016 Jul 1;76(13):3690-701.

3 Haslem DS, Van Norman SB, Fulde G, et al. A retrospective analysis of precision medicine outcomes in patients with advanced cancer reveals improved progression-free survival without increased health care costs. J Oncol Pract. 2017 Feb;13(2):e108-e119.

4 Signorovitch, J., Zhou, Z., Ryan, J., et al. Budget impact analysis of comprehensive genomic profiling in patients with advanced non-small cell lung cancer [published online November 15, 2018]. J Med Econ. doi: 10.1080/13696998.2018.1549056.