Multigene testing in resected early-stage non-small cell lung cancer may be cost effective
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CHICAGO — Comprehensive genomic profiling, or GCP, among patients with resected early-stage non-small cell lung cancer demonstrated a potential cost-benefit according to data presented at ASCO Annual Meeting.
Nathan A. Pennell, MD, PhD, medical oncologist at Cleveland Clinic and associate professor of medical oncology at Cleveland Clinic Lerner College, and colleagues selected 6,725 evaluable patients from Flatiron Health-Foundation Medicine NSCLC, a U.S. nationwide de-identified electronic health record-derived real-world clinico-genomic database. Patients were diagnosed with early-stage lung adenocarcinoma and underwent hybrid-capture-based tissue comprehensive genomic profiling as part of their routine cancer care between January 2011 and June 2021.
According to the poster, specimens were collected in both the early and advanced settings and were studied for the prevalence of NSCLC. The researchers also investigated the “cost implications of universal GCP testing” when downstream treatment costs were included. They compared this to single-gene testing for EGFR in early-stage lung adenocarcinoma.
The final analysis included 1,490 specimens collected in the early stage setting and 5,130 collected in the advanced setting. CPD performed in early-stage disease identified drivers in EGFR for 13% of specimens compared with 16% in advanced-stage disease. Similarly, ALK drivers were identified in 2% of early-stage specimens compared with 4.2% advanced-stage, ROS1 drivers were identified in 0.7% of early-stage specimens compared with 1.1% in advanced-stage, and RET drivers were identified in 1% of early-stage specimens compared with 1.1% in advanced-stage. The researchers noted that the prevalence was also similar with PD-L1-positive specimens.
There were 596 patients who experienced recurrence. Of those who had samples collected prior to recurrence, 196 obtained CGP results before recurrence and 400 obtained them after recurrence. Those who received CGP results before recurrence had less time between recurrence and start of any first-line therapy, according to the abstract.
In the subset of patients who had a detectable and targetable driver, 76% with CGP before recurrence matched first-line tyrosine kinase inhibitors compared with 64% who received CGP after recurrence.
When compared with EGFR single-gene testing, the researchers estimated that universal CGP testing could reduce expected costs by $875 per patient.
The findings show that CGP testing is currently being ordered prior to recurrent diagnosis in 15% of cases and that rate is only “increasing over time.” According to the poster, the use of CGP in early-stage lung adenocarcinoma is leading to more appropriate treatment decision and timely use of first-line therapies. Finally, CGP may reduce costs in early-stage lung adenocarcinoma by demonstrating which therapies to avoid in driver-positive patients who are “unlikely to benefit.”
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Pennell N, et al. Abstract 8525. Presented at: ASCO Annual Meeting, June 3-7, 2022, Chicago.
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