A modeling study makes a strong case for universal next-generation sequencing (NGS) for patients with newly diagnosed advanced nonsquamous non–small cell lung cancer (NSCLC).
The model shows “clinically meaningful” gains in survival with “nonnegligible” reductions in costs with NGS over single-gene testing, the team reported in JCO Precision Oncology last month.
“Tens of thousands of life years lost annually when oncogene-driven NSCLC [patients] are not identified and treated, and biomarker testing and treating every [patient] actually saves $$ compared to treating without that info,” tweeted study investigator Nathan Pennell, MD, PhD, co-director of the Cleveland Clinic Lung Cancer Program in Ohio.
Nonsquamous NSCLC is increasingly classified by genomic alterations, andseveral highly effective targeted therapies have been approved by the US Food and Drug Administration (FDA).
While use of NGS — which identifies many genes — is expanding, single-gene testing remains common. As a result, many patients have actionable driver mutations that are never identified, and thus they don’t receive targeted therapy, Pennell and colleagues note.
The researchers modeled the economic impact and potential life-years gained (LYG) of NGS vs single-gene testing using a population of 89,000 hypothetical patients with newly diagnosed metastatic nonsquamous NSCLC.
The NGS panel that was used in the model included the following actionable driver oncogenes that were recommended by the National Comprehensive Cancer Network at the time of study conception: EGFR, ALK, ROS1, BRAF, RET, MET, and NTRK.
The researchers assumed that 80% of US patients with nonsquamous NSCLC underwent genetic testing of any type, while 20% were ineligible or did not undergo testing.
According to the model, as NGS supplanted single-gene testing, each incremental 10% increase in NGS provided an average of 2627 additional LYG, with an average cost savings per LYG of $75.
Fully replacing single-gene testing with NGS among eligible patients (80% NGS and 0% single-gene testing) resulted in an average of 21,019 additional LYG and an average reduced cost per LYG of $599.
If all eligible patients underwent NGS testing and each patient with an actionable driver oncogene received an indicated targeted therapy, the total average cost per LYG would be $16,642.
These results show that “broad implementation of NGS testing for all guideline-recommended actionable driver oncogenes in practices that currently perform limited genomic testing offers meaningful survival benefits to patients and is financially economical,” Pennell and colleagues write.
Reached for comment, Fred Hirsch, MD, PhD, said he’s “not surprised” by the findings and said “education of doctors and practices” is needed to boost use of NGS in lung cancer.
“The main message is we need to identify practically all patients with driver mutations in lung cancer, and the reason is we have FDA-approved treatments to offer and we have a lot of clinical trials to offer if we don’t have FDA-approved treatments available,” Hirsch, executive director of the Center for Thoracic Oncology, Tisch Cancer Institute at Mount Sinai, New York City, told Medscape Medical News. “NGS is also important for learning more about the biology of the disease.”
The study received no specific funding. Pennell has financial relationships with Lilly, Merck, Genentech, Amgen, Pfizer, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron, ResistanceBio, Takeda, Novartis, Vial CRO. Hirsch has disclosed no relevant financial relationships.
JCO Precis Oncol. Published online January 12, 2023. Full text
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