The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

There may be more value gleaned from the use of broad-panel next-generation sequencing (NGS) than from the use of a single-gene testing (SGT) approach in patients with nonsquamous non-small cell lung cancer (nsNSCLC), researchers argued in a presentation during the ASCO20 Virtual Scientific Program.1

Even though EGFR– and ALK-based testing is widely used in NSCLC — with a combined SGT rate for these mutations approaching 80% in patients with nonsquamous histology across community oncology practices in New Jersey and Maryland, according to a retrospective analysis of the COTA database2 — larger screening panels interrogating for other actionable driver oncogenes (ADOs) may actually be more cost-effective in the long run.

The goal of the simulation, led by Nathan A. Pennell, MD, PhD, of the Cleveland Clinic’s Taussig Cancer Center in Ohio, was to measure the cost and/or value differences between choosing to run a narrow genomics panel or broader NGS. They measured the potential value of each testing approach on the basis of life years gained (LYG) and the cost per LYG.

They considered the rates of reimbursement by the Centers for Medicare & Medicaid Services (CMS) for both a broad NGS test ($627.50) and 2 single gene tests (1 test for ALK and 1 test for EGFR; $732.30), and the cost of treatment for 2 years afterward (which they estimated would be approximately $20,000).


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The researchers estimated the prevalence of ADOs across nsNSCLC (89,000 nsNSCLC patients who would be eligible for testing annually) and then predicted survival outcomes in both the presence and absence of an ADO-based prescribing approach using the rates found in the existing literature. These survival estimates for each group were based on Weibull distributions fit to statistical estimates of both median and 5-year survival.

The model was based on the assumption that if there were an appropriate match for ADO and the patient subsequently received a targeted therapy as a result of the testing, the patient would gain a median additional 2 years of life.

ADOs of interest that were a part of the broader panel included EGFR, ALK, ROS1, BRAF, RET, MET, and NTRK, whereas SGT could only include interrogate for either ALK or EGFR.

Compared with the use of SGT, a more blanketed NGS approach to testing for genetic aberrations was determined to produce “large gains in life years at reduced cost per LYG,” the authors wrote.

Assuming the genetic testing rate in this patient population remains at 80%, a switch from SGT to a wider adoption of NGS “would result in an additional 21,019 LYG with reduced cost per LYG of $599. And if NGS were universally performed for nsNSCLC, the value would rise even higher.

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In addition, not running these multigene tests in a routine manner, the reseearchers argued, could be a missed opportunity — it could mean that actionable mutations would be missed by only using SGT, and patients may not get the best therapy for their disease as a result.

Thus, the investigators concluded, the estimated median survival and 5-year survival for a patient who received NGS followed by a highly effective therapy selected on the basis of that alteration was 39 months and 25%, respectively. The survival estimates would be 14 months and 25%, respectively, for a patient who had an ADO that was not identified by SGT.

Read more of Cancer Therapy Advisor‘s coverage of the ASCO 2020 meeting by visiting the conference page.

Reference

  1. Pennell NA, Zhou J, Hobbs B. A model comparing the value of broad next-gen sequencing (NGS)-based testing to single gene testing (SGT) in patients with nonsquamous non-small cell lung cancer (NSCLC) in the United States. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 9529.
  2. Illei PB, Wong W, Wu N, et al. ALK testing trends and patterns among community practices in the United States. JCO Precision Oncol. 2018:2;1-11.