New JTCC Studies Demonstrate Clinical and Economic Value of Genomic Profiling in Improving Care and Outcomes in Non-Small Cell Lung Cancer and Breast Cancer
June 6, 2016 12:50 PM
Two new studies co-authored by researchers from John Theurer Cancer Center (JTCC) at Hackensack University Medical Center and discussed at the American Society of Clinical Oncology (ASCO) annual meeting demonstrate the potentially substantial therapeutic benefit of genomic profiling in serious, life-threatening cancers.
The first study, “Genomic Profiling of Non-Small Cell Lung Cancer in the Community Setting,” led by Martin Gutierrez, M.D., Director, Drug Discovery and Phase I Unit, John Theurer Cancer Center at Hackensack University Medical Center, demonstrates that genotyping in patients with advanced non-small cell lung cancer (NSCLC) identifies mutations likely to respond to targeted therapies. Most patients with NSCLC present with advanced stages of the disease (stage IIIB or IV). Up to 11 mutations have been reported, seven of which are now recommended for testing in routine practice.
Researchers studied retrospectively 634 patients with NSCLC from the COTA (Cancer Outcomes Tracking & Analysis) database and identified patterns of testing and treatment in the “real-world” clinical setting. The investigators determined that genotyping for two most common relevant mutations i.e., epidermal growth factor receptor (EGFR), a gene involved in cell growth and multiplication; and anaplastic lymphoma kinase (ALK), which contributes to cell proliferation and tumor survival, remain below recommended guidelines. Researchers concluded most patients are under-genotyped for all seven NSCLC treatable mutations.
“The benefit of targeted therapies has been demonstrated in large randomized clinical trials with not only better outcome including survival and less toxicity than standard chemotherapy. Evidently, efforts to support appropriate and timely testing must be encouraged in order to ultimately provide the best option for each of our patients.,” said Andre Goy, M.D., M.S., Chairman, John Theurer Cancer Center, and board member, COTA.
A second study utilizing the COTA genomic database, “Early Economic Benefits of Gene Expression Profiling Using a 21-Gene Panel among Patients with Early Stage, Lymph Node Negative, Hormone Receptor Positive, HER2/neu Oncogene Negative Breast Cancer,” was led by Stanley E. Waintraub, co-chief, Division of Breast Oncology, John Theurer Cancer Center, and Chief, Division of Hematology, Hackensack University Medical Center. Dr. Waintraub and colleagues assessed 227 breast cancer patients under 70 years of age; 68 percent underwent gene expression profiling (GEP).
The study demonstrates that GEP was able to identify a patient cohort showing positive long-term outcomes without need for adjuvant chemotherapy, resulting in significant cost savings, while maintaining a positive quality-adjusted life year (QALY), a measure of disease burden used to assess the value of medical interventions. Data revealed that adjuvant chemotherapy was utilized less in stage II patients with genomic profiled tumors, resulting in net savings of $11,494 per patient inclusive of the cost of the test. The GEP also identified a small group of high-risk patients with stage 1 disease who would likely benefit from chemotherapy, with a cost increase in that group of $4,505.
Researchers concluded that universal GEP testing of stage II or grade II/III lymph node negative breast cancers resulted in lower outpatient costs inclusive of the diagnostic test within the first six months of care. Among patients with stage I disease, GEP identified a small group of higher-risk patients who may derive clinical benefit from adjuvant chemotherapy who otherwise might not have been treated, with acceptable QALY ratios.
“Real-world confirmation of quality-adjusted life year is scant, and few studies focuses on the short-term costs that are critical in value-based payment reform,” said Dr. Goy. “It comes down to adjusting appropriately our diagnostic and therapeutic approaches to optimize our patients’ outcome. Smarter medicine is the answer to provide the best outcome with best value over time. ”
Both abstracts are available for review in the ASCO journal supplement, J Clin Oncol 34, 2016 (lung cancer abstract # e20616, breast cancer abstract #e18255)
About John Theurer Cancer Center at Hackensack University Medical Center
John Theurer Cancer Center is New Jersey’s largest and most comprehensive cancer center dedicated to the diagnosis, treatment, management, research, screenings, preventive care and survivorship of patients with all types of cancer.
Each year, more people in the New Jersey/New York metropolitan area turn to John Theurer Cancer Center for cancer care than to any other facility in New Jersey. The 14 specialized divisions feature a team of medical, research, nursing and support staff with specialized expertise that translates into more advanced, focused care for all patients. John Theurer Cancer Center provides comprehensive multidisciplinary care, state of the art technology, and access to clinical trials, compassionate care and medical expertise— all under one roof. Physicians at John Theurer Cancer Center are members of Regional Cancer Care Associates, one of the nation’s largest professional hematology/oncology groups. For more information please visit www.jtcancercenter.org.
Developed by world-leading oncologists, Cancer Outcomes Tracking & Analysis (COTA) has developed the unique CNA (COTA Nodal Address) System to precisely classify cancer patients into meaningful clinical and prognostic cohorts. Using this sorting technique, COTA is able to account for the biologic variances of cancer, thus permitting more in-depth analyses of treatment variances. This enables doctors and health plans to improve patient care and move from fee-for-service to value-based reimbursement models. COTA arms providers, patients and payers with the actionable, real-time insights needed to improve clinical outcomes, while reducing the costs. Based in New York City, the Company’s mission is to enable optimal care for every cancer patient. To learn more about COTA, call (866) 648-3833 or visit www.oncota.com.