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Abstracts from Research

20150410-genomics-lab05_1x1

"Precision Medicine Improves Survival Without Increasing Costs in Advanced Cancer Patients"


Journal of Clinical Oncology® — The Official Journal of the American Society of Clinical Oncology®

Background

The advent of Next-Generation Sequencing (NGS), and other diagnostic technologies, has enabled the use of genomic information to guide targeted treatment in cancer patients. The outcomes and costs associated with the implementation of precision cancer medicine have been difficult to generate. Leveraging the advantages of an integrated healthcare system, we have implemented a clinical cancer genomics program to personalize targeted treatment for advanced cancer patients in a community setting. We report a retrospective analysis of the clinical outcomes associated with precision cancer medicine.

Methods

We conducted a matched cohort study of 72 patients from July 2013 to December 2014, with metastatic cancer of diverse subtypes. The outcomes of 36 patients treated with precision cancer medicine were compared to 36 historical control patients who received standard chemotherapy. Study and control patients were matched according to age, gender, histological diagnosis, and number of previous treatment lines. PFS was compared between the two groups using a Cox Proportional Hazard model for survival and accounting for potential confounders. Costs includes ED visits, hospitalizations, NGS costs and costs for targeted or standard therapy.

Results

Progression free survival was 22.9 weeks for the treatment group and 12.0 weeks for the historical control group (p = 0.002). Patients receiving precision cancer medicine compared to conventional treatment patients had a hazard ratio of 0.47 (95% confidence interval of 0.29-0.75) when adjusting for age, gender, histological diagnosis and previous treatment lines. Costs per week were $3,204 in the targeted group and $3,501 in the control cohort (p = 0.382).

Conclusions

Precision cancer medicine appears to significantly improve survival for patients with advanced cancer when compared to control patients who received conventional chemotherapy. The additional survival is not associated with increased costs. While the results of this study warrant further investigation in the setting of a prospective randomized control trial, this genomics-based approach appears to be a viable, and perhaps superior, option for patients with advanced or metastatic cancer.

Authors: Lincoln Nadauld, S. Burke Van Norman, Gail Fulde, Justin G. McDermott, David Newman, Allison M. Butler, Brian P. Tudor, Heather Gilbert, Karen Yin Lin, Gary Stone, James M. Ford, Derrick S. Haslem; Intermountain Healthcare, St George, UT; Intermountain Healthcare, Salt Lake City, UT; Stanford University School of Medicine, Stanford, CA

e17641, Journal of Clinical Oncology, 2015, Vol 33 (suppl; abstr e17641)

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HerediGene-Tests

"Implementation of a Precision Cancer Program in an Integrated Health Care System"


Journal of Clinical Oncology® — The Official Journal of the American Society of Clinical Oncology®

Background

The advent of Next-Generation Sequencing (NGS), and other diagnostic technologies, has enabled the use of genomic information to guide targeted treatment in cancer patients. Barriers to implementation of a precision cancer clinic in a community setting include ability to perform appropriate NGS testing, interpretation of results, and drug procurement. Leveraging the advantages of an integrated healthcare delivery system, we implemented a precision cancer program for advanced cancer patients in a community setting. This program includes NGS testing, interpretation by a multi-institutional Molecular Tumor Board (MTB) and a drug navigation process.

Methods

In July 2013, we began seeing metastatic cancer patients who had failed standard treatments in our precision cancer clinic. Patients with a good performance status and ability to consent were eligible. NGS was performed on fresh or archival tissue and each case was presented at our MTB which consists of experts in oncology and cancer genomics. Recommendations from the MTB were given to the treating physician, who then discussed with the patient. If it was decided to treat with the new agent, a drug navigation specialist worked with payers to obtain the drug, sometimes resulting in a complex appeals process. Patients were monitored for survival outcomes, cost and adverse events.

Results

To date, 243 patients with a variety of tumor types have had NGS performed on their tumor as part of our precision cancer clinic. 188 patients (77%) had actionable mutations. This resulted in a treatment change to the targeted drug in 117 patients (62%). In addition, 38 patients (20%) have targeted options available, but are awaiting disease progression through their current treatment. Our drug navigation system has successfully obtained drug for 155 patients (82%) through insurance approval, appeals processes or clinical trials.

Conclusions

Although barriers to precision cancer clinics exist, they can be overcome in the community setting through appropriate implementation of NGS, access to a MTB and a drug procurement process. In the era of personalized medicine, this model offers improved access to genomic medicine for advanced cancer patients outside of the academic setting.

Authors: Lincoln Nadauld, Derrick S. Haslem, Gary Stone, Pravin J. Mishra, Sharanya Raghunath, Jason L. Gillman, David L. Loughmiller, James M. Ford; Intermountain Healthcare, St George, UT; Intermountain Healthcare, St. George, UT; Stanford University School of Medicine, Stanford, CA

e17647, Journal of Clinical Oncology, 2015, Vol 33 (suppl; abstr e17647)

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20150410-genomics-lab09_reverted1x1

"A Retrospective Analysis of Precision Medicine Outcomes in Patients With Advanced Cancer Reveals Improved Progression-Free Survival Without Increased Health Care Costs"


Journal of Clinical Oncology® — The Official Journal of the American Society of Clinical Oncology®

Background

The advent of genomic diagnostic technologies such as next-generation sequencing has recently enabled the use of genomic information to guide targeted treatment in patients with cancer, an approach known as precision medicine. However, clinical outcomes, including survival and the cost of health care associated with precision cancer medicine, have been challenging to measure and remain largely unreported.

Methods

We conducted a matched cohort study of 72 patients with metastatic cancer of diverse subtypes in the setting of a large, integrated health care delivery system. We analyzed the outcomes of 36 patients who received genomic testing and targeted therapy (precision cancer medicine) between July 1, 2013, and January 31, 2015, compared with 36 historical control patients who received standard chemotherapy (n = 29) or best supportive care (n = 7).

Results

The average progression-free survival was 22.9 weeks for the precision medicine group and 12.0 weeks for the control group (P = .002) with a hazard ratio of 0.47 (95% CI, 0.29 to 0.75) when matching on age, sex, histologic diagnosis, and previous lines of treatment. In a subset analysis of patients who received all care within the Intermountain Healthcare system (n = 44), per patient charges per week were $4,665 in the precision treatment group and $5,000 in the control group (P = .126).

Conclusions

These findings suggest that precision cancer medicine may improve survival for patients with refractory cancer without increasing health care costs. Although the results of this study warrant further validation, this precision medicine approach may be a viable option for patients with advanced cancer.

Authors: Derrick S. Haslem, MD, S. Burke Van Norman, BS, Gail Fulde, MS, Andrew J. Knighton, PhD, Tom Belnap, PhD, Allison M. Butler, MS, Sharanya Rhagunath, PhD, David Newman, MS, Heather Gilbert, MD, Brian P. Tudor, MD, Karen Lin, MD, Gary R. Stone, RN, MBA, David L. Loughmiller, MS, Pravin J. Mishra, PhD, Rajendu Srivastava, MD, James M. Ford, MD, and Lincoln D. Nadauld, MD, PhD

DOI: 10.1200/JOP.2016.011486 Journal of Oncology Practice 13, no. 2 (February 1 2017) e108-e119.

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