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