Clinical and Economic Value of Genetic Sequencing for Personalized Therapy in Non-small-cell Lung Cancer

Apostolia M Tsimberidou 1, Sheryl Elkin 2, Robert Dumanois 3, Daryl Pritchard 4

Affiliations

PMID: 32718774
DOI: 10.1016/j.cllc.2020.05.029

Abstract

Two recent studies examining the clinical and economic value of next-generation sequencing (NGS)-based diagnostic testing (multi-gene panel examining ≥ 30 genes) for non-small-cell lung cancer therapy compared with single gene ALK, EGFR testing to select therapy demonstrated statistically insignificant improvement in population-level overall survival and only a moderate incremental cost-effectiveness ratio associated with the NGS testing approach. The data, however, revealed a key practice gap: many patients with actionable mutations did not receive targeted therapies. This gap is attributed, in part, to limitations in the availability and interpretation of NGS results, sample processing constraints, limited access to targeted therapies, and lagging awareness of the rapidly evolving field of personalized medicine, all of which result in "clinical inertia," (ie, suboptimal use of targeted therapy against an actionable driver alteration identified by NGS testing). Additional analysis estimated that cost-effectiveness would improve significantly if a higher percentage of patients received testing and if all patients who were eligible for targeted therapies received them. Strategies to address implementation barriers will help to realize the full value of NGS testing in cancer care.

Keywords: Clinical utility; Cost effectiveness; NSCLC clinical practice gaps; Next-generation sequencing; Personalized/precision medicine.