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Ehman M, Punian J, Weymann D, Regier DA. Next-generation sequencing in oncology: challenges in economic evaluations. Expert Rev Pharmacoecon Outcomes Res 2024:1-18. [PMID: 39096135 DOI: 10.1080/14737167.2024.2388814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Next-generation sequencing (NGS) identifies genetic variants to inform personalized treatment plans. Insufficient evidence of cost-effectiveness impedes the integration of NGS into routine cancer care. The complexity of personalized treatment challenges conventional economic evaluation. Clearly delineating challenges informs future cost-effectiveness analyses to better value and contextualize health, preference-, and equity-based outcomes. AREAS COVERED We conducted a scoping review to characterize the applied methods and outcomes of economic evaluations of NGS in oncology and identify existing challenges. We included 27 articles published since 2016 from a search of PubMed, Embase, and Web of Science. Identified challenges included defining the evaluative scope, managing evidentiary limitations including lack of causal evidence, incorporating preference-based utility, and assessing distributional and equity-based impacts. These challenges reflect the difficulty of generating high-quality clinical effectiveness and real-world evidence (RWE) for NGS-guided interventions. EXPERT OPINION Adapting methodological approaches and developing life-cycle health technology assessment (HTA) guidance using RWE is crucial for implementing NGS in oncology. Healthcare systems, decision-makers, and HTA organizations are facing a pivotal opportunity to adapt to an evolving clinical paradigm and create innovative regulatory and reimbursement processes that will enable more sustainable, equitable, and patient-oriented healthcare.
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Affiliation(s)
- Morgan Ehman
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Jesman Punian
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Deirdre Weymann
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Dean A Regier
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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2
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Lawler M, Keeling P, Kholmanskikh O, Minnaard W, Moehlig-Zuttermeister H, Normanno N, Philip R, Popp C, Salgado R, Santiago-Walker AE, Trullas A, van Doorn-Khosrovani SBVW, Vart R, Vermeulen J, Vitaloni M, Verweij J. Empowering effective biomarker-driven precision oncology: A call to action. Eur J Cancer 2024; 209:114225. [PMID: 39053288 DOI: 10.1016/j.ejca.2024.114225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Precision oncology has a significant role to play in delivering optimal patient care. Biomarkers are critical enablers for precision oncology across the continuum of cancer diagnosis, in defining patient prognosis, and in predicting the response to treatments and their potential toxicities, as well as delineating the risk of hereditary cancer syndromes. Biomarkers also potentiate cancer drug development, accelerating patient access to safe and effective therapies. However, despite an accurate and timely diagnosis being critical to patient survival, advances in genomic testing are not being fully exploited in daily clinical practice, leading to missed opportunities to deliver the most effective treatments for patients. Biomarker testing availability and implementation often lag behind approvals of respective biomarker-informed therapies, limiting prompt patient access to these life-saving drugs. Multiple factors currently impede the routine adoption of biomarker testing including, but not limited to, cost, lack of test reimbursement, limited access, regulatory hurdles, lack of knowledge, insufficient cooperation on assay development, and the urgent need to harmonize and validate testing assays, all leading to inefficient diagnostic pathways. Clinical guidelines increasingly include genomic profiling, and recent evidence suggests that precision oncology can be delivered in a cost-effective way for financially-challenged health systems. Therefore, precision genomic testing for cancer biomarkers must be embedded into the clinical practice of oncology care delivery going forward. We articulate a series of recommendations and a call to action to underpin the mainstreaming of a biomarker-informed precision oncology approach to enhance patient outcomes and deliver cost effective 21st century cancer care.
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Affiliation(s)
- Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, BT9 7AE, UK; Cancer Drug Development Forum, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium.
| | - Peter Keeling
- Diaceutics PLC, Health and Wellbeing Park, Kings Hall, First Floor Building Two, Dataworks at, 490 Lisburn Rd, BT9 6GU Belfast, UK.
| | - Olga Kholmanskikh
- Federal Agency for Medicines and Health Products, Galileelaan 5/03, 1210 Brussels, Belgium.
| | - Warnyta Minnaard
- Missie Tumor Onbekend, Fannius Scholtenstraat 69H 1051 EV, Amsterdam, Netherlands.
| | | | - Nicola Normanno
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via Piero Maroncelli, 40, 47014 Meldola, Italy
| | - Reena Philip
- Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA.
| | - Claudia Popp
- F. Hoffmann-La Roche Ltd, Building 2, CH-4070 Basel, Switzerland.
| | - Roberto Salgado
- Department of Pathology, ZAS Hospitals, Lindendreef 1, 2020 Antwerp, Belgium; Division of Research, Peter Mac Callum Cancer Centre, 305 Grattan Street, Melbourne VIC 3052, Australia.
| | - Ademi E Santiago-Walker
- Janssen Research & Development LLC, Johnson & Johnson Innovative Medicine, 1400 McKean Road, Spring House, PA 19477, USA.
| | - Ana Trullas
- European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands.
| | - Sahar B van Waalwijk van Doorn-Khosrovani
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; CZ Health Insurance, Ringbaan West 236, 5038 KE Tilburg, the Netherlands.
| | - Richard Vart
- Eli Lilly and Company Ltd, 8 Arlington Square West, Downshire Way, Bracknell, RG12 1PU, UK.
| | - Jessica Vermeulen
- Janssen Biologics B.V., a Johnson & Johnson company, Emmy Noetherweg 6, 2333 BK Leiden, the Netherlands.
| | - Marianna Vitaloni
- Digestive Cancers Europe, Rue de la Loi 235/27, 1040 Brussels, Belgium.
| | - Jaap Verweij
- Cancer Drug Development Forum, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium.
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Huang T, Han Y, Chen Y, Diao Z, Ma Y, Feng L, Wang D, Zhang R, Li J. RLP system: A single-tube two-step approach with dual amplification cascades for rapid identification of EGFR T790M. Anal Chim Acta 2024; 1287:342126. [PMID: 38182396 DOI: 10.1016/j.aca.2023.342126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The detection of cancer gene mutations in biofluids plays a pivotal role in revolutionizing disease diagnosis. The presence of a large background of wild-type sequences poses a challenge to liquid biopsy of tumor mutation genes. Suppressing the detection of wild-type sequences can reduce their interference, however, due to the minimal difference between mutant and wild-type sequences (such as single nucleotide variants differing by only one nucleotide), how to suppress the detection of wild-type sequences to the greatest extent without compromising the sensitivity of mutant sequence detection remains to be explored. SIGNIFICANCE The RLP system addresses the incompatibility between RPA and RT-PCR reactions through a physical separation strategy. Besides, due to the remarkable flexibility of locked nucleic acid probes, the RLP system emerges as a potent tool for detecting mutations across diverse genes. It excels in sensitivity and speed, tolerates plasma matrix, and is cost-effective. This bodes well for advancing the field of precision medicine. RESULTS The recombinase-assisted locked nucleic acid (LNA) probe-mediated dual amplification biosensing platform (namely RLP), which combines recombinase polymerase amplification (RPA) and LNA clamp PCR method in one tube, enabling highly sensitive and selective detection of EGFR T790M mutation under the help of well-designed LNA probes. This technique can quantify DNA targets with a limit of detection (LoD) at the single copy level and identify point mutation with mutant allelic fractions as low as 0.007 % in 45 min. Moreover, RLP has the potential for the direct detection of plasma samples without the need for nucleic acid extraction and the cost of a single test is less than 1USD. Furthermore, the RLP system is a cascading dual amplification reaction conducted in a single tube, which eliminates the risk of cross-contamination associated with opening multiple tubes and ensures the reliability of the results.
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Affiliation(s)
- Tao Huang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Yanxi Han
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Yuqing Chen
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Zhenli Diao
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Yu Ma
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Lei Feng
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Duo Wang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Rui Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.
| | - Jinming Li
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, China; National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.
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4
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Henderson RH, French D, Stewart E, Smart D, Idica A, Redmond S, Eckstein M, Clark J, Sullivan R, Keeling P, Lawler M. Delivering the precision oncology paradigm: reduced R&D costs and greater return on investment through a companion diagnostic informed precision oncology medicines approach. J Pharm Policy Pract 2023; 16:84. [PMID: 37408046 DOI: 10.1186/s40545-023-00590-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Precision oncology medicines represent a paradigm shift compared to non-precision oncology medicines in cancer therapy, in some situations delivering more clinical benefit, and potentially lowering healthcare costs. We determined whether employing a companion diagnostic (CDx) approach during oncology medicines development delivers effective therapies that are within the cost constraints of current health systems. R&D costs of developing a medicine are subject to debate, with average estimates ranging from $765 million (m) to $4.6 billion (b). Our aim was to determine whether precision oncology medicines are cheaper to bring from R&D to market; a secondary goal was to determine whether precision oncology medicines have a greater return on investment (ROI). METHOD Data on oncology medicines approved between 1997 and 2020 by the US Food and Drug Administration (FDA) were analysed from the Securities and Exchange Commission (SEC) filings. Data were compiled from 10-K, 10-Q, and 20-F financial performance filings on medicines' development costs through their R&D lifetime. Clinical trial data were split into clinical trial phases 1-3 and probability of success (POS) of trials was calculated, along with preclinical costs. Cost-of-capital (CoC) approach was applied and, if appropriate, a tax rebate was subtracted from the total. RESULTS Data on 42 precision and 29 non-precision oncology medicines from 56 companies listed by the National Cancer Institute which had complete data available were analysed. Estimated mean cost to deliver a new oncology medicine was $4.4b (95% CI, $3.6-5.2b). Costs to bring a precision oncology medicine to market were $1.1b less ($3.5b; 95% CI, $2.7-4.5b) compared to non-precision oncology medicines ($4.6b; 95% CI, $3.5-6.1b). The key driver of costs was POS of clinical trials, accounting for a difference of $591.3 m. Additional data analysis illustrated that there was a 27% increase in return on investment (ROI) of precision oncology medicines over non-precision oncology medicines. CONCLUSION Our results provide an accurate estimate of the R&D spend required to bring an oncology medicine to market. Deployment of a CDx at the earliest stage substantially lowers the cost associated with oncology medicines development, potentially making them available to more patients, while staying within the cost constraints of cancer health systems.
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Affiliation(s)
- Raymond H Henderson
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, UK.
- Queen's Management School, Queen's University Belfast, Belfast, UK.
- Diaceutics PLC, Dataworks at Kings Hall Health and Wellbeing Park, Co Antrim, Belfast, BT9 6GW, UK.
- Salutem Insights Ltd, Clough, Portlaoise, Garryduff, R32 V653, Ireland.
| | - Declan French
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Elaine Stewart
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Dave Smart
- Diaceutics PLC, Dataworks at Kings Hall Health and Wellbeing Park, Co Antrim, Belfast, BT9 6GW, UK
| | - Adam Idica
- Inovalon Inc., 4321 Collington Road, Bowie, MD, 20716, USA
| | - Sandra Redmond
- Salutem Insights Ltd, Clough, Portlaoise, Garryduff, R32 V653, Ireland
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Jordan Clark
- Diaceutics PLC, Dataworks at Kings Hall Health and Wellbeing Park, Co Antrim, Belfast, BT9 6GW, UK
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Peter Keeling
- Diaceutics PLC, Dataworks at Kings Hall Health and Wellbeing Park, Co Antrim, Belfast, BT9 6GW, UK
| | - Mark Lawler
- Patrick G. Johnston Centre for Cancer Research, Queen's University, Belfast, UK
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5
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Lawler M, Davies L, Oberst S, Oliver K, Eggermont A, Schmutz A, La Vecchia C, Allemani C, Lievens Y, Naredi P, Cufer T, Aggarwal A, Aapro M, Apostolidis K, Baird AM, Cardoso F, Charalambous A, Coleman MP, Costa A, Crul M, Dégi CL, Di Nicolantonio F, Erdem S, Geanta M, Geissler J, Jassem J, Jagielska B, Jonsson B, Kelly D, Kelm O, Kolarova T, Kutluk T, Lewison G, Meunier F, Pelouchova J, Philip T, Price R, Rau B, Rubio IT, Selby P, Južnič Sotlar M, Spurrier-Bernard G, van Hoeve JC, Vrdoljak E, Westerhuis W, Wojciechowska U, Sullivan R. European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission. Lancet Oncol 2023; 24:e11-e56. [PMID: 36400101 DOI: 10.1016/s1470-2045(22)00540-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.
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Affiliation(s)
- Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK.
| | - Lynne Davies
- International Cancer Research Partnership, International House, Cardiff, UK
| | - Simon Oberst
- Organisation of European Cancer Institutes, Brussels, Belgium
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK; European Cancer Organisation Patient Advisory Committee, Brussels, Belgium
| | - Alexander Eggermont
- Faculty of Medicine, Utrecht University Medical Center, Utrecht, Netherlands; Princess Máxima Centrum, Utrecht, Netherlands
| | - Anna Schmutz
- International Agency for Cancer Research, Lyon, France
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tanja Cufer
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matti Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - Kathi Apostolidis
- Hellenic Cancer Federation, Athens, Greece; European Cancer Patient Coalition, Brussels, Belgium
| | - Anne-Marie Baird
- Lung Cancer Europe, Bern, Switzerland; Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Andreas Charalambous
- European Cancer Organisation Brussels, Brussels, Belgium; Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; Department of Oncology, University of Turku, Turku, Finland
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Csaba L Dégi
- Faculty of Sociology and Social Work, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Federica Di Nicolantonio
- Department of Oncology, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee, Europa Donna, Istanbul, Türkiye
| | - Marius Geanta
- Centre for Innovation in Medicine and Kol Medical Media, Bucharest, Romania
| | - Jan Geissler
- Patvocates and CML Advocates Network, Leukaemie-Online (LeukaNET), Munich, Germany
| | | | - Beata Jagielska
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Olaf Kelm
- International Agency for Research on Cancer, Lyon, France
| | | | - Tezer Kutluk
- Faculty of Medicine & Cancer Institute, Hacettepe University, Ankara, Türkiye
| | - Grant Lewison
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | | | - Thierry Philip
- Organisation of European Cancer Institutes, Brussels, Belgium; Institut Curie, Paris, France
| | - Richard Price
- European Cancer Organisation Brussels, Brussels, Belgium
| | - Beate Rau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter Selby
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Jolanda C van Hoeve
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Eduard Vrdoljak
- Department of Oncology, University Hospital Center Split, School of Medicine, University of Split, Split, Croatia
| | - Willien Westerhuis
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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Sadigh G, Goeckner HG, Kazerooni EA, Johnson BE, Smith RA, Adams DV, Carlos RC. State legislative trends related to biomarker testing. Cancer 2022; 128:2865-2870. [PMID: 35607821 DOI: 10.1002/cncr.34271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/06/2022]
Abstract
Comprehensive biomarker testing has become the standard of care for informing the choice of the most appropriate targeted therapy for many patients with advanced cancer. Despite evidence demonstrating the need for comprehensive biomarker testing to enable the selection of appropriate targeted therapies and immunotherapy, the incorporation of biomarker testing into clinical practice lags behind recommendations in National Comprehensive Cancer Network guidelines. Coverage policy differences across insurance health plans have limited the accessibility of comprehensive biomarker testing largely to patients whose insurance covers the recommended testing or those who can pay for the testing, and this has contributed to health disparities. Furthermore, even when insurance coverage exists for recommended biomarker testing, patients may incur burdensome out-of-pocket costs depending on their insurance plan benefits, which may also create barriers to testing. Prior authorization for biomarker testing for some patients can add an administrative burden and may delay testing and thus treatment if it is not done in a timely manner. Recently, three states (Illinois, Louisiana, and California) passed laws designed to improve access to biomarker testing at the state level. However, there is variability among these laws in terms of the population affected, the stage of cancer, and whether the coverage of testing is mandated, or the legislation addresses only prior authorization. Advocacy efforts by patient advocates, health care professionals, and professional societies are imperative at the state level to further improve coverage for and access to appropriate biomarker testing.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hilary Gee Goeckner
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Devon V Adams
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia, USA
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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7
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Wang Q, Yan C, Zhang P, Li G, Zhu R, Wang H, Wu L, Xu G. Microarray Identifies a Key Carcinogenic Circular RNA 0008594 That Is Related to Non-Small-Cell Lung Cancer Development and Lymph Node Metastasis and Promotes NSCLC Progression by Regulating the miR-760-Mediated PI3K/AKT and MEK/ERK Pathways. Front Oncol 2021; 11:757541. [PMID: 34858831 PMCID: PMC8632265 DOI: 10.3389/fonc.2021.757541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose This study aimed to explore the circular RNA (circRNA/circ) profile engaged in non-small cell lung cancer (NSCLC) development and metastasis and to investigate potentially key carcinogenic circRNAs related to NSCLC. Methods CircRNA profiles between 10 NSCLC tissues and 10 adjacent tissues and between five NSCLC tissues with lymph node metastasis (LNM) and five NSCLC tissues without LNM were detected by Arraystar Human circRNA Array followed by bioinformatics. Circ_0008594 knockdown, circ_0004293 overexpression, and circ_0003832 overexpression plasmids were transfected into H23 and H460 cells to sort potential oncogenic circRNA. Then circ_0008594 overexpression and knockdown plasmids were transfected, followed by that circ_0008594 knockdown plus miR-760 knockdown plasmids were transfected into these cells. Cell proliferation, apoptosis, invasion, stemness, and pathways were detected. In addition, xenograft mice models were constructed via injecting H23 cells with circ_0008594 overexpression or knockdown to validate the findings. Results A total of 455 dysregulated circRNAs in NSCLC tissues versus adjacent tissues and 353 dysregulated circRNAs in NSCLC tissues with LNM versus those without LNM were discovered. Via cross-analysis, 19 accordant circRNAs were uncovered, among which three candidate circRNAs (circ_0008594, circ_0004293, circ_0003832) were chosen for functional experiments, during which it was observed that circ_0008549 affected H23 and H460 cell proliferation and apoptosis more obviously than circ_0004293 and circ_0003832. Subsequent experiments showed that circ_0008594 promoted H23 and H460 cell proliferation and invasion but affected stemness less and negatively regulated miR-760 via direct binding. Furthermore, miR-760 attenuated the effect of circ_0008549 on regulating H23 and H460 cell functions and the PI3K/AKT and MEK/ERK pathways. In vivo experiments further confirmed that circ_0008549 increased tumor volume, epithelial-mesenchymal transition, and the PI3K/AKT and MEK/ERK pathways while reducing tumor apoptosis and miR-760 NSCLC xenograft models. Conclusion Our study identifies several valuable circRNAs related to NSCLC development and LNM. Furthermore, as a key functional circRNA, circ_0008594 was observed to promote NSCLC progression by regulating the miR-760-mediated PI3K/AKT and MEK/ERK pathways.
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Affiliation(s)
- Qiushi Wang
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunhua Yan
- Department of Respiratory, Longgang District People's Hospital of Shenzhen, Shenzhen, China.,Department of Respiratory, Longgang District The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Pengfei Zhang
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guanghua Li
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ruidong Zhu
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hanbing Wang
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Libo Wu
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guangquan Xu
- The Second Department of General Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Stirling RG. Posttreatment Surveillance Challenges in the Era of Precision Medicine. J Thorac Oncol 2021; 16:e77-e78. [PMID: 34561038 DOI: 10.1016/j.jtho.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Rob G Stirling
- Respiratory Medicine, Alfred Health Melbourne, Department of Medicine, Monash University, Melbourne, Australia.
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