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Parker G, Hunter S, Ghazi S, Hayeems RZ, Rousseau F, Miller FA. Decision impact studies, evidence of clinical utility for genomic assays in cancer: A scoping review. PLoS One 2023; 18:e0280582. [PMID: 36897859 PMCID: PMC10004522 DOI: 10.1371/journal.pone.0280582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Decision impact studies have become increasingly prevalent in cancer prognostic research in recent years. These studies aim to evaluate the impact of a genomic test on decision-making and appear to be a new form of evidence of clinical utility. The objectives of this review were to identify and characterize decision impact studies in genomic medicine in cancer care and categorize the types of clinical utility outcomes reported. METHODS We conducted a search of four databases, Medline, Embase, Scopus and Web of Science, from inception to June 2022. Empirical studies that reported a "decision impact" assessment of a genomic assay on treatment decisions or recommendations for cancer patients were included. We followed scoping review methodology and adapted the Fryback and Thornbury Model to collect and analyze data on clinical utility. The database searches identified 1803 unique articles for title/abstract screening; 269 articles moved to full-text review. RESULTS 87 studies met inclusion criteria. All studies were published in the last 12 years with the majority for breast cancer (72%); followed by other cancers (28%) (lung, prostate, colon). Studies reported on the impact of 19 different proprietary (18) and generic (1) assays. Across all four levels of clinical utility, outcomes were reported for 22 discrete measures, including the impact on provider/team decision-making (100%), provider confidence (31%); change in treatment received (46%); patient psychological impacts (17%); and costing or savings impacts (21%). Based on the data synthesis, we created a comprehensive table of outcomes reported for clinical utility. CONCLUSIONS This scoping review is a first step in understanding the evolution and uses of decision impact studies and their influence on the integration of emerging genomic technologies in cancer care. The results imply that DIS are positioned to provide evidence of clinical utility and impact clinical practice and reimbursement decision-making in cancer care. Systematic review registration: Open Science Framework osf.io/hm3jr.
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Affiliation(s)
- Gillian Parker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hunter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samer Ghazi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z. Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois Rousseau
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Spizzo G, Siebert U, Gastl G, Voss A, Schuster K, Leonard R, Seeber A. Cost-comparison analysis of a multiplatform tumour profiling service to guide advanced cancer treatment. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:23. [PMID: 31641338 PMCID: PMC6802110 DOI: 10.1186/s12962-019-0191-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tumor profiling is increasingly used in advanced cancer patients to define treatment options, especially in refractory cases where no standard treatment is available. Caris Molecular Intelligence (CMI) is a multiplatform tumor profiling service that is comprehensive of next-generation sequencing (NGS) of DNA and RNA, immunohistochemistry (IHC) and in situ hybridisation (FISH). The aim of this study is to compare costs of CMI-guided treatment with prior or planned treatment options in correlation with outcome results. Methods Retrospective data from five clinical trials were collected to define the treatment decision prior to the receipt of the CMI report (n = 137 patients). A systematic review of treatment data from 11 clinical studies of CMI (n = 385 patients) allowed a comparison of planned vs actual (n = 137) and prior vs actual (n = 229) treatment costs. Results Treatment plan was changed in 88% of CMI-profiled cases. The actual CMI guided treatment cost per cycle was £995 in 385 treated patients. Planned treatment costs were comparable to actual treatment costs (£979 vs £945; p = 0.7123) and prior treatment costs were not significantly different to profiling-guided treatments (£892 vs £850; p = 0.631). Conclusions Caris Molecular Intelligence guided treatment cost per cycle was in the range of prior or planned treatment cost/cycle. Due to beneficial overall survival the additional cost of performing CMI's multiplatform testing to the treatment costs seems to be cost-effective.
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Affiliation(s)
- Gilbert Spizzo
- Department of Internal Medicine, Oncologic Day Hospital, Bressanone Hospital (SABES-ASDAA), Bressanone-Brixen, Italy.,2Department of Haematology and Oncology, Innsbruck Medical University, Innrain 66, 6020 Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria
| | - Guenther Gastl
- 2Department of Haematology and Oncology, Innsbruck Medical University, Innrain 66, 6020 Innsbruck, Austria
| | | | | | | | - Andreas Seeber
- 2Department of Haematology and Oncology, Innsbruck Medical University, Innrain 66, 6020 Innsbruck, Austria.,6Laboratory for Oncogenomics, Tyrolean Cancer Research Institute, Innsbruck, Austria
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Purim O, Beny A, Inbar M, Shulman K, Brenner B, Dudnik E, Bokstein F, Temper M, Limon D, Matceyevsky D, Sarid D, Segal A, Semenisty V, Brenner R, Peretz T, Idelevich E, Pelles-Avraham S, Meirovitz A, Figer A, Russell K, Voss A, Dvir A, Soussan-Gutman L, Hubert A. Biomarker-Driven Therapy in Metastatic Gastric and Esophageal Cancer: Real-Life Clinical Experience. Target Oncol 2018; 13:217-226. [PMID: 29353436 PMCID: PMC5886994 DOI: 10.1007/s11523-017-0548-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Precision treatment of cancer uses biomarker-driven therapy to individualize and optimize patient care. OBJECTIVE To evaluate real-life clinical experience with biomarker-driven therapy in metastatic gastric and esophageal cancer in Israel. PATIENTS AND METHODS This multicenter retrospective cohort study included patients with metastatic gastric or esophageal cancer who were treated in the participating institutions and underwent biomarker-driven therapy. Treatment was considered to have a benefit if the ratio between the longest progression-free survival (PFS) post biomarker-driven therapy and the last PFS before the biomarker-driven therapy was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit. RESULTS The analysis included 46 patients (61% men; median age, 58 years; 57% with poorly-differentiated tumors). At least one actionable (i.e., predictive of response to a specific therapy) biomarker was identified for each patient. Immunohistochemistry was performed on all samples and identified 1-8 (median: 3) biomarkers per patient (most commonly: low TS, high TOPO1, high TOP2A). Twenty-eight patients received therapy after the biomarker analysis (1-4 lines). In the 1st line after biomarker analysis, five patients (18%) achieved a partial response and five (18%) stable disease; the median (range) PFS was 129 (12-1155) days. Twenty-four patients were evaluable for PFS ratio analysis; in seven (29.2%), the ratio was ≥1.3. In a one-sided exact binomial test vs. the null hypothesis, p = 0.019; therefore, the null hypothesis was rejected. CONCLUSIONS Our findings demonstrated that implementing biomarker-driven analysis is feasible and could provide clinical benefit for a considerable proportion (~30%) of patients with metastatic gastric or esophageal cancer.
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Affiliation(s)
- Ofer Purim
- Oncology Institute, Assuta Ashdod Academic Hospital, Harefua St 7, 7747629, Ashdod, Israel.
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel.
| | - Alexander Beny
- Oncology Department, Rambam Health Care Campus, 6 Ha'Aliya St, 31096, Haifa, Israel
| | - Moshe Inbar
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Katerina Shulman
- Oncology Unit, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Baruch Brenner
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, 39 Jabotinski St, 49100, Petah Tikva, Israel
| | - Elizabeth Dudnik
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, 39 Jabotinski St, 49100, Petah Tikva, Israel
| | - Felix Bokstein
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Mark Temper
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Dror Limon
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Diana Matceyevsky
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - David Sarid
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Amiel Segal
- Shaare Zedek Medical Center, The Oncology Institute, 12 Bayit St, 91031, Jerusalem, Israel
| | - Valeriya Semenisty
- Oncology Department, Rambam Health Care Campus, 6 Ha'Aliya St, 31096, Haifa, Israel
| | - Ronen Brenner
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
- Oncology Department, Wolfson Medical Center, 62 HaLohamim St, 58100, Holon, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Efraim Idelevich
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
- Kaplan Medical Center, Institute of Oncology, Pasternak St, 76100, Rehovot, Israel
| | - Sharon Pelles-Avraham
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Amichay Meirovitz
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Arie Figer
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Kenneth Russell
- Caris Life Sciences, St. Jakobsstrasse 199, 4052, Basel, Switzerland
| | - Andreas Voss
- Caris Life Sciences, St. Jakobsstrasse 199, 4052, Basel, Switzerland
| | - Addie Dvir
- Teva Pharmaceutical Industries Ltd, 1 Hatee'na St, 60850, Shoham, Israel
| | | | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
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Herzog TJ, Spetzler D, Xiao N, Burnett K, Maney T, Voss A, Reddy S, Burger R, Krivak T, Powell M, Friedlander M, McGuire W. Impact of molecular profiling on overall survival of patients with advanced ovarian cancer. Oncotarget 2017; 7:19840-9. [PMID: 26942886 PMCID: PMC4991422 DOI: 10.18632/oncotarget.7835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/18/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Patients with recurrent epithelial ovarian cancer (EOC) have limited treatment options. Studies have reported that biomarker profiling may help predict patient response to available treatments. This study sought to determine the value of biomarker profiling in recurrent EOC. RESULTS Patients in the Matched cohort had a median OS of 36 months compared to 27 months for patients in the Unmatched cohort (HR 0.62, 95% CI 0.41-0.96; p < 0.03). Individual biomarkers were analyzed, with TUBB3, and PGP prognostic for survival. Biomarker analysis also identified a molecular subtype (positive for at least two of the following markers: ERCC1, RRM1, TUBB3, PGP) with particularly poor overall survival. METHODS 224 patients from a commercial registry (NCT02678754) with stage IIIC/IV EOC at diagnosis, or restaged to IIIC/IV EOC at the time of molecular profiling, were retrospectively divided into two cohorts based on whether or not the drugs they received matched their profile recommendations. The Matched cohort received no drugs predicted to be lack-of-benefit while the Unmatched cohort received at least one drug predicted to be lack-of-benefit. Profile biomarker/drug associations were based on multiple test platforms including immunohistochemistry, fluorescent in situ hybridization and DNA sequencing. CONCLUSIONS This report demonstrates the ability of multi-platform molecular profiling to identify EOC patients at risk of inferior survival. It also suggests a potential beneficial role of avoidance of lack-of-benefit therapies which, when administered, resulted in decreased survival relative to patients who received only therapies predicted to be of benefit.
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | | | - Nick Xiao
- Caris Life Sciences, Phoenix, AZ, USA
| | | | | | | | | | | | - Thomas Krivak
- Western Pennsylvania Gynecological Oncology, Mars, PA, USA
| | - Matthew Powell
- Washington University School of Medicine, St. Louis, MO, USA
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