1
|
Perdrizet K, Stockley TL, Law JH, Smith A, Zhang T, Fernandes R, Shabir M, Sabatini P, Youssef NA, Ishu C, Li JJ, Tsao MS, Pal P, Cabanero M, Schwock J, Ko HM, Boerner S, Ruff H, Shepherd FA, Bradbury PA, Liu G, Sacher AG, Leighl NB. Integrating comprehensive genomic sequencing of non-small cell lung cancer into a public healthcare system. Cancer Treat Res Commun 2022; 31:100534. [PMID: 35278845 DOI: 10.1016/j.ctarc.2022.100534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Standard molecular testing for patients with stage IV non-small cell lung cancer (NSCLC) in the Canadian publicly funded health system includes single gene testing for EGFR, ALK, and ROS-1. Comprehensive genomic profiling (CGP) may broaden treatment options for patients. This study examined the impact of CGP in a publicly funded health system. METHODS Consenting patients with stage IV NSCLC without known targetable alterations underwent CGP on diagnostic samples. Patients that had progressed on targeted therapy were also eligible. The CGP assay was a hybrid capture next generation sequencing (NGS) panel (Oncomine Comprehensive Assay Version 3, ThermoFisher). The number of actionable alterations, changes in treatment, clinical trial eligibility and costs as a result of CGP were evaluated and patient willingness-to-pay. RESULTS Of 182 screened patients,134 (74%) had successful CGP testing. Twenty percent had received prior targeted therapy. Incremental actionable alterations were identified in 31% of patients. The most common novel targets identified were mutations in ERBB2 (exon 20 insertions), MET (exon 14 skipping) and KRAS (G12C). At data cut off (31/12/2020), 16% of patients had a change in treatment as a result of CGP. Additional clinical trial options were identified for 75% of patients. The incremental direct laboratory cost for CGP beyond public reimbursement for single gene tests was $747 CAD/case. CONCLUSION CGP identifies additional actionable targets beyond single gene tests with a direct impact on patient treatment and increased clinical trial eligibility. These benefits highlight the value of CGP in patients with NSCLC in public health systems.
Collapse
Affiliation(s)
- Kirstin Perdrizet
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; William Osler Health System, Brampton, Ontario, Canada.
| | - Tracy L Stockley
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Jennifer H Law
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Adam Smith
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Tong Zhang
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Roxanne Fernandes
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Muqdas Shabir
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Peter Sabatini
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Nadia Al Youssef
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Christine Ishu
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Toronto, Canada
| | - Janice Jn Li
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Prodipto Pal
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Michael Cabanero
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Joerg Schwock
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Hyang Mi Ko
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Scott Boerner
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Heather Ruff
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Adrian G Sacher
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre/University Health Network, Toronto, Canada.
| |
Collapse
|
2
|
Ericson Lindquist K, Gudinaviciene I, Mylona N, Urdar R, Lianou M, Darai-Ramqvist E, Haglund F, Béndek M, Bardoczi E, Dobra K, Brunnström H. Real-World Diagnostic Accuracy and Use of Immunohistochemical Markers in Lung Cancer Diagnostics. Biomolecules 2021; 11:biom11111721. [PMID: 34827719 PMCID: PMC8615395 DOI: 10.3390/biom11111721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: Accurate and reliable diagnostics are crucial as histopathological type influences selection of treatment in lung cancer. The aim of this study was to evaluate real-world accuracy and use of immunohistochemical (IHC) staining in lung cancer diagnostics. Materials and Methods: The diagnosis and used IHC stains for small specimens with lung cancer on follow-up resection were retrospectively investigated for a 15-month period at two major sites in Sweden. Additionally, 10 pathologists individually suggested diagnostic IHC staining for 15 scanned bronchial and lung biopsies and cytological specimens. Results: In 16 (4.7%) of 338 lung cancer cases, a discordant diagnosis of potential clinical relevance was seen between a small specimen and the follow-up resection. In half of the cases, there was a different small specimen from the same investigational work-up with a concordant diagnosis. Diagnostic inaccuracy was often related to a squamous marker not included in the IHC panel (also seen for the scanned cases), the case being a neuroendocrine tumor, thyroid transcription factor-1 (TTF-1) expression in squamous cell carcinomas (with clone SPT24), or poor differentiation. IHC was used in about 95% of cases, with a higher number of stains in biopsies and in squamous cell carcinomas and especially neuroendocrine tumors. Pre-surgical transthoracic samples were more often diagnostic than bronchoscopic ones (72–85% vs. 9–53% for prevalent types). Conclusions: Although a high overall diagnostic accuracy of small specimens was seen, small changes in routine practice (such as consequent inclusion of p40 and TTF-1 clone 8G7G3/1 in the IHC panel for non-small cell cancer with unclear morphology) may lead to improvement, while reducing the number of IHC stains would be preferable from a time and cost perspective.
Collapse
Affiliation(s)
- Kajsa Ericson Lindquist
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
- Division of Pathology, Department of Clinical Sciences, Lund University, SE-221 00 Lund, Sweden
| | - Inga Gudinaviciene
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Nektaria Mylona
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Rodrigo Urdar
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Maria Lianou
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Eva Darai-Ramqvist
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (E.D.-R.); (F.H.)
| | - Felix Haglund
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (E.D.-R.); (F.H.)
- Department of Oncology-Pathology, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Mátyás Béndek
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
| | - Erika Bardoczi
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
| | - Katalin Dobra
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
- Division of Laboratory Medicine, Department of Pathology, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Hans Brunnström
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
- Division of Pathology, Department of Clinical Sciences, Lund University, SE-221 00 Lund, Sweden
- Correspondence: ; Tel.: +46-046-4617-3510
| |
Collapse
|
3
|
Perdrizet K, Sutradhar R, Li Q, Liu N, Earle CC, Leighl NB. Second and later-line erlotinib use in non-small cell lung cancer: real world outcomes and practice patterns overtime in Canada. J Thorac Dis 2021; 13:5419-5429. [PMID: 34659808 PMCID: PMC8482335 DOI: 10.21037/jtd-21-804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/06/2021] [Indexed: 12/25/2022]
Abstract
Background In Canada, epidermal growth factor receptor (EGFR) inhibitor therapies in advanced non-small cell lung cancer (NSCLC) were initially approved regardless of EGFR status. The purpose of this study is to characterise the use of second or later-line erlotinib therapy in Ontario, Canada from 2007–2016, as well as evaluate the impact of erlotinib therapy on survival and emergency department (ED) visits in a real-world population. Methods This is a retrospective cohort study derived at ICES (formerly known as the Institute for Clinical and Evaluative Sciences) of advanced NSCLC patients diagnosed from 2007–2016 in Ontario, Canada, over the age of 65, who received at least one dose of first-line chemotherapy. The exposure of interest was receipt of second or later-line erlotinib. The primary outcome was the hazard ratio for mortality evaluated using a Cox proportional hazards model, and the secondary outcome, ED visits, was evaluated using a Poisson model. Results First-line chemotherapy was administered in 30.4% of stage IV NSCLC patients. Of these patients, 19.7% received second or later-line erlotinib. The proportion of patients prescribed second or later-line erlotinib decreased over the course of the study (P<0.0001). Unadjusted median overall survival in the entire cohort was 325 days (95% CI: 314–337 days), 513 days (95% CI: 485–539 days) in the erlotinib cohort, and 282 days (95% CI: 270–291 days) in the non-erlotinib cohort. Despite this, the adjusted hazard ratio for death was 1.89 (95% CI: 1.73–2.07, P<0.0001) for patients on erlotinib. Patients receiving erlotinib also had a marginally higher relative rates of ED visits with an adjusted relative risk of 1.10 (95% CI: 1.02–1.19, P=0.013). Conclusions This study highlights the importance of using EGFR targeted treatments in NSCLC patients with a predictive biomarker, and suggests that treatment with erlotinib therapy is unlikely to benefit unselected patients with advanced NSCLC.
Collapse
Affiliation(s)
- Kirstin Perdrizet
- Department of Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada.,Division of Oncology, William Osler Health System, Brampton, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,ICES (formerly the Institute for Clinical and Evaluates Sciences), Toronto, Canada.,Department of Biostatistics, Dalla Lana School of Public Health at the University of Toronto, Toronto, Canada
| | - Qing Li
- ICES (formerly the Institute for Clinical and Evaluates Sciences), Toronto, Canada
| | - Ning Liu
- ICES (formerly the Institute for Clinical and Evaluates Sciences), Toronto, Canada
| | - Craig C Earle
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,ICES (formerly the Institute for Clinical and Evaluates Sciences), Toronto, Canada.,Department of Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natasha B Leighl
- Department of Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|