The more biomarkers are included in routine diagnosis, the greater the benefit of using NGS to save time and provide the best therapeutic scheme.
The development of biomarkers, targeted therapies and immuno-oncology have changed the clinical management in non-small cell lung cancer (NSCLC). Next-generation sequencing (NGS) is already widely used for the molecular diagnosis of cancer, tscreening can be done for the entire genome or exome of a patient or only for specific genes. European Society of Medical Oncology recommend the routine use of NGS in advanced non-small cell lung cancer (NSCLC), prostate cancer, ovarian cancers and cholangiocarcinoma.
A new study, published in JCO Precision Oncology, evaluated the cost-effectiveness of NGS testing for lung cancer within reference centers in Spain. The results show that the use of NGS brings major benefits to the healthcare system, both in terms of patient survival and the reduction of costs associated with healthcare. Comprehensive genomic testing improves the detection rate of clinically relevant mutations in cancer patients, expands the number of cases eligible for administration of targeted therapies and enrollment in clinical trials. The study demonstrates the feasibility of such a nationwide approach and is a continuation of a pilot program carried out in a reference center in southern Spain.
A multidisciplinary committee of experts was formed, representing several reference centers, which analyzed the cost-effectiveness profile. The conclusion was that the clinical benefits outweigh the costs if NGS is the strategy of choice for testing metastatic lung cancer cases. Approximately 9,734 patients with advanced NSCLC cancer were selected. When NGS was used rather than single gene testing, 1,873 more mutations were discovered. This led to the enrollment of an additional 82 patients in clinical trials. Long-term, using NGS would provide an additional 1.188 quality-adjusted life years in the target populationcompared to single-gene testing, because more patients may be candidates for treatment depending on the genetic profile of their tumor.
- The clinical benefits outweigh the higher costs associated with NGS versus single-gene testing, even in the short term, largely due to the increased expense of targeted therapies. Therefore, NGS can bring key information in choosing the best therapeutic regimen from the beginning, thereby reducing the high costs associated with treatment, as happens in the classical approach of trial and error.
- More than that, using NGS provides complete results on all mutations in approximately 10 working days. Indeed, the results of single gene testing for ALK, EGFR, ROS1 can be ready in 5.93 working days, but when it is necessary to determine several biomarkers, sequentially, the time can exceed 2 weeks. Therefore, the more biomarkers that are included in routine diagnosis from the start, the greater the benefit of using NGS to save time. Also, NGS involves a high-throughput process that translates into the sequencing of hundreds of thousands of genes at a time and enables multiple applications in research, also facilitating the discovery of new variants.
The use of targeted therapies in the tyrosine kinase inhibitor class and immunotherapy have resulted in an unprecedented increase in survival in eligible patients with NSCLC. Knowing this, the goal of clinical management of lung cancer patients is to individualize and provide the best therapeutic strategy, especially since there are a multitude of drugs that can be used in combination or simultaneously to overcome resistance mechanisms.
Center for Innovation in Medicine recently published White paper on biomarkers in non-small cell lung cancer, a document describing the evolution of molecular testing in non-small cell lung cancer (NSCLC) and its benefits in terms of survival for patients with this type of cancer. As cancer therapies advance and become more precise, the testing techniques used must also be adapted and adopted by each medical system.