New research1 presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) meeting from 4th-8th November 2017 in Glasgow, Scotland has shown the impact of profiling with Caris Molecular Intelligence, which changes treatment decisions in 88% of cases. The research also revealed the far lower treatment costs per patient per cycle using Caris Molecular Intelligence-guided treatment compared with FoundationOne-guided treatment.
Caris Molecular Intelligence (CMI) uses multiplatform molecular profiling to analyse DNA, RNA and proteins from tumour samples to identify specific biomarkers to personalise cancer treatment. Importantly, CMI uses multiple technologies including immunohistochemistry (IHC), 592-gene Next-Generation Sequencing (NGS), Sanger Sequencing, Pyro Sequencing, Fragment Analysis and in situ Hybridization. By contrast, FoundationOne (FMI) does not analyse proteins nor RNA, using only NGS to analyse 315 genes.2 This difference was highlighted in this research as it meant that patients profiled with CMI were more likely to be treated with chemotherapy (owing to IHC results) than those profiled with FMI, who were more likely to receive targeted therapies.1
Planned treatment decisions prior to profiling were captured from physicians and compared to the treatments that were administered after profiling from 5 studies for CMI and 2 studies for FMI. For patients profiled with CMI (n=137), the treating physician changed their treatment decision in 88% of cases. By contrast, for 232 patients profiled with FMI, treatment decisions were changed in only 29% of cases.
Data about the treatments administered after profiling were collated from 11 studies using CMI and 16 studies using FMI. Cost per treatment cycle were calculated using the British National Formulary (BNF). In a cohort of 385 patients profiled with CMI, the majority (70%) of treatments administered were chemotherapy alone. Importantly, this is similar to the prior lines of therapy for these patients for which 72% had chemotherapy alone. In contrast, FMI-guided treatment saw only 2% of patients receive chemotherapy alone, and 67% of patients received targeted therapies. This striking difference between CMI-guided treatments and FMI-guided treatments translated to the nearly 300% increase in treatment costs per patient per cycle when using FoundationOne.
The average treatment cost per patient per cycle in the prior line of treatment for the CMI studies was £979. Guided treatment after profiling with CMI saw the cost per patient per cycle reduce by 3.5% to £945. The average cost of treatment per patient per cycle for FMI was £2,795. The cost explosion that can be seen with FoundationOne-guided treatments is due, in large part, to the focus on targeted therapies.
The reason that the costs of Caris Molecular Intelligence-guided treatments are not significantly different to the cost of prior treatments is because the majority of Caris Molecular Intelligence-guided treatments were chemotherapies.
The researchers also showed that the average cost of CMI-guided treatment per week of progression free survival gained was £500. This was 7% lower than the planned line of treatment costs for these patients. By comparison, the average costs of FMI-guided treatment per week of progression free survival was £945, which was 76% higher than the planned treatment costs.
- Recently presented research has shown that physician treatment decisions are changed in 88% of cases when profiled with CMI and only 29% of cases profiled with FMI.
- 72% of patients who received CMI-guided treatment received chemotherapy alone, as opposed to only 2% those who received FMI-guided treatment.
- After profiling, treatment costs for CMI-guided treatment and FMI-guided treatment were vastly different with CMI-guided treatment on average costing £945 per patient per cycle compared to FMI-guided treatment which cost £2,795 per patient per cycle.
- Russell KJ, Janssens J, Dean A, Hernandez A, Voss A. Treatment choices based on multiplatform profiling platform, unlike those with sequencing alone, do not cause a cost explosion in refractory cancer patients. Value in Health, Vol. 20, Issue 9, A579. [PDF]
- Capdevila J, Rojo F, Gonzalez-Martin A, et al. Molecular profiling for clinical decision making in advanced cancer: a clinical appraisal. Journal of Cancer Research and Treatment. 2017; 5(3): 77-85. [Full article]