New research1 presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) from 4th-8th November 2017 in Glasgow, Scotland has compared the clinical benefit and utility cost of Caris Molecular Intelligence (CMI), FoundationOne (FMI) and Paradigm (PCDx). The research found that 34% of patients profiled with Caris Molecular Intelligence had clinical benefit when compared to 6% of patients profiled with FMI, and 11% of patients profiled with PCDx.
All three services perform molecular profiling on solid tumour samples although they differ markedly in the testing that they do. CMI utilises a multiplatform approach to analyse the DNA, RNA and proteins from tumour samples and it notably uses Next Generation Sequencing (NGS) to analyse 592 key genes and immunohistochemistry (IHC) to analyse proteins.2 PCDx also tests DNA, RNA and proteins of tumour samples, but between IHC and NGS only 186 alterations are tested.3 FMI only uses NGS to analyse 315 genes and does not use IHC to test proteins from samples.2
The research consisted of a review of all of the clinical evidence that had been published for the three services. It defined clinical utility as the percentage of patients who had clinical benefit compared with the total number profiled. The research also highlighted that significantly more patients (77%) who were profiled with Caris Molecular Intelligence were subsequently treated in line with the profiling recommendations when compared with FoundationOne (19%) and Paradigm (26%).
A recent study has shown that only 5.3% of patients who were treated by physician directed therapy who had progressed on at least one line of standard of care treatment had clinical benefit.4 Thus, the fact that 34% of patients who are treated in line with Caris Molecular Intelligence have clinical benefit is a promising finding.
The research also highlighted the much lower utility cost of CMI when compared with FMI and PCDx. Utility cost was defined as the cost of profiling per patient who had clinical benefit. CMI had a utility cost of USD$19,118. By contrast, FMI’s utility cost was 5 times dearer at USD$96,667, and PCDx’s utility cost was over double as expensive coming in at USD$43,636.
The researchers concluded with an important consideration, that precision medicine that utilises a sequencing only approach has such low clinical utility that its costs do not seem to be sustainable outside of research. This highlights that different approaches to precision medicine are not equal in terms of cost-effectiveness or quality.
- New research has shown that 34% of patients profiled with CMI experience clinical benefit, compared with 6% of patients profiled with FMI and 11% profiled with PCDx. To put this in context, only 5.3% of those with physician led therapy have clinical benefit.
- More patients profiled with CMI are subsequently treated in line with the report (77%) than FMI (19%) and PCDx (26%).
- CMI has the lowest utility cost of the three services costing at USD$19,118. PCDx is over twice as expensive at (USD$43,636), and FMI is 5 times more expensive at (USD$96,667).
- Russell KJ, Janssens J, Dean A, et al. Comparison of utility cost in three commercially available precision medicine approaches in oncology. Value in Health. 20(9): A590. [PDF]
- Paradigm Diagnostics. Paradigm Cancer Diagnostic (PCDx) Technical Information. 2017 (accessed 9 December 2017). Available from: [URL Link]
- 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]
- Radovich M, Kiel PJ, Nance SM, et al. Clinical benefit of a precision based approach for guiding treatment of refractory cancers. Oncotarget. 2016; 7(35):56491-56500. [Abstract]