Broader Genetic Testing Can Save Costs, Determine Treatment Plans in Lung Cancer

Using next-generation sequencing (NGS) to test patients with non-small cell lung cancer (NSCLC) for all known genetic mutations associated with the disease appeared to be faster and more cost-effective than testing for one gene at a time — not to mention the results could have treatment implications, according to findings that will be presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.

“The field of lung cancer treatment is moving at a rapid pace, and we need to fully characterize genomic changes to determine the best treatment for patients shortly after they are diagnosed,” lead study author Nathan A. Pennell, M.D., Ph.D., co-director of the Cleveland Clinic Lung Cancer Program, said in a press release.

The study used a model to examine a million hypothetical members on both Medicare and commercial health plans. Using NGS saved $2.1 million for the Medicare group and over $250,000 for the group of patients on commercial insurance. Despite these findings — and the overall benefit of NGS – there is currently no standard for when or how genetic testing should be performed in this patient population.

There are eight known genetic mutations that occur in patients with NSCLC: EGFR, ALK, ROS1, BRAF, MET, HER2, RET and NTRK1. In the model, patients with newly-diagnosed NSCLC received PD-L1 testing plus one of the following:

• upfront NGS testing for all eight genes and KRAS all at once;
• testing for one gene at a time;
• exclusionary KRAS testing, followed by sequential tests for changes in other genes, if KRAS testing came out negative; and
• panel testing, which involved a combined testing for EGFR, ALK, ROS1 and BRAF, followed by either single-gene or NGS testing for changes in other genes.

Not only was NGS more cost-effective, but it could provide patients and their health care teams with answers sooner. While exclusionary and sequential tests took nearly five weeks to process, NGS took an average of only two.

The researchers noted that a patient’s results can have implications for what kind of treatment they receive. The Food and Drug Administration (FDA) previously approved agents to treat patients with EGFR, ALK, ROS1 and BRAF mutations; however, other genetic mutations may point toward that patient being apt for a clinical trial.

Further, patients with NSCLC should also be routinely screened for PD-L1 expression, which would indicate that they are more likely to respond to immunotherapy agents.

“Today, many treatment decisions are guided by the presence or absence of certain genetic changes in a patient’s tumor, and I expect that several more genes will be identified in the near future. Therefore, it becomes even more imperative to find a cost-effective gene test that can quickly identify a large number of gene mutations that can be targeted with treatments,” Pennell said.

And while these results were found looking at health care models, the researchers stated that their next steps would include looking at actual health systems to evaluate the differences in cost-effectiveness in a real-world setting.

ASCO President Bruce E. Johnson, M.D., FASCO, agreed with the potential implications this study offered.

“Precision medicine is driving the most exciting and powerful advances in cancer care today, particularly in lung cancer,” he said in the release. “It's encouraging to see that next-generation genetic testing tools can help physicians and their patients get the crucial genomic information they need to make treatment decisions, at a faster pace and lower cost than with other approaches.”