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Jeffrey Scott



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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.15-16 - Clinical Economic Impact of Improved Genotyping in Patients with Advanced Non-Small Cell Lung Adenocarcinoma (NSCLC) (ID 14255)

      16:45 - 18:00  |  Author(s): Jeffrey Scott

      • Abstract

      Background

      Comprehensive genomic profiling (CGP) at diagnosis and progression identifies NSCLC patients who may benefit from targeted therapies and are unlikely to respond to immunotherapy, however many patients are incompletely or undergenotyped. We developed a cost benefit model to evaluate the clinical and economic impact of using plasma-based cfDNA CGP to guide treatment decisions in first- and second-line advanced NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The model compares the clinical and economic impact of an NCCN guideline driven care paradigm, utilizing Guardant360â (G360), a CLIA certified, CAP accredited, NYSDOH approved cfDNA CGP test, for stage IIIB/IV NSCLC patients versus the current care paradigm and assesses the impact of additional genomic information to aid in therapy selection and subsequent effects on biopsy rates, drug costs, and clinical outcomes (RR, PFS, and median OS). The model targeted patients with NSCLC receiving first or second line treatment enrolled in a U.S. Commercial Health Plan with 10 million lives. Frequency of NCCN genomic targets in first-line patients was per The Cancer Genome Atlas with second-line frequencies modified to reflect the first-line testing, genotyping QNS, biopsy, and undergenotyping rates. Therapy current care distributions were derived from 2017 Integra Connect’s proprietary database.

      4c3880bb027f159e801041b1021e88e8 Result

      Under the guideline directed care, immunotherapy and chemotherapy use decreased as patients are re-assigned to targeted therapy in both first line QNS and second line progression settings, resulting in improved clinical outcomes, including a second line repeat tissue biopsy rate reduction. Individual and overall cost savings were observed in both settings (Table).

      First-Line QNS Patients

      Second-Line Patients

      Current

      Guideline Directed

      Difference

      Current

      Guideline Directed

      Difference

      Overall Patient Cohort

      Immunotherapy Monotherapy

      19.2%

      13.2%

      - 6.00%

      52.5%

      42.9%

      - 9.6%

      Immunotherapy + Chemotherapy

      5.6%

      3.9%

      - 1.7%

      3.3%

      2.7%

      - 0.6%

      Chemotherapy +/- Biologics

      75.2%

      51.7%

      - 23.5%

      35.7%

      29.2%

      - 6.5%

      Targeted Therapy

      0%

      31.3%

      + 31.3%

      8.6%

      25.3%

      + 16.7%

      Overall Clinical Outcome Measures

      Response Rate

      18.1%

      28.3%

      + 10.2%

      20.9%

      25.7%

      + 4.8%

      Progression Free Survival (months)

      4.7

      6.0

      + 1.3

      4.7

      5.6

      + 0.9

      Overall Survival (months)

      11.1

      12.6

      + 1.5

      11.0

      12.1

      + 1.1

      Reassigned Patient Cohort

      Immunotherapy Monotherapy

      6.0%

      -

      -6.0%

      9.6%

      -

      - 9.6%

      Immunotherapy + Chemotherapy

      1.8%

      -

      - 1.8%

      0.6%%

      -

      - 0.6%

      Chemotherapy +/- Biologics

      23.5%

      -

      - 23.5%

      6.5%

      -

      - 6.5%

      Targeted Therapy

      -

      31.3%

      + 31.3%

      -

      16.7%

      + 16.7%

      Clinical Outcome Measures for Reassigned Patients

      Response Rate

      18.1%

      50.7%

      + 32.6%

      17.7%

      49.5%

      + 31.8%

      Progression Free Survival (months)

      4.7

      8.8

      + 4.0

      4.2

      9.7

      + 5.5

      Overall Survival (months)

      11.1

      15.9

      + 4.9

      10.3

      17.3

      + 7.0

      Second-line re-biopsy rate

      -

      -

      -

      25%

      11%

      -14%

      Overall Cost per Patient

      $140,950

      $130,141

      -$10,809

      $175,563

      $161,810

      - $13,753

      Overall Total Cost

      $55,516,110

      $51,258,713

      -$4,257,397

      $209,553,002

      $193,136,843

      - $16,416,159

      8eea62084ca7e541d918e823422bd82e Conclusion

      cfDNA CGP application in first line tissue QNS and second line progressing advanced NSCLC patients improved outcomes and cost savings. Shifting from chemotherapy and immunotherapy to relatively more efficacious, less toxic, and less expensive targeted therapies resulted in improved patient outcomes. Cost savings are driven by decrease in immunotherapy, infusion costs, emergency room/hospital visits, and avoidance of tissue biopsy.

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