Journal Article Research Support, Non-U.S. Gov't Ppublish 2 citations
PubMed: 37409516 DOI: 10.1002/cam4.6315
Compliance to genomic test recommendations to guide adjuvant chemotherapy decision-making in the case of hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, in real-life settings.
Cancer Med 12(16):16889-16895
Authors: D Hequet, N Hajjaji, E Charafe-Jauffret, A Boucrauta, F Dalenc, V Nicolai, J Lopez, O Tredan, E Deluche, V Fermeaux, L Tixier, A Cayre, E Menet, F Lerebours, R Rouzier
Affiliations
- Surgery Department, Institut Curie, St. Cloud, France.
- PSL, St. Cloud, U900, INSERM, France.
- Breast Cancer Department, Oscar Lambret Cancer Center, Lille, France.
- Laboratoire Protéomique, Réponse inflammatoire et Spectométrie de Masse (PRISM), University of Lille, Lille, U1192, Inserm, France.
- Department of Biopathology, Institut Paoli Calmettes, Marseille, France.
- Department of Medical Oncology, Institut universitaire du cancer-oncopole, Institut Claudius-Regaud, Toulouse, France.
- Department of Biopathology, Hospices Civiles de Lyon, Lyon, France.
- Department of Medical Oncology, Centre Leon Berard, Lyon, France.
- Centre de Recherche en Cancerologie de Lyon, Lyon, UMR5286, CNRS, France.
- Department of Medical Oncology, CHU, Limoges, France.
- Department of Biopathology, CHU, Limoges, France.
- Department of Biopathology, Center Jean Perrin, Clermont Ferrand, France.
- University Clermont Auvergne, Clermont-Ferrand, U1240, INSERM, France.
- Pathology Department, Institut Curie, St. Cloud, France.
- Oncology Department, Institut Curie, St. Cloud, France.
- Surgery Department, Centre François Baclesse, Caen, France.
Abstract
BACKGROUND
Genomic tests are a useful tool for adjuvant chemotherapy decision-making in the case of hormone receptor-positive (HR+), and human epidermal growth factor receptor 2-negative (HER2-) breast cancer with intermediate prognostic factors. Real-life data on the use of tests can help identify the target population for testing.
METHODS
French multicentric study (8 centers) including patients, all candidates for adjuvant chemotherapy for HR-positive, HER2-negative early breast cancer. We describe the percentage of tests performed outside recommendations, according to the year of testing. We calculated a ratio defined as the number of tests required to avoid chemotherapy for one patient, and according to patient and cancer characteristics. We then performed a cost-saving analysis using medical cost data over a period of 1 year from diagnosis, calculated from a previous study. Finally, we calculated the threshold of the ratio (number of tests required to avoid chemotherapy for one patient) below which the use of genomic tests was cost-saving.
RESULTS
A total of 2331 patients underwent a Prosigna test. The ratio (performed test/avoided chemotherapy) was 2.8 [95% CI: 2.7-2.9] in the whole population. In the group following recommendations for test indication, the ratio was 2.3 [95% CI: 2.2-2.4]. In the case of non-abidance by recommendations, the ratio was 3 [95% CI: 2.8-3.2]. Chemotherapy was avoided in 841 patients (36%) following the results of the Prosigna test. The direct medical costs saved over 1 year of care were 3,878,798€ and 1,718,472€ in the group of patients following test recommendations. We calculated that the ratio (performed test/avoided chemotherapy) needed to be under 6.9 for testing to prove cost-saving.
CONCLUSION
The use of genomic testing proved cost-saving in this large multicentric real-life analysis, even in certain cases when the test was performed outside recommendations.
MeSH
Research Design, Epidermal Growth Factor, Growth, Breast Neoplasms, Neoplasms, Decision Making, Drug Therapy, Hormones, Chemotherapy, Adjuvant, Receptors, Growth Factor, Breast, Chemotherapy