Clinical Utility in Cancer Patient Management
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- Lynette Cannon
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1 Clinical Utility in Cancer Patient Management National Cancer Policy Forum Workshop Oct 29-30, 2018 Lincoln Nadauld, MD PhD Executive Director, Precision Genomics Intermountain Healthcare
2 Disclosure Information I have the following financial relationships to disclose: Advisor: Navican, Ciitizen, Roche Consulting: Genentech Stockholder: TOMA Biosciences Employee of: Intermountain Healthcare - and - I will not discuss off label use of specific drugs and/or investigational use in my presentation.
3 Intermountain Healthcare: An Integrated System 22 Hospitals 2,800 Licensed Beds 180 Medical Group Clinics 875,000 SelectHealth Members
4 Precision Oncology Workflow Clinic Pathology Review Molecular Analysis (NGS) Molecular Tumor Board Day 1 Day 5 Day 7 Day 9 Day 2-4 Day 6 Day 8 Day 10 Biopsy or FFPE Sample Prep Bioinformatics Results and Treatment 4
5 MTB Interpretation included on the report Interp. in the report
6 Intermountain Precision Medicine Cohort Study Patients received standard trx within Intermountain 36 standard trx match: dx, age, gen, #prev. trx 61 with actionable mutation, and received targeted trx 36 genomics+trg trx match: dx, age, gen, #prev. trx 25 without match: dx, age, gen, prev. trx Assess: -PFS -Cost of care Assess: -PFS -Cost of care Haslem and Nadauld. JOP. 2016
7 Precision Oncology: Overall Survival Weeks after treatment start Standard chemotherapy (n=22) Avg. = 11.0 wks PFS Avg. = 25.8 wks overall survival Targeted cancer therapy (n=22) Healthcare costs ~$30 / week ~$70K / week Avg. = 21.4 wks PFS Avg. = 51.7 wks overall survival Haslem et al., Oncotarget. 2018
8 Precision Oncology Costs Control (N=22) Targeted (N=22) Difference Inpatient $552 $448 ($104) Outpatient $2,376 $1,167 ($1,209) ER $34 $45 $11 Rx drugs $346 $940 $594 Hospice $146 $9 ($137) Sequencing $0 $112 $112 Total/week $3,453 $2,720 ($734) Haslem et al., Oncotarget. 2018
9 Precision Oncology Costs $50,000 Costs per patient among Select Health members in the last 3 months of life, by site of care $45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0 Total Inpatient Outpatient Office Rx Pharmacy ER/UC All other SelectHealth - Standard Tx (n=1,721) SelectHealth - Targeted Tx (n=93) Total Inpatient Outpatient Office Rx Pharmacy ER/UC All other SelectHealth - Standard Tx $46,940 $29,523 $7,425 $3,663 $1,415 $1,385 $1,177 SelectHealth - Targeted Tx $43,711 $15,535 $11,216 $6,265 $5,500 $1,469 $1, % -47.4% 51.1% 71.1% 288.7% 6.1% 5.5%
10 Genomic Testing now covered by local health plan
11 Precision Medicine Menu ICG100 TM Cancer Panel RxMatch TM Pharmacogenomics in Mental Health HerediGene TM Hereditary Cancer Panel All orderable and reportable within the EMR (Cerner)
12 Intermountain Biorepository 4.5 million archival samples Accumulated from 1975-present Longitudinal healthcare outcome data (30yrs)
13 Intermountain biorepository: Oncology Total distinct patients: ~150K 000s of patients with primary diagnosis Breast 15 Prostate 14 Gastrointestinal 11 Reproductive 10 Blood 10 Other 6 Lung 6 Skin 5 Thyroid 4 Bladder 3 Kidney 3 Brain/Spine 2 Pancreatic 1 Liver 13
14 Intermountain biorepository: CNS, Immunology & CVD CNS Total distinct patients: ~500K Immunology CVD Total distinct patients: ~200K Total distinct patients: ~400K 000s of patients with primary diagnosis Back and Spine Fatigue Carpal Tunnel & Other 67 Sleep Disorders 35 Headache E.g. includes ~2k AD patients 26 Seizures / Convulsions 9 Degenerative Disorders 9 Neuropathy 8 Dementia E.g. includes ~12k RA patients 104 Arthropathies 51 Autoimmune disorders 38 Enlarged lymph nodes, allergies & other E.g. includes ~12k IBD patients 33 Transplantation 15 Neoplasms 8 Immunodeficiency Disorders 6 Multiple Sclerosis 4 Lupus 151 Hypertension 149 Metabolic 136 Thrombus, Cardiomegaly & Other 94 Ischemic Heart Disease E.g. includes ~55k CAD patients 81 Cardiac Arrhythmias 55 Cerebrovascular 37 Edema 31 Arterial Disease 14
15 NGSOne: Whole Genome Product + Impact o Whole Genome, Whole Exome Sequencing, Whole Transcriptome o New external collaborations o NICU sequencing o Precision Nephrology o Biorepository (4.3M archival samples)
16 Acknowledgements Intermountain Precision Genomics: Derrick Haslem Gary Stone Pravin Mishra David Loughmiller Genomics Core Lab Cancer Clinical Program Sharanya Raghunath Jason Gillman Robin Romero Brent James Stanford University Jim Ford Hanlee Ji NCI AACR ASCO
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