Finding the tissue of origin of the tumour would be a great step towards its treatment decisions and patient survival depicts a study.

Team@CMHF

Use of guideline-recommended cancer therapy increased by more than 50% when oncologists included a tumor’s gene expression profile in the decision-making process, according to a study reported here.

The proportion of patients treated in accordance with published guidelines increased from 42% to 65% and use of non-guideline regimens declined from 28% to 13%.

The changes were projected to improve survival by 3.6 months, and cancer registry data showed that the patients’ overall survival matched the retrospectively calculated projection.

The cost of care rose as more patients received targeted therapies as a result of the tissue of origin test results, but an economic analysis suggested that use of the gene-expression test would fall within current standards for cost-effectiveness.
“The changes that oncologists made in response to the test results weren’t limited to the choice of chemotherapy,” John Hornberger, MD, of Stanford University, said “Some patients had surgery that initially wasn’t planned and, in at least one case, the treating oncologist referred a patient to a different oncologist because the test showed the tissue of origin was different from what was indicated by pathology. Referrals to hospice also increased.”
Gene expression profiling has proven useful to decision making in oncology as a supplement to traditional clinical and pathologic information about a tumor’s of origin, particularly in cases of metastatic or poorly differentiated disease. Whether the testing made economic sense remained unclear.
To address the cost-effectiveness of tumor gene-expression profiling, Hornberger and colleagues retrospectively reviewed records of 107 patients with metastatic cancer. In all cases, the primary tumor’s origin remained uncertain despite extensive clinical and pathologic evaluations.
The patients’ initial diagnoses encompassed 23 different types of cancer, the most common being lung, colorectal, pancreatic, and ovarian cancer.
Initial planned treatment was no chemotherapy or best supportive care for 25.9% of patients, non-guideline chemotherapy for 28%, and guideline-consistent chemotherapy for 43%.
After the oncologists reviewed the gene-expression results, the percentages for each course of action changed to 12.5, 13.1%, and 65.4%, respectively.
With increased use of guideline-supported therapy, survival was projected to increase from 15.9 months to 19.5 months. The actual survival for the 107 patients was 20 months.
For the economic analysis, Hornberger and colleagues relied on data from a cost-effectiveness registry and the Center for Medicare and Medicaid Services.
“Uncertainty about a tumor’s tissue of origin is not uncommon, as these results showed,” Hornberger told MedPage Today. “Even after an extensive evaluation, a pathologist or oncologist is not always sure about the diagnosis. Gene-expression profiling for the tissue of origin offers a way to minimize the uncertainty.”

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