A Retrospective Analysis of Precision Medicine Outcomes in Patients With Advanced Cancer Reveals Improved Progression-Free Survival Without Increased Health Care Costs.
The advent of genomic diagnostic technologies such as next-generation sequencing has recently enabled the use of genomic information to guide targeted treatment in patients with cancer, an approach known as precision medicine. However, clinical outcomes, including survival and the cost of health care associated with precision cancer medicine, have been challenging to measure and remain largely unreported.



We conducted a matched cohort study of 72 patients with metastatic cancer of diverse subtypes in the setting of a large, integrated health care delivery system. We analyzed the outcomes of 36 patients who received genomic testing and targeted therapy (precision cancer medicine) between July 1, 2013, and January 31, 2015, compared with 36 historical control patients who received standard chemotherapy (n = 29) or best supportive care (n = 7).



The average progression-free survival was 22.9 weeks for the precision medicine group and 12.0 weeks for the control group ( P = .002) with a hazard ratio of 0.47 (95% CI, 0.29 to 0.75) when matching on age, sex, histologic diagnosis, and previous lines of treatment. In a subset analysis of patients who received all care within the Intermountain Healthcare system (n = 44), per patient charges per week were $4,665 in the precision treatment group and $5,000 in the control group ( P = .126).



These findings suggest that precision cancer medicine may improve survival for patients with refractory cancer without increasing health care costs. Although the results of this study warrant further validation, this precision medicine approach may be a viable option for patients with advanced cancer.
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Derrick S
DS
Haslem
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
S Burke
SB
Van Norman
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Gail
G
Fulde
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Andrew J
AJ
Knighton
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Tom
T
Belnap
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Allison M
AM
Butler
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Sharanya
S
Rhagunath
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
David
D
Newman
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Heather
H
Gilbert
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Brian P
BP
Tudor
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Karen
K
Lin
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Gary R
GR
Stone
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
David L
DL
Loughmiller
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Pravin J
PJ
Mishra
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Rajendu
R
Srivastava
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
James M
JM
Ford
Intermountain Healthcare, Saint George and Salt Lake City; University of Utah School of Medicine, Salt Lake City, UT; Duke University School of Medicine, Durham, NC; and Stanford University School of Medicine, Stanford, CA.
Lincoln D
LD
Nadauld
D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000191:economics; D009154:Mutation; D009369:Neoplasms / Q000191:economics / Q000235:genetics / Q000401:mortality* / Q000628:therapy*; D057285:Precision Medicine / Q000191:economics*; D012189:Retrospective Studies