PMID- 34152087
OWN - NLM
STAT- MEDLINE
DCOM- 20220214
LR  - 20230920
IS  - 2045-7634 (Electronic)
IS  - 2045-7634 (Linking)
VI  - 10
IP  - 15
DP  - 2021 Aug
TI  - Clinical and cost outcomes following genomics-informed treatment for advanced 
      cancers.
PG  - 5131-5140
LID - 10.1002/cam4.4076 [doi]
AB  - BACKGROUND: Single-arm trials are common in precision oncology. Owing to the lack 
      of randomized counterfactual, resultant data are not amenable to comparative 
      outcomes analyses. Difference-in-difference (DID) methods present an opportunity 
      to generate causal estimates of time-varying treatment outcomes. Using DID, our 
      study estimates within-cohort effects of genomics-informed treatment versus 
      standard care on clinical and cost outcomes. METHODS: We focus on adults with 
      advanced cancers enrolled in the single-arm BC Cancer Personalized OncoGenomics 
      program between 2012 and 2017. All individuals had a minimum of 1-year follow up. 
      Logistic regression explored baseline differences across patients who received a 
      genomics-informed treatment versus a standard care treatment after genomic 
      sequencing. DID estimated the incremental effects of genomics-informed treatment 
      on time to treatment discontinuation (TTD), time to next treatment (TTNT), and 
      costs. TTD and TTNT correlate with improved response and survival. RESULTS: Our 
      study cohort included 346 patients, of whom 140 (40%) received genomics-informed 
      treatment after sequencing and 206 (60%) received standard care treatment. No 
      significant differences in baseline characteristics were detected across 
      treatment groups. DID estimated that the incremental effect of genomics-informed 
      versus standard care treatment was 102 days (95% CI: 35, 167) on TTD, 91 days 
      (95% CI: -9, 175) on TTNT, and CAD$91,098 (95% CI: $46,848, $176,598) on costs. 
      Effects were most pronounced in gastrointestinal cancer patients. CONCLUSIONS: 
      Genomics-informed treatment had a statistically significant effect on TTD 
      compared to standard care treatment, but at increased treatment costs. 
      Within-cohort evidence generated through this single-arm study informs the 
      early-stage comparative effectiveness of precision oncology.
CI  - (c) 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
FAU - Weymann, Deirdre
AU  - Weymann D
AUID- ORCID: 0000-0002-3072-5657
AD  - Cancer Control Research, BC Cancer, Vancouver, Canada.
FAU - Pollard, Samantha
AU  - Pollard S
AD  - Cancer Control Research, BC Cancer, Vancouver, Canada.
AD  - School of Population and Public Health, University of British Columbia, 
      Vancouver, Canada.
FAU - Chan, Brandon
AU  - Chan B
AD  - Cancer Control Research, BC Cancer, Vancouver, Canada.
FAU - Titmuss, Emma
AU  - Titmuss E
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
FAU - Bohm, Alexandra
AU  - Bohm A
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
FAU - Laskin, Janessa
AU  - Laskin J
AD  - Division of Medical Oncology, BC Cancer, Vancouver, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, Canada.
FAU - Jones, Steven J M
AU  - Jones SJM
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
AD  - Department of Medical Genetics, Faculty of Medicine, University of British 
      Columbia, Vancouver, Canada.
FAU - Pleasance, Erin
AU  - Pleasance E
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
FAU - Nelson, Jessica
AU  - Nelson J
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
FAU - Fok, Alexandra
AU  - Fok A
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
FAU - Lim, Howard
AU  - Lim H
AD  - Division of Medical Oncology, BC Cancer, Vancouver, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, Canada.
FAU - Karsan, Aly
AU  - Karsan A
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
AD  - Division of Medical Oncology, BC Cancer, Vancouver, Canada.
AD  - Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of 
      British Columbia, Vancouver, Canada.
FAU - Renouf, Daniel J
AU  - Renouf DJ
AD  - Division of Medical Oncology, BC Cancer, Vancouver, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, Canada.
FAU - Schrader, Kasmintan A
AU  - Schrader KA
AD  - Department of Medical Genetics, Faculty of Medicine, University of British 
      Columbia, Vancouver, Canada.
AD  - Department of Molecular Oncology, BC Cancer, Vancouver, Canada.
AD  - Hereditary Cancer Program, BC Cancer, Vancouver, Canada.
FAU - Sun, Sophie
AU  - Sun S
AD  - Division of Medical Oncology, BC Cancer, Vancouver, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, Canada.
FAU - Yip, Stephen
AU  - Yip S
AD  - Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of 
      British Columbia, Vancouver, Canada.
AD  - Department of Pathology, BC Cancer, Vancouver, Canada.
FAU - Schaeffer, David F
AU  - Schaeffer DF
AD  - Division of Anatomical Pathology, Vancouver General Hospital, University of 
      British Columbia, Vancouver, Canada.
FAU - Marra, Marco A
AU  - Marra MA
AD  - Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
AD  - Department of Medical Genetics, Faculty of Medicine, University of British 
      Columbia, Vancouver, Canada.
FAU - Regier, Dean A
AU  - Regier DA
AD  - Cancer Control Research, BC Cancer, Vancouver, Canada.
AD  - School of Population and Public Health, University of British Columbia, 
      Vancouver, Canada.
LA  - eng
GR  - G05CHS/Genome British Columbia / Genome Canada/
GR  - BC Personalized OncoGenomics Program/
GR  - BC Cancer Foundation Strategic Priorities Fund Awards/
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210621
PL  - United States
TA  - Cancer Med
JT  - Cancer medicine
JID - 101595310
SB  - IM
MH  - Breast Neoplasms
MH  - Costs and Cost Analysis
MH  - Female
MH  - Gastrointestinal Neoplasms/genetics/mortality/pathology/therapy
MH  - Genome-Wide Association Study
MH  - Genomics/economics/methods
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/*genetics/mortality/pathology/*therapy
MH  - Precision Medicine/*economics/methods
MH  - Retrospective Studies
MH  - *Sequence Analysis, DNA
MH  - Treatment Outcome
MH  - Withholding Treatment
PMC - PMC8335838
OTO - NOTNLM
OT  - biostatistics
OT  - genomic sequencing
OT  - healthcare costs
OT  - precision oncology
OT  - quasi-experimental methods
OT  - treatment outcomes
COIS- Brandon Chan, Steven J.M. Jones, and Marco A. Marra report no conflicts of 
      interest. Deirdre Weymann and Samantha Pollard codirect IMPRINT Research 
      Consulting and have consulted for Roche Canada. Janessa Laskin has received 
      honoraria for academic talks from: Roche Canada, Pfizer Canada, Astra-Zeneca 
      Canada, and BI Canada; her institution has received research funding for her 
      projects from: Roche Canada, Asta-Zeneca Canada, and BI Canada. Daniel J. Renouf 
      disclosures include research funding and honoraria from Bayer and Roche, and 
      travel funding and honoraria from Servier, Celgene, Taiho, Ipsen, and Astra 
      Zenec. Howard Lim has received honoraria from Eisai, Taiho, Roche, Lilly, BMS, 
      Amgen, and Leo for consultant work and is an investigator on trials with Bayer, 
      BMS, Lilly, Roche, Astra-Zeneca, and Amgen. Sophie Sun has received research 
      grant and honoraria funding from Astra-Zeneca. Stephen Yip is an advisory board 
      member for and has received travel allowance from Amgen, AstraZeneca, Bayer, 
      Norvatis, and Roche. Dean A. Regier has received speaking honoraria from Roche 
      Canada. DF Schaeffer has received honoraria from Alimentiv, Pfizer, Merck, and 
      Diaceutics. Kasmintan A. Schrader has received speaking honoraria from 
      AstraZeneca and Pfizer.
EDAT- 2021/06/22 06:00
MHDA- 2022/02/15 06:00
PMCR- 2021/06/21
CRDT- 2021/06/21 09:02
PHST- 2021/05/10 00:00 [revised]
PHST- 2021/02/23 00:00 [received]
PHST- 2021/05/12 00:00 [accepted]
PHST- 2021/06/22 06:00 [pubmed]
PHST- 2022/02/15 06:00 [medline]
PHST- 2021/06/21 09:02 [entrez]
PHST- 2021/06/21 00:00 [pmc-release]
AID - CAM44076 [pii]
AID - 10.1002/cam4.4076 [doi]
PST - ppublish
SO  - Cancer Med. 2021 Aug;10(15):5131-5140. doi: 10.1002/cam4.4076. Epub 2021 Jun 21.