Testing advanced lung cancer patients for all of the possible genetic mutations that could be driving their cancer at once is more cost effective than testing for one or a limited number of genes at a time, U.S. researchers reported Wednesday.

There are eight targeted therapies doctors can use to treat nonsmall-cell lung cancer (NSCLC) patients based on genetic defects, and more treatments are in clinical trials or awaiting approval.

Companies such as Foundation Medicine Inc. and Thermo Fisher Scientific Inc. offer genetic profiling tests using so-called next-generation sequencing that can identify hundreds of potential cancer-causing gene mutations from a small tissue sample at once. These tests are used to match patients to specific therapies targeting those genes or to clinical trials testing new drugs.

Insurance companies have been slow to pay for sequencing for all possible mutations at once, arguing such comprehensive testing amounts to funding research, not medical care. They often require doctors to test for individual genes sequentially or use a limited panel that looks for suspect genes associated with approved treatments.

“Our results showed there were substantial cost savings compared with all the other strategies,” Dr. Nathan Pennell of the Cleveland Clinic’s lung cancer program said in a telephone briefing Wednesday.

Last November, the U.S. Food and Drug Administration approved Foundation’s next-generation test, and the Centers for Medicare and Medicaid Services in March said it would pay for next-generation sequencing for Medicare-eligible patients with advanced cancer.

Often, tumor tissue from a biopsy is scarce, and sequential testing can sometimes require a second biopsy to gather more sections of the tumor.

In the study released ahead of the American Society of Clinical Oncology Meeting in Chicago next month, researchers at the Cleveland Clinic and colleagues modeled the cost of next-generation sequencing versus other types of testing to Medicare and to a commercial health plan with one million hypothetical members.

In the model, which was based on the number and age of NSCLC patients in the United States, next-generation sequencing saved as much as $2.1 million for Medicare, the government health plan for older Americans, and more than $250,000 for commercial providers.

The study did not factor in the cost of treatment.

The study was funded by Swiss drugmaker Novartis, maker of Zykadia, a drug that targets ALK mutations found in about 4 percent of NSCLC cases.
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