OBJECTIVES:

The project aims to measure the impact of the Molecular Tumour Board (MTB) on the oncological patient diagnostic journey (from diagnostic suspect to MTB evaluation), in terms of costs and access to personalized therapies.

METHODS:

We implemented a study in an Italian centre of excellence in oncology (Istituto Nazionale Tumori, Milan), focused on 676 patients discussed by the institutional MTB in 2021. In particular, we analysed four cancer subtypes, namely non-small cell lung cancer (NSCLC), cholangiocarcinoma (CCA), pancreatic carcinoma (PC) and gastric carcinoma (GC). We evaluated patients’ eligibility for target therapies (on-label, off-label, clinical trial), comparing patients tested with small (≤ 50 biomarkers) and large (>50 biomarkers) NGS panels. Immunohistochemical biomarkers for immune therapy eligibility (example, PD-L1) were not included in the current analysis. We also estimated the total cost per patient journey (diagnosis, testing and MTB), the impact of MTB cost on the overall journey and the incremental cost per patient (considering testing and MTB costs) to access personalized therapies in the four different cancers relative to NGS panel size.

RESULTS:

Larger NGS panels increased patients’ eligibility to target therapies compared to smaller panels (NSCLC: 39% large panel vs. 37% small panel; CCA: 44% vs. 17%; PC: 35% vs. 2%; GC: 40% vs 0%). Considering personnel costs, MTB cost per patient was around 113€/patient (impacting 2-5% on the total cost of the patient diagnostic journey). The incremental cost per patient changed using larger NGS panels (NSCLC: 2.8K small panel vs. 5K large panel; CCA: 4.4K vs. 4.4K; PC: 27K vs. 5.5K; GC: 86.8K vs. 5.2K).

CONCLUSIONS:

MTB and comprehensive genomic profiling (NGS with large panels) raise patient eligibility to personalized therapies and optimize the incremental cost, especially for CCA, PC and GC.