Biomarker Testing in Advanced Cancer
Menée aux Etats-Unis à partir de données portant sur 26 311 patients adultes atteints d'un cancer de stade avancé diagnostiqué entre 2018 et 2022 (âge moyen : 68 ans ; 62 % de femmes), cette étude examine les traitements reçus, les coûts liés aux soins et le recours aux tests ou biomarqueurs pour identifier les patients éligibles aux thérapies ciblées
Precision oncology seeks to improve cancer care by tailoring treatment to the unique molecular characteristics of each patient’s tumor. In the past 30 years, targeted therapies directed against specific molecular driver alterations have revolutionized outcomes in several types of cancer. Early enthusiasm for this approach led to several trials evaluating the clinical utility of more comprehensive genomic profiling (CGP), incorporating testing for mutations in dozens or hundreds of genes at once, to guide therapy selection. Studies such as BATTLE, NCI-MATCH, and TAPUR explored whether tailoring therapy based on next-generation sequencing results could improve clinical trial participation rates and patient outcomes. However, rates of targeted therapy in these cohorts have generally been low and benefits modest, highlighting the challenges of demonstrating benefits to CGP in heterogeneous populations with limited targeted therapy options. In this context, a study by Byfield et al leverages claims data from a large health insurance company to derive insights into the use and outcomes of biomarker testing in advanced cancer. In this study, comprehensive biomarker testing rates were overall lower than might be hoped, although they have been increasing in recent years. Of note, Byfield et al found that patients with non–small cell lung cancer and colorectal cancer who underwent CGP were more likely to receive targeted therapy compared with those who received non-CGP testing. Notably, CGP was not associated with increased costs of care compared with non-CGP profiling, suggesting that the potential benefits of CGP may be achievable without escalating health care expenditures.
JAMA Network Open , éditorial en libre accès, 2025