Nathan Pennell, MD, PhD, director, Lung Cancer Medical Oncology Program, Cleveland Clinic Taussig Cancer Institute, discusses the economic impact of next-generation sequencing (NGS) for patients with non—small cell lung cancer (NSCLC).

The study, which was presented at the 2018 ASCO Annual Meeting, took a hypothetical cohort of 1 million patients from a payer perspective, identifying how many were likely to get metastatic NSCLC and how many would be covered by Medicare or Medicaid versus private insurance. Researches calculated the costs of single-gene tests versus NGS and then compared what it would cost all of them using 3 other strategies.

For those under national insurance programs, NGS represented savings of $1,393,678 versus exclusionary mutation, $1,530,869 versus sequential testing and $2,140,795 versus panel testing. NGS saved commercial payers up to $3,809 versus exclusionary and up to $250,842 versus panel testing.

Pennell explained that NGS was also faster, and a higher percentage of patients with genetic alterations who could benefit from treatment identified with the trial’s strategy.

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Nathan Pennell, MD, PhD, director, Lung Cancer Medical Oncology Program, Cleveland Clinic Taussig Cancer Institute, discusses the economic impact of next-generation sequencing.

Dr. Pennell on the Economic Impact of Next-Generation Sequencing

Nathan Pennell, MD, PhD, medical oncologist, Department of Hematology and Oncology, Cleveland Clinic, discusses some of the rare toxicities seen in patients with lung cancer in an interview during the IASLC Chicago Multidisciplinary Symposium in Thoracic Oncology.

Pennell sheds light on the importance of having a high degree of suspicion when it comes to treating these patients. Oncologists are encouraged to assume any strange side effects they see are related to the drug that a patient is receiving.

A particularly rare toxicity in this setting is pneumonitis, which occurs in up to 5% of patients with lung cancer. Serious pneumonitis typically presents with shortness of breath and cough, which are both quite common for patients with lung cancer, and can therefore be attributed to any number of causes. Pennell recommends doing a CT scan of the chest as soon as symptoms develop, in order to differentiate an infection from potential pneumonitis.

Nathan Pennell, MD, PhD, medical oncologist, Department of Hematology and Oncology, Cleveland Clinic, discusses some of the rare toxicities seen in patients with lung cancer.

Dr. Pennell on Unique Treatment-Related Toxicities in Lung Cancer

Nathan Pennell, MD, PhD, associate professor of Medicine at Cleveland Clinic, discusses the importance of testing patients with non—small cell lung cancer (NSCLC) to determine if they harbor the 

 mutation, as well as the agents available to target that genetic abnormality.

 in the first-line setting, Pennell explains. Additionally, patients should not be treated with an EGFR-targeted agent unless they have the mutation. If they do have the mutation, gefitinib (Iressa), erlotinib (Tarceva), and afatinib (Gilotrif) are the 3 targeted agents available for this population.

For patients who acquire resistance to an EGFR TKI and harbor the 

 resistance mutation, they may be able to receive treatment with the well-tolerated agent osimertinib (Tagrisso). Patients must be biopsied to determine whether they have the 

Nathan Pennell, MD, PhD, associate professor of Medicine at Cleveland Clinic, discusses the importance of testing patients with non–small cell lung cancer (NSCLC) to determine if they harbor the EGFR mutation, as well as the agents available to target that genetic abnormality.

Nathan Pennell, MD, PhD

Articles

Dr. Pennell on the Economic Impact of Next-Generation Sequencing

Dr. Pennell on Unique Treatment-Related Toxicities in Lung Cancer

Dr. Pennell on Importance of EGFR Testing in NSCLC