Abstract P2-14-10: Prosigna® test in clinical routine: Impact on adjuvant chemotherapy decision and medico-economic considerations in France
Authors: Hequet Delphine , Harrissart Guillaume , Callens Celine , Gentien David , Bieche Ivan , Cottu Paul , Guinebretiere Jean-Marc , Vincent-Salomon Anne , Lerebours Florence , Rouzier Roman 
Published: March 2020

The Prosigna® test has been performed in Institut Curie, France, since 2016 in clinical routine with a financial support of the health ministry dedicated to innovative procedures. The genomic platform at the Institut Curie performs the Prosigna® test for patients cared for at the Curie Hospital and in other institutions. Our main objective was to evaluate the impact of Prosigna® tests on adjuvant chemotherapy decisions. The second objective was to assess the costs associated with implementation of the test for patient management.

Methods: Early breast cancer patients with estrogen receptor positive and human epidermal growth factor receptor 2-negative tumors, who had a Prosigna® test in clinical routine, were prospectively registered and observed. The Prosigna® test was indicated for a population candidate for a chemotherapy, with an intermediate risk of recurrence defined by our regional guidelines (1): grade 1 T1cN1, grade 1 T2N0-1, grade 2 T1cN0 with risk factors (Ki67&gt;20% or lympho-vascular emboli), grade 2 T2N0, grade 3 T1cN0. The French Health Authority (FHA) has also recently defined the population who are candidates for genomic testing: T1c/T2 and N0/N1(mic) and grade 2 without risk factors (age&lt;40, lympho-vascular emboli, T2; association of at least 2 criteria). To evaluate the decision impact of Prosigna® test, we compared the number patients recommended for chemotherapy before and after the test, in both the full real-life population and in the population defined by FHA. To evaluate costs, we compared the use of the test and the direct medical and non-medical costs of chemotherapy avoidance after tests results. All costs were considered at a National Health Insurance perspective. Genomic tests are reimbursed 1,849.50€. We previously evaluated the direct costs of the first year of management of early operable breast cancer including medical costs and non-medical costs (transportation, daily allowance), in a prospective study (2,3, ClinicalTrials.gov identifier: NCT02813317). The total added direct costs of chemotherapy were 9,737€/ patient.

Results: Prosigna® test was performed for 831 patients in clinical practice from 2016 and 2019 at Institut Curie. Due to missing data, analyses have been performed on 735 patients. Median age was 57 years-old (28-80), and median size 18 mm (3-80). We observed a majority of grade 2 tumors (n=572, 78%), and 21% of lymph node involvement. Median Ki67 was 20 (0-100). Prosigna® tests classified respectively 234 (32%), 295 (40%) and 206 (28%) in high, intermediate and low risk categories. In the all real-life population (n=735), chemotherapy was avoided for 308 (42%) patients after Prosigna® test results, and in 192 (44%) cases in the population defined by the FHA (n=433). From a financial point of view, both the real-life data and the population defined by FHA demonstrated cost savings,1 739 614€ (n=735 patients). and 1 068 671€(n=433), respectively.

Conclusion: This large real-life study showed a 40% decrease in adjuvant chemotherapy recommendations after introduction of the Prosigna® test in a population of chemotherapy candidates. Moreover, this therapeutic de-escalation demonstrated an overall cost savings for the health system despite the added cost of the test.

References:

1. https://www.gustaveroussy.fr/sites/default/files/referentiel-cancer-du-sein-gustaveroussy-curie-2016-2017.pdf

2. Baffert S, et al. The patient-breast cancer care pathway: how could it be optimized? BMC Cancer. 2015 May 12;15:394

3. Héquet D, et al. Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: results of a French multicenter prospective study. Plosone 2019, accepted, in press.

Citation Format: Delphine Hequet, Guillaume Harrissart, Celine Callens, David Gentien, Ivan Bieche, Paul Cottu, Jean-Marc Guinebretiere, Anne Vincent-Salomon, Florence Lerebours, Roman Rouzier. Prosigna® test in clinical routine: Impact on adjuvant chemotherapy decision and medico-economic considerations in France [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-10.