Cost-savings analysis of AR-V7 testing in mCRPC patients eligible for treatment with abiraterone or enzalutamide

New paper below.

"Clinical-grade AR-V7 testing is currently available at our institution." ... Johns Hopkins

"upfront testing of AR-V7 status (at a price of $1,000 per test) would result in a net cost savings of $150 Million in the United States per year"

"We determined that AR-V7 testing would result in substantial cost savings as long as the true prevalence of AR-V7 was >5%. In our prior studies, we estimated that approximately 30% of mCRPC patients may have detectable AR-V7 in circulating tumor cells (CTCs)."

This seems to say that the presence of any AR-V7 at all should rule out Zytiga & Xtandi. But what if only a small percent of one's PCa cells were AR-V7 positive? AR-V7 can be present at an early stage - certainly before CRPC.

$1,000 is such a nice round number. I wonder what the true cost is?

-Patrick

ncbi.nlm.nih.gov/pubmed/274...

Prostate. 2016 Jul 12. doi: 10.1002/pros.23232. [Epub ahead of print]

Cost-savings analysis of AR-V7 testing in patients with metastatic castration-resistant prostate cancer eligible for treatment with abiraterone or enzalutamide.

Markowski MC1, Frick KD2, Eshleman JR1,3, Luo J4, Antonarakis ES1,4.

Author information

1Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.

2Johns Hopkins Carey Business School, Baltimore, Maryland.

3Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

4Department of Urology, Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland.

Abstract

INTRODUCTION:

Identification of cancer biomarkers that inform clinical decisions and reduce the use of ineffective therapies is a major goal of precision oncology. An abnormal splice variant of the androgen receptor, AR-V7, was recently found to confer resistance to novel hormonal therapies (abiraterone and enzalutamide) in men with metastatic castration-resistant prostate cancer (mCRPC), but did not negatively affect responses to taxane chemotherapies, suggesting that early use of chemotherapy may be a more effective option for AR-V7(+) patients.

METHODS:

We calculated the cost savings of performing AR-V7 testing in mCRPC patients prior to starting abiraterone/enzalutamide (and avoiding these drugs in AR-V7(+) men) versus treating all mCRPC patients empirically with abiraterone/enzalutamide (without use of the biomarker).

RESULTS:

We determined that AR-V7 testing would result in substantial cost savings as long as the true prevalence of AR-V7 was >5%. In our prior studies, we estimated that approximately 30% of mCRPC patients may have detectable AR-V7 in circulating tumor cells (CTCs). In this population, upfront testing of AR-V7 status (at a price of $1,000 per test) would result in a net cost savings of $150 Million in the United States per year.

CONCLUSIONS:

AR-V7 testing in mCRPC patients would be cost-beneficial when considering the current price of treatment, and may reduce the ineffective use of abiraterone/enzalutamide, leading to a significant net cost savings to the healthcare system. Clinical-grade AR-V7 testing is currently available at our institution. Prostate © 2016 Wiley Periodicals, Inc.

© 2016 Wiley Periodicals, Inc.

KEYWORDS:

AR-V7 testing; CLIA-certified; cost savings; healthcare costs; prostate cancer

PMID: 27404039 DOI: 10.1002/pros.23232

[PubMed - as supplied by publisher]

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  • I told my doctor about the JohnsHopkins V7 test. He would not hear of it. Said it was "not approved. Still being validated. Still experimental" etc. (of course assuming zytiga or abi)