Cost-Savings Analysis of AR-V7 Testing in Patients With Metastatic Castration-Resistant Prostate Cancer Eligible for Treatment With Abiraterone or Enzalutamide

Mark C. Markowski, Kevin D. Frick, James R. Eshleman, Jun Luo, Emmanuel S. Antonarakis

Research output: Contribution to journalArticlepeer-review

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 76:1484–1490, 2016.

Original languageEnglish (US)
Pages (from-to)1484-1490
Number of pages7
JournalProstate
Volume76
Issue number16
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Bibliographical note

Funding Information:
This work was partially supported by the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins NIH grant P30 CA006973 (E.S.A.) and the Prostate Cancer Foundation (E.S.A). It was also partially supported by an ASCO/CCF Young Investigator Award (M.C.M). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Publisher Copyright:
© 2016 Wiley Periodicals, Inc.

Keywords

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

Fingerprint

Dive into the research topics of 'Cost-Savings Analysis of AR-V7 Testing in Patients With Metastatic Castration-Resistant Prostate Cancer Eligible for Treatment With Abiraterone or Enzalutamide'. Together they form a unique fingerprint.

Cite this