Solomon J. Lubinga

Real-World Molecular Testing Rates and Patterns in Patients With Primary Advanced or Recurrent Endometrial Cancer in the United States

PURPOSE This retrospective cohort study estimated the real-world utilization of biomarker testing among patients with primary advanced/recurrent endometrial cancer (pA/rEC) and characterized testing according to demographic and clinical characteristics. MATERIALS AND METHODS A nationwide electronic health record–derived deidentified database was used. Records from January 1, 2013, to August 31, 2023, for women age 18 years and older with pA/rEC were searched for DNA mismatch repair (MMR)/microsatellite instability (MSI), human epidermal growth factor receptor 2 (HER2), and estrogen receptor (ER) or progesterone receptor (PR) testing; a subsample data set (advEndo Spotlight) was searched from April 1, 2013, to November 30, 2022, for additional biomolecular testing. Testing rates were reported by index year and molecular marker. Multivariate logistic regression analyses were conducted to identify characteristics associated with testing. RESULTS The full data set included 2,982 patients, of whom 53% were age 65 years and older; most were non-Hispanic White (56%) and received care in a community setting (73%). The advEndo Spotlight subsample (n = 509) had similar characteristics. From 2013 to 2021, testing for any biomarker increased from 53% to 89% (MMR/MSI, 17% to 81%; ER/PR, 45% to 62%; HER2, 15% to 43%). Patients who received care at an academic versus community facility, had commercial/other insurance versus Medicare/Medicaid, had primary advanced versus recurrent EC, had endometrioid versus nonendometrioid carcinoma, or had no previous surgery as part of primary treatment were more likely to receive testing. CONCLUSION Molecular testing rates in pA/rEC have increased over time, likely due in part to incorporation of biomarker testing into treatment guidelines. This highlights an unmet need to ensure universal access to testing in patients with pA/rEC. Understanding these factors can inform approaches to increase access to molecular testing and increase testing rates.

Budget impact of dostarlimab plus carboplatin-paclitaxel for primary advanced or recurrent endometrial cancer from a third-party US payer perspective

Dostarlimab plus carboplatin-paclitaxel (CP) significantly increased progression-free survival in patients with primary advanced or recurrent endometrial cancer (pA/rEC) vs CP alone in the RUBY trial (NCT03981796). This analysis estimated the per-member-per-month (PMPM) costs of introducing dostarlimab + CP as a treatment alternative from a third-party US payer perspective. A budget impact model was developed to estimate the costs of introducing dostarlimab + CP into commercial and Medicare health plans over a 3-year time horizon (2023-2025). Costs were sourced from relevant literature and US-specific databases and were calculated using epidemiology data, clinical inputs, treatment costs, and market share estimates. Clinical inputs were sourced from primary clinical trials for each respective treatment (i.e. dostarlimab + CP, CP, pembrolizumab, pembrolizumab plus lenvatinib, bevacizumab + CP, and pembrolizumab + CP). Current and future market shares assumed dostarlimab + CP reduced the market share of CP only. Analyses were performed in mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations using a US 2023 cost year. For a commercial plan, the model estimated (dMMR/MSI-H and overall populations) that 7 and 26 patients would be treated with dostarlimab + CP, respectively; average annual budget impacts per patient treated were $118,257 and $116,094; average budget impacts per patient treated per month (PPPM) were $9,855 and $9,675; average budget impacts PMPM were $0.02 and $0.06. For a Medicare plan, the model estimated that 28 and 93 patients, respectively, would be treated with dostarlimab + CP. Average annual budget impacts per patient treated and PPPM were the same as those for the commercial plan in both populations; average budget impacts PMPM were $0.07 and $0.22, respectively. Introducing dostarlimab + CP as a first-line treatment for patients with pA/rEC results in minimal budget impact PMPM from a US third-party payer's perspective. Together with the efficacy and safety results from RUBY, these results support the use of dostarlimab + CP as a treatment option.