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Current Oncology
Volume 28
Issue 5
10.3390/curroncol28050284
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Article

Reflex ROS1 IHC Screening with FISH Confirmation for Advanced Non-Small Cell Lung Cancer—A Cost-Efficient Strategy in a Public Healthcare System

by
Maisam Makarem
1,2,
Doreen A. Ezeife
3,
Adam C. Smith
1,4,
Janice J. N. Li
1,
Jennifer H. Law
1,
Ming-Sound Tsao
1,4 and
Natasha B. Leighl
1,2,*
1
Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
2
Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
3
Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
4
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 2C4, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(5), 3268-3279; https://doi.org/10.3390/curroncol28050284
Submission received: 7 June 2021 / Revised: 17 August 2021 / Accepted: 19 August 2021 / Published: 25 August 2021
(This article belongs to the Section Thoracic Oncology)
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Abstract

ROS1 rearrangements are identified in 1–2% of lung adenocarcinoma cases, and reflex testing is guideline-recommended. We developed a decision model for population-based ROS1 testing from a Canadian public healthcare perspective to determine the strategy that optimized detection of true-positive (TP) cases while minimizing costs and turnaround time (TAT). Eight diagnostic strategies were compared, including reflex single gene testing via immunohistochemistry (IHC) screening, fluorescence in-situ hybridization (FISH), next-generation sequencing (NGS), and biomarker-informed (EGFR/ALK/KRAS wildtype) testing initiated by pathologists and clinician-initiated strategies. Reflex IHC screening with FISH confirmation of positive cases yielded the best results for TAT, TP detection rate, and cost. IHC screening saved CAD 1,000,000 versus reflex FISH testing. NGS was the costliest reflex strategy. Biomarker-informed testing was cost-efficient but delayed TAT. Clinician-initiated testing was the least costly but resulted in long TAT and missed TP cases, highlighting the importance of reflex testing. Thus, reflex IHC screening for ROS1 with FISH confirmation provides a cost-efficient strategy with short TAT and maximizes the number of TP cases detected.
Keywords: ROS1; IHC; reflex testing; NSCLC; cost; biomarker ROS1; IHC; reflex testing; NSCLC; cost; biomarker

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MDPI and ACS Style

Makarem, M.; Ezeife, D.A.; Smith, A.C.; Li, J.J.N.; Law, J.H.; Tsao, M.-S.; Leighl, N.B. Reflex ROS1 IHC Screening with FISH Confirmation for Advanced Non-Small Cell Lung Cancer—A Cost-Efficient Strategy in a Public Healthcare System. Curr. Oncol. 2021, 28, 3268-3279. https://doi.org/10.3390/curroncol28050284

AMA Style

Makarem M, Ezeife DA, Smith AC, Li JJN, Law JH, Tsao M-S, Leighl NB. Reflex ROS1 IHC Screening with FISH Confirmation for Advanced Non-Small Cell Lung Cancer—A Cost-Efficient Strategy in a Public Healthcare System. Current Oncology. 2021; 28(5):3268-3279. https://doi.org/10.3390/curroncol28050284

Chicago/Turabian Style

Makarem, Maisam, Doreen A. Ezeife, Adam C. Smith, Janice J. N. Li, Jennifer H. Law, Ming-Sound Tsao, and Natasha B. Leighl. 2021. "Reflex ROS1 IHC Screening with FISH Confirmation for Advanced Non-Small Cell Lung Cancer—A Cost-Efficient Strategy in a Public Healthcare System" Current Oncology 28, no. 5: 3268-3279. https://doi.org/10.3390/curroncol28050284

APA Style

Makarem, M., Ezeife, D. A., Smith, A. C., Li, J. J. N., Law, J. H., Tsao, M.-S., & Leighl, N. B. (2021). Reflex ROS1 IHC Screening with FISH Confirmation for Advanced Non-Small Cell Lung Cancer—A Cost-Efficient Strategy in a Public Healthcare System. Current Oncology, 28(5), 3268-3279. https://doi.org/10.3390/curroncol28050284

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