Treatment of unmethylated MGMT-promoter recurrent glioblastoma with cancer stem cell assay-guided chemotherapy and the impact on patients' healthcare costs

Tulika Ranjan; Alexander Yu; Shaed Elhamdani; Candace M Howard; Seth T Lirette; Krista L Denning; Jagan Valluri; Pier Paolo Claudio

doi:10.1093/noajnl/vdad055

Treatment of unmethylated MGMT-promoter recurrent glioblastoma with cancer stem cell assay-guided chemotherapy and the impact on patients' healthcare costs

Neurooncol Adv. 2023 May 12;5(1):vdad055. doi: 10.1093/noajnl/vdad055. eCollection 2023 Jan-Dec.

Authors

Tulika Ranjan^{1

2}, Alexander Yu³, Shaed Elhamdani¹, Candace M Howard⁴, Seth T Lirette⁵, Krista L Denning⁶, Jagan Valluri^{7

8}, Pier Paolo Claudio^{9

8}

Affiliations

¹ Department of Neuro-oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
² Department of Neuro-Oncology, Cancer Center Southern Florida, and Tampa General Hospital, Tampa, Florida, USA.
³ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁴ Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁵ Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁶ Department of Anatomy and Pathology, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA.
⁷ Translational Genomics Laboratory, Department of Biological Sciences, Marshall University, Huntington, West Virginia, USA.
⁸ Cordgenics, LLC, Huntington, West Virginia, USA.
⁹ Department of Pharmacology, University of Mississippi Medical Center, Cancer Center and Research Institute, Jackson, Mississippi, USA.

Abstract

Background: Glioblastoma (GBM) is a lethal disease. At least in part, the recurrence of GBM is caused by cancer stem cells (CSCs), which are resistant to chemotherapy. Personalized anticancer therapy against CSCs can improve treatment outcomes. We present a prospective cohort study of 40 real-world unmethylated Methyl-guanine-methyl-transferase-promoter GBM patients treated utilizing a CSC chemotherapeutics assay-guided report (ChemoID).

Methods: Eligible patients who underwent surgical resection for recurrent GBM were included in the study. Most effective chemotherapy treatments were chosen based on the ChemoID assay report from a panel of FDA-approved chemotherapies. A retrospective chart review was conducted to determine OS, progression-free survival, and the cost of healthcare costs. The median age of our patient cohort was 53 years (24-76).

Results: Patients treated prospectively with high-response ChemoID-directed therapy, had a median overall survival (OS) of 22.4 months (12.0-38.4) with a log-rank P = .011, compared to patients who could be treated with low-response drugs who had instead an OS of 12.5 months (3.0-27.4 months). Patients with recurrent poor-prognosis GBM treated with high-response therapy had a 63% probability to survive at 12 months, compared to 27% of patients who were treated with low-response CSC drugs. We also found that patients treated with high-response drugs on average had an incremental cost-effectiveness ratio (ICER) of $48,893 per life-year saved compared to $53,109 of patients who were treated with low-response CSC drugs.

Conclusions: The results presented here suggest that the ChemoID Assay can be used to individualize chemotherapy choices to improve poor-prognosis recurrent GBM patient survival and to decrease the healthcare cost that impacts these patients.

Keywords: Cancer Stem Cell Assay; Cancer stem cells; ChemoID; Recurrent Glioblastoma.