Advice
Specialist commentator comments
Specialist commentator comments
Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
Two out of 4 specialist commentators were familiar with Caris Molecular Intelligence (CMI): 1 had used it before and 1 is currently using it.
Level of innovation
One specialist stated that CMI was only a minor variation on the current UK standard of care, but another felt that it represented a paradigm shift in managing cancer. Two specialist commentators stated that the multi-platform nature of CMI and the report's provision of a list of potential drugs to use were both innovative aspects. The commentators were aware of similar technologies, but noted that CMI is the only test that combines immunohistochemistry, in situ hybridisation and next-generation sequencing.
Potential patient impact
All 4 specialist commentators thought that CMI offered potential benefits to patients by guiding the most appropriate therapy, and steering clinicians and patients away from treatments that are predicted to have no benefit.
The specialists identified a range of people who may benefit from CMI, including people:
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with advanced and multi-organ cancers
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with cancer of unknown primary origin and people with malignancy of an unknown origin, for whom using CMI could avoid the need for costly and potentially invasive investigations
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with rare cancers for whom published evidence to guide therapy is unavailable
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who have exhausted standard treatment options
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who may tolerate targeted therapies better if a driver mutation is found
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who are in hospitals or services where current 'best practice' does not occur.
All 4 specialists stated that CMI has the potential to improve clinical outcomes, leading to more diverse treatment pathways and allowing a broader range of therapies and potentially less invasive treatments to be offered.
Potential system impact
The specialist commentators had mixed views on the cost-saving potential of CMI. One felt that it would cost less overall because it would prevent people with advanced cancers and multiple cancers from starting treatments that offered little to no benefit. Two commentators noted that the system impact would only become clear through validation of the technology, and if it could be shown that clinicians were willing to follow CMI's recommendations and modify established patterns of care. Another specialist thought that using CMI was likely to cost more than current standard care, simply because of the cost of the test itself and potentially the costs of appropriate treatments it identified.
One specialist thought that CMI may lead to an increase in outpatient treatment. Another felt that it would shift funding from treatment to diagnosis, but both they and 1 other commentator did not think that there would be a change in how patients were managed, in terms of the setting. Two specialist commentators thought that there may be an increase in cost and resources in terms of taking fresh biopsies, but noted that archived samples can also be used. Two specialists thought that CMI's high cost may prohibit its use in the NHS.
Two specialist commentators thought that some training in the interpretation of the report would be needed, but this is provided by the company. One commentator noted that CMI could potentially recommend drugs that may not be licensed for use in the relevant indication.
General comments
One specialist commentator stated that CMI has sometimes suggested treatments they would not otherwise have considered. Another commentator stated that CMI has limitations, and that not all tests achieved successful molecular profiles (for unknown reasons). They added that CMI was not able to detect all abnormalities known to be present within the tumour that was profiled.
Three specialist commentators felt that more evidence is needed for CMI, including specifically: testing in a UK centre; technical research on multi-platform molecular profiling; cost-effectiveness analyses; trials of CMI‑guided therapy compared with clinician choice in cancers of unknown primary origin and malignancy of unknown origin; and comparisons of current best care with CMI‑guided treatment.