Is molecular profiling for gynaecological cancers worth the cost?

As we are getting into the era of precision medicine in cancer, molecular profiling is gaining growing importance to keep pace with the rapid evolution we are seeing in targeted therapies and, in the future, comprehensive genomic profiling is going to be a vital part of the management of gynaecological malignancies. Molecular profiling has changed the face of cancer management, increasing patient benefit by stratifying treatment options based on the predicted magnitude of benefit and also identifying individuals at high risk. Initially less commonly used than in other tumours, such as breast cancers, molecular profiling of gynaecological cancers is gathering momentum. Profiling is important not just for identifying potential targets. It may not always have a direct clinical impact in terms of treatment selection, but molecular profiling can provide a wealth of information about the disease that will inform future management.

One of the main barriers to the widespread adoption of profiling is cost. Targeted genetic testing is likely to be cost-effective for ovarian cancer (Value Health. 2021;24:303–312) and for profiling according to recommendations for early-stage, high-risk endometrial cancer (Gynecol Oncol. 2022;164:129–135). However, it remains to be seen if targeted profiling is justified across all stages of different gynaecological cancers and, crucially, whether comprehensive profiling is cost-effective. And even where profiling is shown to be cost-effective, difficult decisions may still be required where there are cost constraints.

Of course, cost of profiling is an important consideration, particularly in healthcare communities with restricted resources. However, while testing is currently relatively expensive, economics suggest that costs will reduce with time. In addition, the oncology community needs to investigate ways to make affordable profiling more widely accessible.