Molecular Testing Improves Survival Outcomes for Patients With Endometrial Cancer, Study Finds
Key Takeaways:
- The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) was associated with increased life-years (LYs) and quality-adjusted LYs (QALYs) among patients with endometrial cancer (EC).
- ProMisE testing resulted in lower incremental costs than no testing, reducing total lifetime costs by $22 973.
- These findings demonstrate how molecular testing can result in more targeted therapies, thus improving clinical outcomes for patients with EC.
Treatment for EC is typically influenced by cancer stage, tumor grade, and molecular subtype, including biomarkers such as tumor protein 53 (p53), and DNA polymerase-ε catalytic subunit (POLE). Identifying these factors allows for more targeted and personalized therapies, which can improve patient outcomes.
ProMisE uses sequential testing for DNA mismatch repair deficiency (dMMR), p53 mutations, and POLE mutations to classify a patient’s molecular subtype.
Study Methods and Outcomes
Researchers compared the cost-effectiveness of ProMisE against no molecular testing. Using electronic health records from the Flatiron Health Research Database, investigators created a hypothetical cohort of patients with stage III/IV primary advanced or recurrent (pa/r) EC. A decision tree was used for molecular classification, followed by a partitioned survival model to evaluate care costs and patient outcomes.
Primary outcomes included total LYs, total QALYs, total costs, and incremental cost-effectiveness ratio (ICER).
ProMisE vs No Molecular Testing
ProMisE testing had higher total LYs and QALYs compared to no testing, 5.36 and 4.08 vs 3.83 and 2.89, respectively. Therefore, ProMisE resulted in a 1.53 LY gain and 1.19 QALY gain.
Patients with dMMR had the highest LYs and QALYs gained compared to other molecular subtypes, 8.78 and 6.83, respectively. Conversely, patients with p53 mutations had the lowest LYs (3.48) and QALYs (2.62).
ProMisE appeared to be more cost effective than no testing, with an ICER of $66 321 per QALY gained. Lifetime costs were reduced by $22 973 with ProMisE.
ProMisE had higher total costs compared to no testing, $233 989 and $155 305, respectively. Despite accumulating higher drug and testing costs, ProMisE was also associated with lower subsequent treatment costs.
Implications for Oncology Care
Identifying molecular biomarkers can improve survival outcomes as it helps inform treatment decisions and guide providers toward prescribing more appropriate therapies, especially for patients with dMMR and p53 mutations.
The study showed how ProMisE testing is a more clinically beneficial and cost-effective strategy for classifying and treating patients with stage III/IV pa/rEC.
The authors said, “Given the heterogeneity of molecular subtypes in stage III/IV pA/rEC, molecular testing offers a clinically meaningful pathway to personalized medicine. From an economic standpoint, broader adoption of molecular classification represents a high-value strategy for guiding treatment decisions.”
Reference
Chen Y, Lubinga SJ, Ramsey S, Hurteau J, Reynolds J, Carlson JJ. Molecular testing in primary advanced or recurrent endometrial cancer: a cost-effectiveness analysis. JCO Precision Oncol. 2026;10(7):e2501110. doi:10.1200/PO-25-01110
