# Informing health system planning for biomarker-based treatment: statistical prevalence projections for solid cancers with key pan-tumour biomarkers (dMMR, MSI, high TMB) in Australia to 2042

## TL;DR

This study projects the future prevalence of cancer patients in Australia with specific biomarkers to help plan for targeted treatments.

## Contribution

The paper provides the first long-term prevalence projections for key pan-tumour biomarkers in Australia.

## Key findings

- The 5-year prevalence of solid cancer cases is projected to increase by 54.2% from 2018 to 2042.
- Advanced disease at diagnosis is expected to rise by 37.6% during the same period.
- Biomarker prevalence in advanced disease is projected to increase, e.g., dMMR from 3983 to 5448 cases.

## Abstract

Targeted cancer treatment based on mismatch repair deficiency (dMMR), microsatellite instability (MSI), or high tumour mutational burden (TMB) holds promise for improving patient outcomes, but presents substantial healthcare costs.

Using validated statistical methods, we projected 1-year to 5-year prevalence of individuals diagnosed with solid tumours exhibiting these biomarkers in Australia to 2042, for all solid cancers combined and 23 individual cancer types/groups, and separately for all stages combined, advanced disease at diagnosis (here, distant metastasis/lymph node involvement), and advanced disease after progression post-diagnosis.

The 5-year prevalence of individuals diagnosed with any solid cancer regardless of biomarker status is estimated to increase by 54·2%, from 438,346 in 2018 to 675,722 in 2042 (advanced disease at diagnosis: by 37·6% from 109,855 to 151,199), primarily due to population growth and ageing. The 5-year prevalence of individuals whose tumours exhibit a biomarker is estimated to increase accordingly, e.g. for advanced disease at diagnosis, from 3983 to 5448 for dMMR, from 2484 to 3553 for MSI, and from 13,310 to 17,893 for high TMB (representing 3·6%, 2·3% and 11·8% of 5-year prevalence of individuals with advanced disease at diagnosis, respectively; noting considerable overlap in the presence of these biomarkers).

We present the first long-term projections for cancer prevalence associated with key pan-tumour biomarkers in Australia, to inform health policy and healthcare planning for targeted therapies.

Medical Research Future Fund—Preventive and Public Health Research Initiative—2019 Targeted Health System and Community Organization Research Grant Opportunity (MRF1200535), 10.13039/501100001171Cancer Institute NSW Career Development Fellowship (2022/CDF1154), 10.13039/501100000925National Health and Medical Research Council of Australia Investigator Grant (APP1194679).