Demographic and clinical characteristics of patients with metastatic colorectal cancer (mCRC) associated with RAS testing from 129 million covered lives.

739 Background: Guidelines for the treatment of patients with metastatic colorectal cancer (mCRC) recommend that all tumors be tested for RAS mutations to identify patients who will most benefit from chemotherapy regimens with biologic agents. The aim of this study was to describe characteristics of patients captured by a large national health claims database who were tested vs those who were not tested for RAS mutations and to identify potential predictors of RAS testing. Methods: Patients with mCRC diagnosed from 2012–2014 (ICD-9 codes 153.x, 154.0x, or 154.1x and 197.x–198.x) were identified from a US healthcare claims database consisting of 129 million unique covered patient lives. Patient demographics and baseline clinical characteristics were compared between patients who were and were not tested for RAS mutations (identified by CPT codes) using chi-square and t-tests. Odds ratios (ORs) were estimated for potential predictors by fitting multivariate logistic regressions to adjust for patient characteristics. Results: Of the 4,527 mCRC patients identified (mean age at diagnosis, 61.2 years; 54% male); 39% (n = 1,787) had a claim for RAS testing during the study period. Patients tested had similar mean age and comorbidity index at diagnosis compared to those not tested (60.8 vs 61.5 years, P = 0.06; 3.98 vs 3.90, P = 0.47). A greater proportion of RAS-tested patients were commercially insured compared to those not tested (37% vs 26%, P < 0.01). Adjusted for other patient characteristics, patients with commercial insurance (OR: 1.62 [95% confidence interval–CI: 1.41–1.87]), metastases to viscera (OR: 1.61 [95% CI: 1.42–1.84]), or diagnosis of colon primary site compared to rectum (OR: 1.32 [95% CI: 1.16–1.51]) had increased odds of receiving RAS testing; all P < 0.01. Conclusions: These observational data show that mCRC patients with commercial insurance, metastases to viscera, and colon cancer have a higher probability of being tested for RAS mutations. Overall, the data suggest that RAS status is underdetermined, with certain subgroups appearing to be more likely to be tested than others.

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Assessing real-world biomarker testing rates in metastatic colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.209 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 209-209

Author(s):

Shazia Nakhoda ◽

Mengying Deng ◽

Pritish Iyer ◽

Elizabeth A. Handorf ◽

Rishi Jain ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Performance Status ◽

Univariate Analysis ◽

Patient Characteristics ◽

Metastatic Colon Cancer ◽

Chi Square ◽

Initial Stage ◽

Chart Abstraction ◽

Biomarker Testing

209 Background: Despite national guideline recommendations for universal biomarker testing (KRAS, NRAS, BRAF, and mismatch repair/microsatellite instability [MMR/MSI]) in all patients with metastatic colorectal cancer (mCRC), little is known regarding adherence to these recommendations in the community. Methods: We evaluated 20,333 patients aged >18 years with mCRC diagnosed between 1/1/2013-12/27/18 from the nationwide de-identified Flatiron Health electronic health record-derived database. Changes in rates of biomarker testing based upon chart abstraction according to date of mCRC diagnosis were assessed in patients with ≥ 6 months of follow-up using Cochran-Armitage trend tests. We also assessed whether testing differed by patient characteristics using chi-square tests. Results: Biomarker testing rates increased between 2013 and 2018 (15.3 to 65.7% for NRAS, 23.9 to 56.6% for BRAF, and 34 to 76.6% for MMR, all p < 0.0001). There was no change in rate of KRAS testing (63.8 to 68.3% p= 0.1695) over this period of time. Univariate analysis showed that patients with, worse performance status, and Medicare/Medicaid insurance were less likely to be tested (for all variables, p <0.0001). There were no meaningful differences in testing rates by tumor sidedness, race, gender, or initial stage. Conclusions: In mCRC, adoption of guideline-driven recommendations for NRAS, BRAF and MMR/MSI testing increased significantly between 2013-2018. Adoption of BRAF and NRAS testing has neared the rate of KRAS testing. Interpretation of overall testing rates must recognize potential for missing biomarker test information for care not captured within the Flatiron network. Further study is required to characterize the magnitude of and reasons for absent biomarker testing among patients with metastatic colorectal cancer.

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Patient demographics and management landscape of metastatic colorectal cancer in the third‐line setting: Real‐world data in an australian population

Asia-Pacific Journal of Clinical Oncology ◽

10.1111/ajco.13553 ◽

2021 ◽

Author(s):

Sandy Tun Min ◽

Aflah Roohullah ◽

Annette Tognela ◽

Azim Jalali ◽

Margaret Lee ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Real World ◽

Real World Data ◽

Australian Population ◽

World Data ◽

Patient Demographics ◽

The Third ◽

Third Line ◽

Line Setting

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Implementing a small media intervention to increase colorectal cancer screening in primary care clinics

Translational Behavioral Medicine ◽

10.1093/tbm/iby063 ◽

2018 ◽

Vol 9 (4) ◽

pp. 605-616 ◽

Cited By ~ 1

Author(s):

Cathy L Melvin ◽

Anissa I Vines ◽

Allison M Deal ◽

Holly O Pierce ◽

William R Carpenter ◽

...

Keyword(s):

Colorectal Cancer ◽

Task Force ◽

Controlled Trial ◽

Preventive Services ◽

Patient Characteristics ◽

The United States ◽

Chi Square ◽

Return Rates ◽

The Usa ◽

Participant Characteristics

Abstract Colorectal cancer (CRC) is one of the most common cancers in the USA. In 2017, an estimated 135,420 people were diagnosed with CRC and 50,260 people died from CRC. Several screening modalities are recommended by the United States Preventive Services Task Force (USPSTF), including annual stool tests that are usually completed at home and under-used compared with colonoscopy despite stated patient preferences for an alternative to colonoscopy. The Community Preventive Services Task Force recommends use of small media interventions (SMIs) to increase CRC screening and calls for a greater understanding of its independent impact on screening participation. This study tested whether a SMI increased the likelihood of participant return of a USPSTF recommended Fecal Immunochemical Test (FIT). In total, 804 individuals participated in a two-group, prospective randomized controlled trial. Descriptive statistics with chi-square tests compared differences in participant characteristics and return rates. Multivariable log-binomial modeling estimated combined effects of patient characteristics with FIT return rates. No differences in return rates were observed overall or by participant characteristics other than the year of enrollment. A multivariable model controlling for all covariates, found gender, insurance type, and regular place for healthcare to be significantly associated with return rates. Receipt of the SMI did not independently increase overall return rates but it may have improved the ease of completing the FIT by some participants, particularly women, those with insurance, and those with a regular place for healthcare.

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ASO Author Reflections: RAS Mutations in Metastatic Colorectal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-018-7020-6 ◽

2018 ◽

Vol 25 (S3) ◽

pp. 850-851 ◽

Cited By ~ 1

Author(s):

Guillaume Passot ◽

Jean-Nicolas Vauthey ◽

Yun Shin Chun

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Ras Mutations

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KRAS and NRAS mutational gene profile of metastatic colorectal cancer patients in Jordan: Molecular spectrum, frequency and distribution pattern

10.21203/rs.2.11767/v1 ◽

2019 ◽

Author(s):

Muhammad Awidi ◽

Nidaa Ababneh ◽

Maha Shomaf ◽

Feras Al Fararjeh ◽

Laila Owaidi ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Distribution Pattern ◽

Cancer Patients ◽

Molecular Spectrum ◽

Kras Mutations ◽

Exon 2 ◽

Ras Mutations ◽

Colorectal Cancer Patients ◽

Kras Exon

Abstract Background A constitutively active RAS protein in the absence of stimulation of the epidermal growth factor receptor (EGFR) is the result of mutations in KRAS and NRAS genes. Mutations in the KRAS exon 2 and outside exon 2 have been found to predict the resistance to anti-EGFR monoclonal therapy. A substantial proportion of metastatic colorectal cancer cases (mCRC) exhibit RAS mutations outside KRAS exon 2, particularly in KRAS exon 3 and 4 and NRAS exons 2, 3. No data about RAS mutations outside KRAS exon 2 are available for Jordanian patients with mCRC. We aim to study the molecular spectrum, frequency, and distribution pattern of KRAS and NRAS mutations in Jordanian patients with mCRC. Methods A cohort of 190 Jordanian metastatic colorectal cancer patients were enrolled in the trial. We detected mutations in exon 2 of the KRAS and NRAS gene as well as mutations outside of exon 2 using the StripAssay technique. The KRAS StripAssay covered 29 mutations and 22 NRAS mutations. Results Mutations were observed in 92 (48.42%) cases, and KRAS exon 2 accounted for 76 cases (83.69%). KRAS G12D was the most common mutation, occurring in 18 cases, followed by KRAS G12A in 16 cases, and G12T in 13 cases. Mutations outside of KRAS exon 2 represented 16.3% of the mutated cases. Among those, 6 cases (6.48%) carried mutations in NRAS exon 2, 3 and 10 cases (10.87%) in KRAS exon 3 and 4. Conclusion The frequency of NRAS and KRAS mutations outside of exon 2 appears to be higher in Jordanian patients in comparison with patients from western countries. KRAS mutations outside of exon 2 should be tested routinely to identify patients who should not be treated with anti-EGFR antibodies.

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