Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Jan;22(1):91-101.
doi: 10.1158/1055-9965.EPI-12-0545. Epub 2012 Nov 15.

KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings

Jennifer Webster  1 , Tia L Kauffman, Heather Spencer Feigelson, Pamala A Pawloski, Adedayo A Onitilo, Arnold L Potosky, Deanna Cross, Paul R Meier, Anousheh S Mirabedi, Thomas Delate, Yihe Daida, Andrew E Williams, Gwen L Alexander, Catherine A McCarty, Stacey Honda, Lawrence H Kushi, Katrina A B Goddard; CERGEN study team
Collaborators, Affiliations
Comparative Study

KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings

Jennifer Webster et al. Cancer Epidemiol Biomarkers Prev. 2013 Jan.

Abstract

Background: In metastatic colorectal cancer (mCRC), mutations in the KRAS gene predict poor response to EGF receptor (EGFR) inhibitors. Clinical treatment guidelines now recommend KRAS testing if EGFR inhibitors are considered. Our study investigates the clinical uptake and utilization of KRAS testing.

Methods: We included 1,188 patients with mCRCs diagnosed from 2004 to 2009, from seven integrated health care delivery systems with a combined membership of 5.5 million. We used electronic medical records and targeted manual chart review to capture the complexity and breadth of real-world clinical oncology care.

Results: Overall, 428 patients (36%) received KRAS testing during their clinical care, and 266 (22%) were treated with EGFR inhibitors. Age at diagnosis (P = 0.0034), comorbid conditions (P = 0.0316), and survival time from diagnosis (P < 0.0001) influence KRAS testing and EGFR inhibitor prescribing. The proportion who received KRAS testing increased from 7% to 97% for those treated in 2006 and 2010, respectively, and 83% of all treated patients had a KRAS wild-type genotype. Most patients with a KRAS mutation (86%) were not treated with EGFR inhibitors. The interval between mCRC diagnosis and receipt of KRAS testing decreased from 26 months (2006) to 10 months (2009).

Conclusions: These findings show rapid uptake and incorporation of this predictive biomarker into clinical oncology care.

Impact: In this delivery setting, KRAS testing is widely used to guide treatment decisions with EGFR inhibitors in patients with mCRCs. An important future research goal is to evaluate utilization of KRAS testing in other delivery settings in the United States.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overview of KRAS Test Utilization for study participants.
Figure 2
Figure 2
Percentage of patients who received KRAS testing before EGFR Inhibitor treatment (white bars) and at any time in their clinical care (black bars) by year that EGFR inhibitor treatment was initiated, among patients who received EGFR inhibitors.
Figure 3
Figure 3
System characteristics: Practice variation in (A) the proportion of patients who received KRAS testing and (B) the median test interval (number of days between diagnosis with mCRC and receipt of KRAS testing) across integrated health systems participating in this study.
Figure 3
Figure 3
System characteristics: Practice variation in (A) the proportion of patients who received KRAS testing and (B) the median test interval (number of days between diagnosis with mCRC and receipt of KRAS testing) across integrated health systems participating in this study.
See this image and copyright information in PMC

References

    1. Blue Cross and Blue Shield Association. KRAS Mutations and Epidermal Growth Factor Receptor Inhibitor Therapy in Metastatic Colorectal Cancer. [cited 2012 Jan 4]. Available from: http://bcbs.com/blueresources/tec/vols/23/23_06.pdf. - PubMed
    1. Allegra CJ, Jessup JM, Somerfield MR, Hamilton SR, Hammond EH, Hayes DF, et al. American Society of Clinical Oncology provisional clinical opinion: testing for KRAS gene mutations in patients with metastatic colorectal carcinoma to predict response to anti-epidermal growth factor receptor monoclonal antibody therapy. J Clin Oncol. 2009;27(12):2091–6. - PubMed
    1. National Comprehensive Cancer Network. NCCN Updates Guidelines for Colorectal Cancer. [cited 2012 Jan 15]. Available from: http://www.nccn.org/about/news/newsinfoasp?NewsID=194.
    1. Engstrom P, Arnoletti J, Benson A, Chen Y, Choti M, Cooper H. Colon Cancer Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2009;7(8):778–831. - PubMed
    1. Engstrom P, Arnoletti J, Benson A, Chen Y, Choti M, Cooper H. Colon Cancer Clinical Practice Guidelines in Oncology. [cited 2012 Jan 5]. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

Publication types

MeSH terms