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

Jennifer Webster, 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

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)91-101
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume22
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

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Epidermal Growth Factor Receptor
Colorectal Neoplasms
Medical Oncology
Therapeutics
Integrated Delivery of Health Care
Mutation
Electronic Health Records
Biomarkers
Genotype
Guidelines
Survival
Genes

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Webster, J., Kauffman, T. L., Feigelson, H. S., Pawloski, P. A., Onitilo, A. A., Potosky, A. L., ... Goddard, K. A. B. (2013). KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings. Cancer Epidemiology Biomarkers and Prevention, 22(1), 91-101. https://doi.org/10.1158/1055-9965.EPI-12-0545

KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings. / Webster, Jennifer; Kauffman, Tia L.; Feigelson, Heather Spencer; Pawloski, Pamala A.; Onitilo, Adedayo A.; Potosky, Arnold L.; Cross, Deanna; Meier, Paul R.; Mirabedi, Anousheh S.; Delate, Thomas; Daida, Yihe; Williams, Andrew E.; Alexander, Gwen L.; McCarty, Catherine A.; Honda, Stacey; Kushi, Lawrence H.; Goddard, Katrina A B.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 22, No. 1, 01.2013, p. 91-101.

Research output: Contribution to journalArticle

Webster, J, Kauffman, TL, Feigelson, HS, Pawloski, PA, Onitilo, AA, Potosky, AL, Cross, D, Meier, PR, Mirabedi, AS, Delate, T, Daida, Y, Williams, AE, Alexander, GL, McCarty, CA, Honda, S, Kushi, LH & Goddard, KAB 2013, 'KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings', Cancer Epidemiology Biomarkers and Prevention, vol. 22, no. 1, pp. 91-101. https://doi.org/10.1158/1055-9965.EPI-12-0545
Webster, Jennifer ; Kauffman, Tia L. ; Feigelson, Heather Spencer ; Pawloski, Pamala A. ; Onitilo, Adedayo A. ; Potosky, Arnold L. ; Cross, Deanna ; Meier, Paul R. ; Mirabedi, Anousheh S. ; Delate, Thomas ; Daida, Yihe ; Williams, Andrew E. ; Alexander, Gwen L. ; McCarty, Catherine A. ; Honda, Stacey ; Kushi, Lawrence H. ; Goddard, Katrina A B. / KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings. In: Cancer Epidemiology Biomarkers and Prevention. 2013 ; Vol. 22, No. 1. pp. 91-101.
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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.",
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T1 - KRAS testing and epidermal growth factor receptor inhibitor treatment for colorectal cancer in community settings

AU - Webster, Jennifer

AU - Kauffman, Tia L.

AU - Feigelson, Heather Spencer

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AU - Onitilo, Adedayo A.

AU - Potosky, Arnold L.

AU - Cross, Deanna

AU - Meier, Paul R.

AU - Mirabedi, Anousheh S.

AU - Delate, Thomas

AU - Daida, Yihe

AU - Williams, Andrew E.

AU - Alexander, Gwen L.

AU - McCarty, Catherine A.

AU - Honda, Stacey

AU - Kushi, Lawrence H.

AU - Goddard, Katrina A B

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N2 - 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.

AB - 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.

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