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KRAS testing of patients with metastatic colorectal cancer in a community-based oncology setting: a retrospective database analysis.

Carter GC, Landsman-Blumberg PB, Johnson BH, Juneau P, Nicol SJ, Li L, Shankaran V - J. Exp. Clin. Cancer Res. (2015)

Bottom Line: Univariate and multivariate analyses were used to compare patient characteristics at diagnosis between tested and not-tested cohorts, and to identify factors associated with KRAS testing.The proportions of KRAS-tested patients who had been diagnosed in previous years but not tested previously increased from 17.7% in 2008 to 27.0% in 2009, then decreased to 19.0% in 2010 and 17.6% in 2011.Patients more likely to have been tested included those with lung metastases, poor performance status, more comorbidities, and mCRC diagnosis in 2009 or later.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA. cuyun_carter_gebra@lilly.com.

ABSTRACT

Background: In 2009, treatment guidelines were updated to recommend KRAS testing at diagnosis for patients with metastatic colorectal cancer (mCRC). We investigated KRAS testing rates over time and compared characteristics of KRAS-tested and not-tested patients in a community-based oncology setting.

Methods: Adult patients with a diagnosis of mCRC from 2008-2011 were selected from the ACORN Data Warehouse (ACORN Research LLC, Memphis, TN). Text mining of physician progress notes and full chart reviews identified KRAS-tested patients, test dates, and test results (KRAS status). The overall proportion of eligible patients KRAS-tested in each calendar year was calculated. Among KRAS-tested patients, the proportion tested at diagnosis (within 60 days) was calculated by year. Univariate and multivariate analyses were used to compare patient characteristics at diagnosis between tested and not-tested cohorts, and to identify factors associated with KRAS testing.

Results: Among 1,363 mCRC patients seen from 2008-2011, 648 (47.5%) were KRAS-tested. Among newly diagnosed mCRC patients, the rate of KRAS testing increased from 5.9% prior to 2008, to 13.9% in 2008, and then jumped dramatically to 32.3% in 2009, after which a modest yearly increase continued. The proportions of KRAS-tested patients who had been diagnosed in previous years but not tested previously increased from 17.7% in 2008 to 27.0% in 2009, then decreased to 19.0% in 2010 and 17.6% in 2011. Among patients who were KRAS-tested, the proportions tested at the time of diagnosis increased annually (to 78.4% in 2011). Patients more likely to have been tested included those with lung metastases, poor performance status, more comorbidities, and mCRC diagnosis in 2009 or later.

Conclusions: The frequency of KRAS testing increased over time, corresponding to changes in treatment guidelines and epidermal growth factor receptor inhibitor product labels; however, approximately 50% of eligible patients were untested during the study period.

No MeSH data available.


Related in: MedlinePlus

KRAS testing by calendar year. Proportion of newly diagnosed patients with mCRC tested for KRAS genotype and proportion of patients diagnosed in a prior year but not previously tested for KRAS genotype by calendar year (A), and among KRAS-tested patients, proportion tested at time of mCRC diagnosis by calendar year (B). Abbreviation: mCRC = metastatic colorectal cancer.
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Fig1: KRAS testing by calendar year. Proportion of newly diagnosed patients with mCRC tested for KRAS genotype and proportion of patients diagnosed in a prior year but not previously tested for KRAS genotype by calendar year (A), and among KRAS-tested patients, proportion tested at time of mCRC diagnosis by calendar year (B). Abbreviation: mCRC = metastatic colorectal cancer.

Mentions: The proportions of eligible patients ever KRAS-tested increased from 5.9% to 16.1% in the calendar year 2008 (prior to the inclusion of testing recommendations in the NCCN guidelines) and continued to increase to 29.1% in 2009 (coincident with NCCN and ASCO guidance updates and US labeling changes regarding KRAS genotype for cetuximab and panitumumab), after which the proportions of tested patients remained fairly consistent. However, as shown in Figure 1A, when looking separately at the two populations of eligible patients, the proportions of newly diagnosed mCRC patients KRAS-tested increased from 13.9% in 2008 to 40.5% in 2011, while patients who were previously diagnosed, but not tested, tended to remain not tested over time. Among patients who were KRAS-tested, the proportions of those tested at the time of diagnosis increased greatly over the four years testing was widely available (27.4% in 2008 to 78.4% in 2011) (Figure 1B).Figure 1


KRAS testing of patients with metastatic colorectal cancer in a community-based oncology setting: a retrospective database analysis.

Carter GC, Landsman-Blumberg PB, Johnson BH, Juneau P, Nicol SJ, Li L, Shankaran V - J. Exp. Clin. Cancer Res. (2015)

KRAS testing by calendar year. Proportion of newly diagnosed patients with mCRC tested for KRAS genotype and proportion of patients diagnosed in a prior year but not previously tested for KRAS genotype by calendar year (A), and among KRAS-tested patients, proportion tested at time of mCRC diagnosis by calendar year (B). Abbreviation: mCRC = metastatic colorectal cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4380249&req=5

Fig1: KRAS testing by calendar year. Proportion of newly diagnosed patients with mCRC tested for KRAS genotype and proportion of patients diagnosed in a prior year but not previously tested for KRAS genotype by calendar year (A), and among KRAS-tested patients, proportion tested at time of mCRC diagnosis by calendar year (B). Abbreviation: mCRC = metastatic colorectal cancer.
Mentions: The proportions of eligible patients ever KRAS-tested increased from 5.9% to 16.1% in the calendar year 2008 (prior to the inclusion of testing recommendations in the NCCN guidelines) and continued to increase to 29.1% in 2009 (coincident with NCCN and ASCO guidance updates and US labeling changes regarding KRAS genotype for cetuximab and panitumumab), after which the proportions of tested patients remained fairly consistent. However, as shown in Figure 1A, when looking separately at the two populations of eligible patients, the proportions of newly diagnosed mCRC patients KRAS-tested increased from 13.9% in 2008 to 40.5% in 2011, while patients who were previously diagnosed, but not tested, tended to remain not tested over time. Among patients who were KRAS-tested, the proportions of those tested at the time of diagnosis increased greatly over the four years testing was widely available (27.4% in 2008 to 78.4% in 2011) (Figure 1B).Figure 1

Bottom Line: Univariate and multivariate analyses were used to compare patient characteristics at diagnosis between tested and not-tested cohorts, and to identify factors associated with KRAS testing.The proportions of KRAS-tested patients who had been diagnosed in previous years but not tested previously increased from 17.7% in 2008 to 27.0% in 2009, then decreased to 19.0% in 2010 and 17.6% in 2011.Patients more likely to have been tested included those with lung metastases, poor performance status, more comorbidities, and mCRC diagnosis in 2009 or later.

View Article: PubMed Central - PubMed

Affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA. cuyun_carter_gebra@lilly.com.

ABSTRACT

Background: In 2009, treatment guidelines were updated to recommend KRAS testing at diagnosis for patients with metastatic colorectal cancer (mCRC). We investigated KRAS testing rates over time and compared characteristics of KRAS-tested and not-tested patients in a community-based oncology setting.

Methods: Adult patients with a diagnosis of mCRC from 2008-2011 were selected from the ACORN Data Warehouse (ACORN Research LLC, Memphis, TN). Text mining of physician progress notes and full chart reviews identified KRAS-tested patients, test dates, and test results (KRAS status). The overall proportion of eligible patients KRAS-tested in each calendar year was calculated. Among KRAS-tested patients, the proportion tested at diagnosis (within 60 days) was calculated by year. Univariate and multivariate analyses were used to compare patient characteristics at diagnosis between tested and not-tested cohorts, and to identify factors associated with KRAS testing.

Results: Among 1,363 mCRC patients seen from 2008-2011, 648 (47.5%) were KRAS-tested. Among newly diagnosed mCRC patients, the rate of KRAS testing increased from 5.9% prior to 2008, to 13.9% in 2008, and then jumped dramatically to 32.3% in 2009, after which a modest yearly increase continued. The proportions of KRAS-tested patients who had been diagnosed in previous years but not tested previously increased from 17.7% in 2008 to 27.0% in 2009, then decreased to 19.0% in 2010 and 17.6% in 2011. Among patients who were KRAS-tested, the proportions tested at the time of diagnosis increased annually (to 78.4% in 2011). Patients more likely to have been tested included those with lung metastases, poor performance status, more comorbidities, and mCRC diagnosis in 2009 or later.

Conclusions: The frequency of KRAS testing increased over time, corresponding to changes in treatment guidelines and epidermal growth factor receptor inhibitor product labels; however, approximately 50% of eligible patients were untested during the study period.

No MeSH data available.


Related in: MedlinePlus