Uptake of KRAS Testing and Anti-EGFR Antibody Use for Colorectal Cancer in the VA.

Becker DJ, Lee KM, Lee SY, Lynch KE, Makarov DV, Sherman SE, Morrissey CD, Kelley MJ, Lynch JA. Uptake of KRAS Testing and Anti-EGFR Antibody Use for Colorectal Cancer in the VA. JCO precision oncology. 2021 Jan 1; 5.

Related HSR&D Project(s)

• CDA 16-206 – Improving the Use of Tumor Genetic Testing with Decision Science

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Abstract:

Advances in precision oncology, including testing to predict response to epidermal growth factor receptor monoclonal antibodies (EGFR mAbs) in colorectal cancer (CRC), can extend patients' lives. We evaluated uptake and clinical use of molecular testing, guideline recommended since 2010, in the Veterans Affairs Healthcare System (VA). MATERIALS AND METHODS: We conducted a retrospective cohort study of patients with stage IV CRC diagnosed in the VA 2006-2015. We gathered clinical, demographic, molecular, and treatment data from the VA Corporate Data Warehouse and 29 commercial laboratories. We performed multivariable analyses of associations between patient characteristics, testing, and EGFR mAb treatment. RESULTS: Among 5,943 patients diagnosed with stage IV CRC, only 1,053 (17.7%) had testing. Testing rates increased from 2.3% in 2006 to 28.4% in 2013. In multivariable regression, older patients (odds ratio, 0.17; 95% CI, 0.09 to 0.32 for age 85 < 45 years) and those treated in the Northeast and South regions were less likely, and those treated at high-volume CRC centers were more likely to have testing (odds ratio, 2.32; 95% CI, 1.48 to 3.63). Rates of potentially guideline discordant care were high: 64.3% (321/499) of wild-type (WT) went untreated with EGFR mAb and 8.8% (401/4,570) with no testing received EGFR mAb. Among -WT patients, survival was better for patients who received EGFR mAb treatment (29.6 18.8 months; < .001). CONCLUSION: We found underuse of testing in advanced CRC, especially among older patients and those treated at lower-volume CRC centers. We found high rates of potentially guideline discordant underuse of EGFR mAb in patients with -WT tumors. Efforts to understand barriers to precision oncology are needed to maximize patient benefit.