Uptake of KRAS mutation testing in patients with metastatic colorectal cancer in Europe, Latin America and Asia

Abstract

The mutation status of the KRAS gene in the tumors of patients with metastatic colorectal cancer (mCRC) is a predictive biomarker for the efficacy of epidermal growth factor receptor monoclonal antibody therapy. The establishment of KRAS mutation testing in this setting represents a significant change to standard diagnostic procedures and a major advance in the personalization of cancer care. Against a changing regulatory background, three cross-sectional surveys of physicians in 14 countries in Europe, Latin America and Asia were conducted in 2008, 2009, and 2010 to investigate the uptake and outcome of KRAS testing for patients with mCRC. Physicians in each year answered questions on four patients (last patient seen and last seen in first-, second- and third-line settings). Fieldwork was carried out February-May 2008, January-April 2009, and January-April 2010. Data from 3,819, 3,740 and 3,820 anonymized, uncoded patient records were collated. The frequency of KRAS testing in patients with mCRC increased from 3% in 2008 to 47% in 2009 and 69% in 2010. The 2010 survey revealed that test results were available within 15 days for 82%, 51% and 98% of the 1679, 679, and 261 tested patients in the European, Latin American and Asian regions, respectively. Cetuximab was the most commonly administered targeted agent in tested patients with KRAS wild-type mCRC (798/1607 patients; 50%) and bevacizumab was the most commonly administered targeted agent in tested patients with KRAS mutant tumors (396/893; 44% overall). In conclusion, KRAS testing is now widely established as a routine diagnostic procedure for patients with mCRC and is used increasingly to guide treatment selection.

The prevalence of KRAS mutation in colorectal cancer patients in Iranian population: A systematic review and meta-analysis study

“…Mutation in codons 12, 13, and 61 of KRAS is common in CRC (Amirifard et al, 2016). Some studies in different parts of word reported the prevalence of KRAS mutation was 24% in the Middle East (Burt, 2000), 36% in Europa, (Ciardiello et al, 2011) 37.4% in Asian, 23% in Thailand, and 50% in Japan. In European countries, KRAS mutation was 30% in Italy, 49.3% in the UK, 31.6% in the USA, 28% in Australia, 23 to 28% in Africa, (Omidifar et al, 2015), 38% in France (Chretien et al, 2013) and 62.2% in Italy (Miglio et al, 2013).…”

Exploring the Use of a Participative Design in the Early Development of a Predictive Test: The Importance of Physician Involvement

“…Research shows that the physicians' education and experience both influence their decision-making process, including their adherence to practice guidelines [13,[33][34][35] . Empirical findings on test adoption by physicians highlight specific issues to consider while introducing such innovations [36][37][38][39] . The development of a predictive test through PD building on the physician's experience and involving them in evidence-based medicine is likely to encourage them to incorporate this tool into their practice.…”

Untitled

“…Between 2008 and 2010, a growing amount of data demonstrated that patients harbouring mutations in codon 12 or 13 on the Kirsten rat sarcoma viral oncogene homologue (KRAS) have a negligible chance to benefit from EGFR-I 3 , regardless these target drugs were administered alone 4,5 or in combination with chemotherapy 6,7 . This body of information has promptly induced the international community and the Regulatory Agencies to limit the use of EGFR-I in KRAS wildtype tumours only 8 . Soon after, this evolving landscape has broadened frenetically beyond KRAS exon 2 mutational status 9 .…”