224849 Utilization and effectiveness of KRAS testing for colorectal cancer

Sunday, November 7, 2010

Alanna Kulchak Rahm, MS , Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
Heather Spencer Feigelson, PhD, MPH , Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
Katrina Goddard, PhD , Center for Health Research, Kaiser Permanente Northwest, Portland, OR
Pamala Pawloski, PharmD , HealthPartners Research Foundation, HealthPartners, Minneapolis, MN
Catherine A. McCarty, PhD , Marshfield Clinic Research Foundation, Marshfield Clinic, Marshfield, WI
Adedayo Onitilo, MD , Marshfield Clinic Research Foundation, Marshfield Clinic, Marshfield, WI
Lawrence Kushi, ScD , Division of Research, Kaiser Permanente of Northern California, Oakland, CA
Robert L. Davis, MD, MPH , Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA
Arnold L. Potosky, PhD , Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
Background: Genomic and personalized medicine (GPM) applications have the potential to enhance our ability to screen for disease predisposition and treatment responsiveness. Testing colorectal cancer (CRC) tissue for mutations in the KRAS gene is one such test that can help oncologists decide how to treat patients with metastatic colorectal cancer (mCRC). KRAS testing is already standard clinical practice in many settings and allows oncologists to tailor the use of anti-EGFR therapy to increase treatment effectiveness and potentially minimize adverse events. The FDA has also changed the labeling of these therapies indicating they are not effective for treatment of patients with KRAS mutations. Methods: This study evaluates the characteristics of patients, providers, and health systems as they relate to the diffusion and utilization of KRAS testing. A comparative analysis of KRAS testing for mCRC patients treated in community practices to evaluate its effectiveness in terms of both progression-free survival and overall survival will also be conducted. Total sample includes 800 mCRC cases diagnosed between January 1, 2005 and July 31, 2010 from 7 different sites. Electronic medical record data at each site captures information on patient characteristics including disease characteristics, comorbidities, history of all cancer-directed therapies, acute complications, receipt of palliative care and contextual socioeconomic variables. Chart review data will supplement and verify the electronic data. Conclusions: This study will serve as a model for evaluating the potential impact of GPM applications to improve health outcomes, reduce costs, and influence patient and physician decision-making in the area of personalized therapies.

Learning Areas:
Clinical medicine applied in public health

Learning Objectives:
Describe the actual diffusion and utilization of KRAS testing by providers and health plans for the treatment of metastatic colorectal cancer. Discuss the comparative effectiveness of KRAS testing on patient outcomes.

Keywords: Genetics, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am project manager for the multi-site research project on KRAS comparative effectiveness.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.