KRAS testing before anti-EGFR therapy in metastatic colorectal cancer urged

NEW YORK (Reuters Health) - The American Society of Clinical Oncology (ASCO) today released its first "Provisional Clinical Opinion" on the use of KRAS gene mutation testing in patients with metastatic colorectal cancer to guide use of the epidermal growth factor receptor (EGFR) inhibitors cetuximab (Erbitux) and panitumumab (Vectibix).

ASCO's Provisional Clinical Opinion recommends that all patients with metastatic colorectal cancer who are candidates for anti-EGFR therapy have their tumors tested for KRAS gene mutations before receiving these agents.

If a patient has a mutated form of the KRAS gene, ASCO recommends against the use of anti-EGFR therapy, based on several recent studies indicating this treatment is only effective in patients with the wild-type form of the KRAS gene. It is estimated that 40 percent of colon cancer patients carry mutated KRAS.

An economic analysis presented Monday at the 2009 Gastrointestinal Cancers Symposium in San Francisco, co-sponsored by ASCO, found that routine testing for KRAS gene mutations in patients with metastatic colorectal cancer could save the United States health system up to $604 million per year in costs of cetuximab alone.

In a statement from the meeting, study presenter Dr. Veena Shankaran from Northwestern University's Robert H. Lurie Comprehensive Cancer Center said: "Personalizing cancer treatment based on gene status could spare thousands of people with colorectal cancer from side effects of treatments that are highly unlikely to improve their health, while saving the health care system substantial sums."

"Previous research has shown that treatment decisions for patients with metastatic colorectal cancer should be based on KRAS testing," Dr. Shankaran added. "Although a significant number of institutions are incorporating this, it's not yet universal. Our findings show that KRAS testing is not only good medicine, it's also good economics."

ASCO President Dr. Richard L. Schilsky, from the University of Chicago Medical Center, said in a press release from the society: "Using KRAS testing to guide colorectal cancer treatment is a prime example of where cancer care is heading."

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