Bayer Healthcare Pharmaceuticals, Whippany, NJ
Arvind Katta , Afsaneh Barzi , Brian Thomas Hocum , Sreevalsa Appukkutan , David Cosgrove , Ila Sruti , Junxin Shi , Wei Dai , Gregory A. Patton , Svetlana Babajanyan , Tanios S. Bekaii-Saab
Background: Testing for BRAF and KRAS/NRAS mutations, HER2 amplifications, and MSI/MMR status is a standard of care for all patients with mCRC. There are limited real-world (RW) data regarding biomarker testing patterns among robust patients who are candidates for multiple LOT. We evaluated biomarker testing patterns among patients treated in community oncology practices who initiated regorafenib (REGO) and/or trifluridine/tipiracil (FTD/TPI), predominantly in 3rd or later lines of therapy. Methods: A retrospective analysis utilizing electronic medical record data from The US Oncology Network examined adult patients with mCRC who initiated REGO and/or FTD/TPI between 09/01/2015 and 11/30/2022 with follow-up until 05/31/2023. The proportion of patients tested for various biomarkers was assessed. Results: A total of 2684 mCRC patients initiated REGO and/or FTD/TPI (including 895 pts receiving both) in any LOT during the study period. The mean age of patients at baseline was 62.9 years, of whom 54.9% were male, 1599 (59.6%) patients were White and 436 (16.2%) were underrepresented minorities (Black or Hispanic/Latino). Patients were most commonly tested for KRAS mutations (75.2%) and least commonly for HER2 amplifications (22.6%). Age, gender, and race/ethnicity characteristics were similar between treatment subgroups, with 29.6% of minority and 23.1% of white patients not undergoing KRAS testing. Types of biomarkers tested and proportion of patients tested are reported in the table below. Conclusions: About one quarter of patients who were sufficiently robust to receive aggressive therapy did not undergo testing for KRAS, the oldest standard of care biomarker in CRC. We observed disparities by race/ethnicity. We also observed a correlation between rates of testing and treatment intensity, with patients who received both REGO and FTD/TPI having a higher rate of testing than those who received only one of the treatments. Understanding the pitfalls in biomarker testing will help pave the way for appropriate and equitable access to cancer care.
Biomarker | Overall (N=2684) | Minority (N=436) | White (N=1599) | REGO or FTD/TPI (N=1789) | Both REGO and FTD/TPI (N=895) |
---|---|---|---|---|---|
BRAF, N(%) | 1314 (49.0%) | 196 (45.0%) | 798 (49.9%) | 852 (47.6%) | 462 (51.6%) |
KRAS, N(%) | 2019 (75.2%) | 307 (70.4%) | 1230 (76.9%) | 1328 (74.2%) | 691 (77.2%) |
NRAS, N(%) | 1059 (39.5%) | 171 (39.2%) | 614 (38.4%) | 679 (38.0%) | 380 (42.5%) |
HER2, N(%) | 607 (22.6%) | 92 (21.1%) | 358 (22.4%) | 388 (21.7%) | 219 (24.5%) |
MSI/MMR, N(%) | 1759 (65.5%) | 279 (64.0%) | 1045 (65.4%) | 1160 (64.8%) | 599 (66.9%) |
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