Evolution of RAS testing in colorectal cancer in France, Germany, Italy, Spain and UK (EU5).

Abstract

e14679 Background: EGFR monoclonal antibodies, cetuximab (cetux) and panitumumab (pani) are treatment choices for colorectal cancer (CRC) patients with KRAS wild type (WT) disease. Despite this, a number of KRAS WT patients fail to respond to these therapies. There has been discussion to expand CRC testing to include NRAS. This study evaluates the trends in RAS testing across the EU5, as identifying the right patients for treatment is paramount in ensuring optimal treatment outcomes. Methods: IMS Oncology Analyzer, an anonymised patient database ( > 57,000 patients annually) collected through a quarterly physician panel survey, from 2009 to 2014, provides data on patterns of cancer care in the European Union across a range of different cancers. Inclusion criteria were metastatic patients diagnosed with CRC who are currently receiving chemotherapy. RAS testing uptake was analyzed from time 0 (Q1 2009 for KRAS and Q4 2013 for NRAS) until 2014. Results: In Q2 2009, 43% (278/646) of patients were tested for KRAS status in EU5. While France, Germany, Italy and Spain had established testing rates between 48-58%, the UK testing rate was 5% (6/116). Over the following years KRAS testing continued to increase at a rate of 3%, these rates differed slightly by market – FR 1.5%, DE 3.0%, IT, 2.2%, ES 2.0%, UK 11.5%. Current testing rates across the EU5 are at 84%. In Q3 2014, 47% (183/386) of KRAS tested patients in EU5 were KRAS mutant (MT). Following the regulatory requirement for NRAS testing for cetuximab, total RAS testing increased from 14% (268/1980) to 44% (228/513) in Q3 2014 at a rate of 37%. As with KRAS, the slowest uptake for total RAS testing was observed in the UK (25% in Q3 2014). In Q3 2014 K/NRAS dual testing identified 11% of KRAS WT patients as NRAS MT. Conclusions: Testing for KRAS mutations is now commonplace across EU5, with over 80% of patients being tested. NRAS testing however is a fairly recent requirement set out by the EMA in Nov 2013. A clear uptake of NRAS testing is observed following this time period and can be expected to become more routine within clinical practice as physicians strive to better personalize cancer treatment management.