Researchers report that screening for KRAS and BRAF mutations can reduce the cost of anti-EGFR treatment for metastatic colorectal cancer but with a very small reduction in overall survival according to a new study published on November 28 in the Journal of the National Cancer Institute.
Metastatic colorectal cancer patients whose tumors harbor mutations in KRAS (and to a lesser extent, in BRAF) are unlikely to respond to costly anti-EGFR therapies. Screening of patients who are candidates for these therapies for mutations in one of these genes (KRAS) has been recommended, with the goal of providing treatment to those who are likely to benefit from it while avoiding unnecessary costs and harm to those who are not likely to benefit. However, the real-world impact of mutation screening for both KRAS and BRAF is unclear.
To better understand the impact of mutation screening with regard to health outcomes, costs, and value, Ajay S. Behl, Ph.D., M.B.A., of the HealthPartners Research Foundation in Bloomington, Minnesota, and colleagues, performed a cost-effectiveness analysis that took into account the treatments, resection of metastases, and survival for the different types of metastases. They conducted patient-level decision analytic simulation modeling comparing four strategies involving KRAS and BRAF mutation testing to select treatments for metastatic colorectal cancer patients: no anti-EGFR therapy (best supportive care); anti-EGFR therapy without screening; screening for KRAS mutations only (before providing anti-EGFR therapy); and screening for KRAS and BRAF mutations (before providing anti-EGFR therapy).
The researchers found that compared with no anti-EGFR therapy, screening for both KRAS and BRAF mutations showed a very high (ie, unfavorable) incremental cost-effectiveness ratio, meaning it was very costly in relation to its benefits. Compared with anti-EGFR therapy without screening, screening for KRAS mutations saved approximately $7,500 per patient; adding BRAF mutation screening saved another $1023, with little reduction in expected survival.
The authors write, "In general, our results are less supportive of the use of anti-EGFR therapy than previous analyses, and they indicate lower cost savings from KRAS testing than previously reported. Although we cannot confirm that anti-EGFR therapy is a cost-effective use of health care resources, we can affirm that KRAS testing is cost-saving. BRAF testing may offer additional savings."
In an accompanying editorial, Josh J. Carlson, M.P.H., Ph.D., of the Department of Pharmacy, University of Washington, and Scott D. Ramsey, MD, PhD, of the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, both in Seattle, note two practical points highlighted by the study: that molecular testing is as much about generating cost savings by identifying nonresponders as it is about improving survival by identifying responders, and that good modeling must account for the fact that community practice (as opposed to clinical trials) "is messy." They write, "most importantly, this study of an unusually accurate test raises important issues that should be considered for other molecular tests in other settings."
Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org
This press release was posted to serve as a topic for discussion. Please comment below. We try our best to only post press releases that are associated with peer reviewed scientific literature. Critical discussions of the research are appreciated. If you need help finding a link to the original article, please contact us on twitter or via e-mail.
Biologists are reporting signs of a possible zombie apocalypse. Well, at least for the honeybee population. A parasite that has been turning bees on the West Coast into zombie-like creatures has started infecting bees in the East, and biologists are still puzzled as to how it all works.
An innate ability some people have to manipulate their vocal frequency could be the key to sounding charismatic, according to new research.
Time-lapse imagery of scavengers tucking in proves that dead jellyfish aren't unpalatable after all, so can return nutrients to the sea's food webs
When bird pairs break up females often lay more eggs with a new partner, but the split can be disastrous for the male of the species
Spontaneous gene mutations, not ones inherited from parents, increase a child's risk of autism, scientists say. By comparing genes within families they've identified more than 100 suspects.
Slovenian archaeologist Ivan prajc is behind discovery of three significant ruins in the remote jungles of the Yucatán peninsula
Every year, Nikon selects the most artful, scientifically enlightening and skillfully produced images from thousands of submissions for its Small World microscope photography contest. Tomorrow, another set of impressive winners will be announced for the contest’s 40th year.
Seaview divers routinely cover 2 kilometers in a dive and generate 3,000 panoramic images in a day. Only a fraction of the best are uploaded to Google Street View.
Meeting sharks can be a moving experience, says photographer Jean-Marie Ghislain, who works to educate people on the plight of sharks around the world
From kraken to mermaids, some monsters are real—if you know how to look for them