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.
After a severe brain injury, some people remain in a vegetative or minimally conscious state, unable to speak or move intentionally, and apparently unaware of the world around them. But in recent years, neuroscientists have found signs that some of these patients may still be conscious, at least to a degree. Now researchers have used a branch of mathematics called graph theory to search for neural signatures of consciousness.
Few parasitoids are more bizarre or disturbing than the wasps of the genus Glyptapanteles, whose females inject their eggs into living caterpillars. Once inside, the larvae mature, feeding on the caterpillar’s body fluids before gnawing through its skin en masse and emerging into the light of day. And despite the trauma, not only does the caterpillar survive---initially at least---but the larvae proceed to mind-control it, turning their host into a bodyguard that protects them as they spin their cocoons and finish maturing. Then, finally, the caterpillar starves to death, but only after the tiny wasps emerge from their cocoons and fly away.
From their new book A History of Life in 100 Fossils, Paul Taylor and Aaron O'Dea share the story of 10 incredible fossils
We love origin stories. When we see successful groups of animals and plants, we wonder where they came …
First research of its kind shows that tasers could impair a person's memory and thought process
Sometimes the most fascinating animals are the ones that are no longer with us. The oddly named sthenurine is no exception.
Australian banded stilts use mysterious cues to know when to head toward ephemeral lakes in the country’s otherwise dry interior
The intriguing story of how whale evolution was unpicked is told in The Walking Whales, revealing what it's like to be a globe-trotting palaeontologist
Cells derived from embryos appear to have improved vision in more than half of the 18 patients who had become legally blind because of two progressive, currently incurable eye diseases.
Oil rigs are rarely lauded by conservationists, but fish seem to love them – they have more fish living around them than natural rocky reefs do