Does KRAS testing in metastatic colorectal cancer impact overall survival? A comparative effectiveness study in a population-based sample.

摘要: Membership of the CERGEN Study Team is provided in Acknowledgments. The Comparative Effectiveness Research Genomics Colon Cancer (CERGEN) includes: Gwen Alexander, Henry Ford Health System (HFHS); Chris Anderson, Partners Institute for Education and (HPIER); Ajay Behl, HPIER; Kris Bennett, Kaiser Permanente Northwest (KPNW); Kathleen Bow, Hawai'i (KPHI); Jennifer Carney, KPHI; Ned Colange, Denver Public Colorado; Christopher Cold, Marshfield Clinic Foundation (MCRF); Deanna Cross, MCRF; YeeHwa Daida, Padmavati Dandamudi, KPNW; Robert Davis, KPG; Teri Defor, Thomas Delate, Colorado (KPCO); Jessica Engel, Rene Faryniarz, HFHS; Heather Spencer Feigelson, KPCO (lead author); Flottemesch, Mamie Ford, KPNC; Jared Freml, KPCO; Kellyan Funk, Joan Garhy, Katrina Goddard, Julie Harris, Northern California (KPNC); Mia Hemmes, Georgia (KPG); Paul Hitz, Rebecca Holmes, Stacey Honda, Stephen Houston, Karl Huang, Clara Hwang, Sheng-Fang Jiang, Monique Johnson, Oregon Sciences University (OHSU); Tia Kauffman, Terrie Kitchner, Richard Krajenta Tatjana Kolevska, Lawrence Kushi, Smyth Lai, Anh Q Le, Loic LeMarchand, Hawaii; Petra Liljestrand, KPNC;Jennifer Lin Celeste Machen, Michael Maciosek, Catherine McCarty, McCance, Meenan, Alex Menter, Jill Mesa,KPNW; Meier, Anousheh Mirabedi, Judith Morse, Kristin Muessig,KPNW; Andrew Nelson, Carsie Nyirenda, Maureen O'Keeffe Rosetti, Kim Olson, Suzanne O'Neill, Georgetown University; Adedayo Onitilo, Brian Owens, HPIER;Pamala Pawloski, Alanna Rahm, C. Sue Richards, OHSU; Denise Schwarzkopf, Caitlin Senger, Carol Somkin Amy Stone-Murai, KPHI;Nagendra Tirumali, Laurie VanArman, David Veenstra, Washington; Aleli Vinoya, Carmel Wax, Elizabeth Webber, Webster, Evelyn Whitlock Williams, Carmen Wong, Chan Zeng, Sarah Zuber, KPNW. Purpose: Epidermal growth factor receptor (EGFR) inhibitors are approved treating metastatic colorectal cancer (CRC); KRAS mutation testing recommended prior to treatment. We conducted a non-inferiority analysis examine whether has impacted survival CRC patients. Patients Methods: included 1186 cases from seven health plans. A cutpoint July, 2008, was used define two time period groups: "pre-testing" (n = 760 cases) ''post-testing'' 426 cases). Overall (OS) estimated, difference median OS between groups calculated. lower bound one-sided 95% confidence interval (CI) test null hypothesis post-testing inferiority. Multivariable Cox regression models were constructed adjust covariates. Results: unadjusted 15.4 months (95% CI: 14.0-17.5) 12.8 10.0-15.2) pre-and groups, respectively. -2.6 with -5.13 months, which less than margin (-5.0 p 0.06), leading failure reject inferiority period. In contrast, adjusted analysis, identified (p 0.001). Sensitivity analyses using cutpoints before after also met criteria non-inferiority. Conclusion: Implementation did not influence OS. Our data support use guide administration EGFR treatment without diminished