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P219: Assessment of Genomic Profiling in Colorectal Cancer Patients Treated in Community Oncology Practices

Poster Presenter

Emily Leigh Paul

Director of Product Delivery, Clinico-Genomic
McKesson
United States

Objectives

This study examined the rates of biomarker testing in patients with colorectal cancer treated in a community oncology setting.

Method

Data was collected from patients with colorectal cancer treated at 113 community oncology practices in a 4-year period (2018-2022). Clinical data was from the iKnowMed(SM) electronic health record system. Genomic data was collected from two sources: chart abstracted data and clinical lab reports.

Results

All stages of colorectal cancers were included in the selection of a cohort of 41,980 patients for further assessment. Patients were required to have primary colon or rectal cancer, be at least 20 years old at diagnosis, and have at least 2 office visits. Structured data was used to assemble the profiles of these patients. The cohort had a median age of 66 years and 62% were white. Of these, 18,782 (45%) underwent biomarker testing. Biomarker testing included all forms of genomic information gathered, including next-generation sequencing (NGS)-based tests, targeted testing, and immuno-oncology biomarker testing. Genomic testing rates increased by 61% across all stages of disease combined over the 4-year time span. The highest rate of biomarker testing was among patients with stage IV disease at diagnosis, representing 21% (n=9,021), 81% of which had one viable biomarker test performed (n=7291). The most frequently assessed biomarker was BRAF (n=17,576), with nearly 16% of the cohort showing a mutation, and 35% of these had the V600E mutation (n=967). Microsatellite instability (MSI) was observed in 14% of patients. There was an overlap in patients with gene-specific biomarkers and MSI-positive results, with the most common biomarker overlap being BRAF+ and MSI (n=405) and the least common overlap being NRAS+ and MSI (n=16). Circulating tumor DNA testing was part of some patient profiles, with 350 patients who had multiple genetic reports (3+). In that group, 245 were enrolled in clinical trials.

Conclusion

In this study, we observed the increase of genetic profiling of colorectal cancer patients over time. The guidelines recommend biomarker testing at Stage IV, and our observations show that this is occurring for a majority of these patients, as noted above. While MSI testing is the primary biomarker collected for Stages I-III, we have observed other biomarker data collected for these stages, reflecting an expansion of data collected. Data were collected via single gene tests or NGS-based comprehensive genomic profiling. Additional research into the use of targeted therapies and outcomes will be performed and presented. The exploratory genomic regions of the NGS-based assays tested may also provide new potential targets as the database of combined clinical and genetic information develops.