Online Exclusive - March 25, 2009
From January 15-17, 2009, ASCO teamed with the American Gastroenterological Association (
AGA), the American Society for Radiation Oncology (
ASTRO), and the Society of Surgical Oncology (
SSO) to sponsor the 6
th annual Gastrointestinal Cancers Symposium in San Francisco, California.
More than 2,500 oncology professionals attended the meeting to discuss and debate advances in the screening, prevention, and treatment of gastrointestinal cancers, including cancers of the esophagus, stomach, hepatobiliary, pancreas, small bowel, colon, and rectum.
Among the 500 presentations was an important economic and scientific study that discussed the possibility of more than half a billion dollars in savings for the United States health care system. The study prompted ASCO to issue its first Provisional Clinical Opinion, now published in the
Journal of Clinical Oncology.
This study provided an economic analysis demonstrating that routine testing for
KRAS gene mutations in patients with metastatic colorectal cancer has the potential to save up to $604 million per year in health care costs by identifying the individuals who would actually benefit from taking cetuximab. Recent studies have shown that cetuximab is only effective in patients with the wild-type form of the
KRAS gene. Both the study and ASCO’s Provisional Clinical Opinion received coverage in the
Wall Street Journal, Bloomberg,
USA Today, and several health news publications.
Veena Shankaran, MD a postdoctoral fellow at the Veterans Administration Center for the Management of Complex Chronic Care and Northwestern University’s Robert H. Lurie Comprehensive Cancer Center, and the lead author of the study, said the implications of her research reach beyond economic savings.
“Personalizing cancer treatment based on gene status could spare thousands of people with colorectal cancer from side effects of treatments that are highly unlikely to improve their health, while saving the healthcare system substantial sums,” she said.
Following this study, ASCO released its first ever Provisional Clinical Opinion (PCO). The opinion recommends that all patients with metastatic colorectal cancer who are candidates for anti-EFGR therapy have their tumors tested for
KRAS gene mutations. If a patient has a mutated form of the
KRAS gene, the PCO recommends against the use of anti-EFGR antibody therapy, based on recent studies that found that treatment is only effective in patients with the wild-type form of the
KRAS gene. The PCO is a new tool that ASCO can use to provide the oncology community with timely, but preliminary, clinical direction based on recent data.
“Personalized medicine is the next frontier in cancer care. Basing cancer treatment on the unique genetic characteristics of the tumor or the patient will improve patient outcomes and help avoid unnecessary costs and side effects for patients who are unlikely to benefit,” said Richard L. Schilsky, MD, ASCO President. “Using
KRAS testing to guide colorectal cancer treatment is a prime example of where cancer care should be heading. Cancer treatments should not be used in patients who won’t benefit.”
The
KRAS study was just one of many notable studies presented at the 2009 GI Symposium. Another highlighted study, focusing on improving patient-targeted care to alleviate health care costs, involved identifying variations that may predict survival and outcomes for people with pancreatic cancer. These early findings have the potential to spare patients from unpleasant side effects and high costs of aggressive surgery, chemotherapy, and/or radiation when such treatment is unlikely to provide any health benefit.
These studies and others presented at the 2009 GI Symposium could have far reaching implications in the screening, treatment, and prevention of gastrointestinal cancer. More than 270,000 people are diagnosed with GI cancers in the United States every year, and more than 135,000 people die from them annually.
