BRAF Mutation Testing and Metastatic Colorectal Cancer in the Community Setting: Is There an Urgent Need for More Educat
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ORIGINAL RESEARCH ARTICLE
BRAF Mutation Testing and Metastatic Colorectal Cancer in the Community Setting: Is There an Urgent Need for More Education? Timothy J. Price1,2 • Carol Beeke3 • Amanda Rose Townsend1,2 Louisa Lo1 • Roy Amitesh4 • Robert Padbury3 • David Roder5 • Guy Maddern6 • James Moore7 • Christos Karapetis4,8
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Ó Springer International Publishing Switzerland 2015
Abstract Background Patients with metastatic colorectal cancer (mCRC) with BRAF mutation (BRAF MT) generally have a poorer prognosis. BRAF MT may also have implications for treatment strategy. Despite this, inclusion of BRAF in routine molecular testing varies. Here we report the frequency of BRAF reporting in the South Australian (SA) mCRC registry reflecting community practice, together with the survival outcomes based on mutation status. Methods The SA population-based mCRC registry was analysed to assess the number of patients where a BRAF MT result was available. The patient characteristics are
Presented in part at ECC/ESMO meeting, Vienna, September 2015. & Timothy J. Price [email protected]; [email protected]
reported and overall survival was analysed using the Kaplan–Meier method. Results Of the 3639 patients who have been entered in the registry, only 6.2 % (227) have BRAF MT results available. Of the patients tested, the BRAF MT rate is 12.7 %. The mutation rate was highest in rightsided primary; right colon 23 versus left colon 8.9 % and rectum 7 %. There was no significant difference in median age or male/female proportion. The median overall survival (mOS) for BRAF MT versus wild-type (WT) patients is 14.0 versus 32.9 months (p = 0.003). For patients who have chemotherapy (plus or minus surgery) the mOS is 14.6 months BRAF MT versus 36.1 months (p B 0.001) WT. Liver or lung resection was performed on only 8 % of the BRAF MT group versus 26.5 % of the WT group. Conclusion Results in a population setting confirm our understanding that BRAF MT is more frequently right sided and of lower frequency in rectal cancer. Survival is lower for patients with mCRC that have BRAF MT, regardless of the therapy. BRAF testing is currently performed infrequently in an Australian setting despite its importance as a significant prognostic factor, and the implications for alternate therapeutic approaches.
1
Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA 5011, Australia
2
School of Medicine, University of Adelaide, Adelaide, SA, Australia
3
Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
Key Points
4
Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
BRAF mutation is a new subgroup of advanced colorectal cancer.
5
School of Population Health, University of South Australia, Adelaide, SA, Australia
6
Department of Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia
7
Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
8
Flinders University, Flinders Centre for Innovation in Can
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