John Theurer Cancer Centre Identifies Flaws in Colorectal Cancer Screening

In New Jersey, researchers at John Theurer Cancer Center (JTCC) has reported poor rates of testing to check the biomarkers of colorectal cancer.

This centre at Hackensack University Medical Center reports poor observance of genomic profiling that is necessary to find four biomarkers related to metastatic colorectal cancer. These biomarkers facilitate health professionals in looking for the most efficient treatment method, checking a patient’s response to therapy, and improving consequences.

A journal of American Society of Clinical Oncology (ASCO) – “JCO Precision Oncology” has presented this study in its issue of December 06, 2019.

Stuart L. Goldberg is the study’s senior author and has specialization in haematology, leukaemia, and medical oncology. He is an investigator at JTCC and is also working as an Associate Professor at Seton Hall School of Medicine.

He stated that according to genomic profiling guidelines, it is suggested that individuals who have metastatic colorectal cancer should get tested for four common biomarkers. But in spite of these recommendations, it was found that only 40 percent of such individuals are being tested for these biomarkers.

He added, the researchers at JTCC were expecting that with the passage of time, there will be an increase in awareness about these guidelines and improved rates of testing.

But the results were not in accordance with their expectations.

According to the national guidelines, genomic testing is supposed to be a necessity for guiding health professionals in the selection of appropriate and most efficient treatment for patients who have metastatic colorectal cancer.

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Genomic profiling checks presence or absence of any genetic changes (also called as Microsatellite instability – MSI) or mutations in genes like BRAF and RAS (NRAS and KRAS). It can help in predicting the patient’s response to different treatment methods such as immunotherapy with pembrolizumab, cetuximab, and panitumumab.

Since 2009, the NCCN (National Comprehensive Cancer Network) and ASCO have been publishing guidelines suggesting individuals with metastatic colorectal cancer should have genomic testing for MSI, BRAF, NRAS, and KRAS status.

JTCC researchers have evaluated the database of the COTA Real-World Data.

Using this data, they have identified 1,497 patients who were suffering from metastatic colorectal cancer. These patients were diagnosed with this cancer during 2013 – 2017.

The data showed that among these patients, biomarkers testing rates were 43 percent for BRAF, 41 percent for RAS and 51 percent for MSI.

Whereas, the rates of BRAF and RAS testing were observed to be more in academic medical centres than community hospitals.

Further analysis revealed that among 177 patients using panitumumab or cetuximab, only 28 percent were tested for RAS status.

Suboptimal rates of biomarker testing may halt or delay the provision of appropriate therapies for patients with metastatic colorectal cancer. Adherence to biomarker testing can decrease the patient’s risk of exposure to ineffective and costly therapies, leading to improved patient care and outcomes.

Researchers have also observed some of the possible hurdles while increasing the rates of biomarker testing. These were found to be cost and insurance problems, physician knowledge, patient preferences, turnaround time, availability of tumour tissue, and patient’s eligibility for treatment on the basis of overall health.