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Sub-category:
Prevention, diagnosis, and screening
Category:
Colon and Rectum
Meeting:
2009 Gastrointestinal Cancers Symposium
Session Type and Session Title:
General Poster Session E
Abstract No:
298
Author(s):
V. Shankaran, D. J. Bentrem, M. F. Mulcahy, C. L. Bennett, A. B. Benson III
Abstract:
Background: Recent studies have demonstrated a benefit with the addition of cetuximab to FOLFOX or FOLFIRI in the first-line treatment of metastatic CRC. Subsequent correlative analyses have shown that this benefit is limited to patients whose tumors have wild type Kras status by PCR-based testing. Based on these results, patients with mutated Kras should no longer receive cetuximab in first or subsequent lines of therapy. In addition to avoiding unnecessary toxicity, tailoring therapy based on Kras will result in significant cost savings for the health care system. Methods: Using the 2008 American Cancer Society estimated incidence of metastatic CRC, the cost of Kras testing in all patients was determined. With the assumption that patients would receive first-line therapy with a cetuximab-containing regimen, the amount saved by withholding cetuximab in Kras mutants (excluding costs of managing drug toxicity) was calculated. Cost estimate for Kras testing was obtained from a commercial lab. Results: Based on an annual incidence of 29,762 new metastatic CRC cases, upfront Kras testing would cost $13 million ($452/patient). Using the average wholesale price of cetuximab ($4,032/loading dose and $2,880/weekly dose for a patient of average height/weight), drug cost is $71,120/patient; this assumes an average of 24 doses per patient, as seen in the CRYSTAL analysis (Van Cutsem, E. ASCO 2007). With the assumption that patients with mutated Kras (35.6% of all patients) would not receive cetuximab (other studies have found Kras mutation in up to 46% of patients), theoretical drug cost savings would be $753 million; considering the cost of Kras testing, net savings would be $740 million. Conclusion: To our knowledge, this is the first analysis to demonstrate cost savings by customizing therapy in a GI malignancy using a molecular test. Though cetuximab is used more commonly in second- and third-line therapy where treatment duration is shorter, Kras-based treatment selection is likely to result in cost savings across all lines of therapy. On a large scale, development of validated predictive molecular markers will not only spare patients ineffective and toxic therapies, but will also greatly reduce futile costs.
Faculty Disclosures
Abstract Disclosures
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy
and are designated with a caret symbol (^) here and in the print version.
 Associated Presentation(s):
Other Abstracts in this Sub-Category:
Abstracts by V. Shankaran:
Presentations by V. Shankaran:
Educational Book Manuscripts by V. Shankaran:
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