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Middle East and North Africa Registry to Characterize Rate of RAS Testing Status in Newly Diagnosed Patients with Metastatic Colorectal Cancer

Oukkal M 1 , Bouzid K 2 , Bounedjar A 3 , Alnajar A 4 , Taleb FA 5 , Alsharm A 6 Show all authors , Mahfouf H 7 , Larbaoui B 8 , Abdelaziz A 9 , Ouamer A 10 , Bashir L 11

Affiliations 

  • 1 Department of Medical Oncology, University Center of Beni Messous, Algiers, Algeria
  • 2 Department of Medical Oncology, Center Pierre and Marie Curie, Algiers, Algeria
  • 3 Department of Medical Oncology, University Center of Blida, Blida, Algeria
  • 4 GI Oncology Department, Kuwait Cancer Control Center, Sabah Health Region, Kuwait
  • 5 Department of Medical Oncology, Zagazig University Faculty of Medicine, Zagazih, Al-Sharkeyya, Egypt
  • 6 Department of Medical Oncology, King Fahad Medical City Hospital, Comprehensive Cancer Center, Riyadh, Kingdom of Saudi Arabia
  • 7 Department of Medical Oncology, Public Hospital of Rouiba, Algiers, Algeria
  • 8 Department of Medical Oncology, Cancer Center of Oran, Messerghine, Algeria
  • 9 Department of Medical Oncology, Alexandria University Faculty of Medicine, Alexandria, Egypt
  • 10 Department of Oncology, AMGEN Maghreb, Algiers, Algeria
  • 11 Department of Oncology, Hematology and Nephrology, AMGEN (Middle East), Dubai, United Arab Emirates
Turk J Gastroenterol, 2023 Feb;34(2):118-127.
PMID: 36445057 DOI: 10.5152/tjg.2022.22106

Abstract

BACKGROUND: Rat sarcoma virus mutational status guides first-line treatment in metastatic colorectal cancer. This study was a multi center, multi-country ambispective, observational study in the Middle East and North Africa assessing regional rat sarcoma virus testing practices in newly diagnosed patients.

METHODS: The retrospective arm (2011-2014) included adults with metastatic colorectal cancer who had initiated first-line therapy with ≥1 post-baseline visit and survival data. The prospective arm (2014-2019) enrolled newly diagnosed patients with histologically proven metastatic colorectal cancer with ≥1 measurable lesion per Response Evaluation Criteria in Solid Tumors, and tissue availability for biomarker analysis. Data look-back and follow-up were 2 years; the rate of RAS mutation was evaluated.

RESULTS: RAS testing was ordered for patients in retrospective (326/417) and prospective (407/500) studies. In the former, testing was typically prescribed after first-line treatment initiation, significantly more in patients with stage IV disease (P < .005), resulting in the addition of targeted therapy (41.8% anti-epidermal growth factor receptor, 30.2% anti-vascular endothelial growth factor) in wild-type metastatic colorectal cancer, and significantly impacted the treatment of left-sided tumors (P = .037). In the latter, 58.4% were RAS wild-type; 41.6% were RAS mutant. Non-prescription of RAS testing was attributed to test unavailability, financial, or medical rea sons; predictors of testing prescription were older age, primary tumor in ascending colon, and high tumor grade. RAS status knowledge resulted in the addition of anti-vascular endothelial growth factor (20.4%) or anti-epidermal growth factor receptor therapy (21.2%).

CONCLUSION: Before 2014, RAS testing in patients with colorectal cancer in the Middle East and North Africa was often performed after first-line treatment. Testing is more routine in newly diagnosed patients, potentially shifting early treatment patterns.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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