A recent article on personalized testing in CAP Today discussed many of the issues surrounding KRAS testing. There are many benefits of KRAS testing for patients, not only health related but economic as well. Nearly 4 out of 10 patients with colorectal cancer (CRC) will harbor a KRAS mutation (the actual percentage seems to be approximately 38%). Of the remaining 6 patients (62% to be exact) with normal KRAS, typically 3 of the 6 will experience some benefit from EGFR targeted therapy (the reason why all 6 do not respond is probably because we need additional biomarkers, but this will be the subject of a future blog). So with KRAS testing, 3 of 6 instead of 3 of 10 patients will derive benefit, thus sparing 4 patients from a therapy that they will not benefit from and therefore any adverse effects from these drugs as well. In addition, the one thing that most cancer patients lack is time. The longer someone has to wait, the further their tumor can spread, so they can not afford the time it takes to be treated with an ineffective therapy.
The article goes on to state that there is an obvious economic impact to KRAS testing as well. Erbitux treatment can cost nearly $10,000 per month per person. The cost for 10 patients would be nearly $100,000 per month. If 4 out of 10 people would not benefit from Erbitux treatment, this would amount to a savings of almost $40,000 per month (which easily eclipses the cost of 10 KRAS mutation tests). One reason these costs matter to patients is because ultimately the decision by payors to reimburse for a test has a large impact on how widespread adoption of the test becomes. In this scenario, the cost of a KRAS test to a payor is in the hundreds of dollars (and a 1 time expense) compared with a savings of thousands of dollars every month in treatment costs.
At TMD we are actively speaking with payors about the benefits of KRAS testing, including the different methods of KRAS testing. We are always open to discussion on this topic.