What we know:

• We know that ~35-45% of colorectal cancer cells bear the KRAS mutation.

  Article Prognostic significance of KRAS gene mutations in colorectal...

• We know that certain chemotherapy drugs are NOT effective in treating colorectal cancer cells bearing K-ras mutations (cetuximab (Erbitux) and panitumumab (Vectibix)).

  Article Wild-Type KRAS Is Required for Panitumumab Efficacy in Patie...

  Article K-ras Mutations and Benefit from Cetuximab in Advanced Color...

• We know that most experts agree KRAS testing is important in determining chemotherapy treatment.

  Article KRAS Early Testing: Consensus Initiative and Cost-Effectiven...

So, what percentage of physicians actually order KRAS genetic testing for their colon cancer patients? To be determined.

Is it cost effective? Turns out it's average.

"Results

Screening for both KRAS and BRAF mutations compared with the base strategy (of no anti-EGFR therapy) increases expected overall survival by 0.034 years at a cost of $22 033, yielding an incremental cost-effectiveness ratio of approximately $650 000 per additional year of life. Compared with anti-EGFR therapy without screening, adding KRAS testing saves approximately $7500 per patient; adding BRAF testing saves another $1023, with little reduction in expected survival.

Conclusions

Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year."

https://academic.oup.com/jnci/article/104/23/1785/1043777

To Consider:

(1) What drugs might be more effective against colon cancer cells bearing the KRAS mutation?

(2) What drugs might be more cost effective against colon cancer cells bearing the KRAS mutation?

(3) Relating to cost effective treatment, how often do we prescribe drugs or assign treatment plans that are expensive $$$, decrease the length of the patient's life, and decrease the patient's quality of life? How can this be prevented? (E.g., recommending surgery procedures for aged colon cancer patients). How do we incentivize treatment that is most cost effective?