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Opportunities for personalizing colorectal cancer care: an analysis of SEER-medicare data
Zachary T Rivers1,2, Helen M Parsons3,4, Pamala A Jacobson4,5
1Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN, USA. zrivers@fredhutch.org.
Abstract:
United States clinical practice guidelines for metastatic colorectal cancer recommend use of medications impacted by genetic variants but do not recommend testing. We analyzed real-world treatment using a cancer registry and claims dataset to explore pharmacogenomic (PGx) medication treatment patterns and characterize exposure. In a cohort of 6957 patients, most (86.9%) were exposed to at least one chemotherapy medication with PGx guidelines. In a cohort of 2223 patients with retail pharmacy claims available, most (79.2%) were treated with at least one non-chemotherapy (79.2%) medication with PGx guidelines. PGx-associated chemotherapy exposure was associated with age, race/ethnicity, educational attainment, and rurality. PGx-associated non-chemotherapy exposure was associated with medication use and comorbidities. The potential impact of PGx testing is large and policies aimed at increasing PGx testing at diagnosis may impact treatment decisions for patients with metastatic colorectal cancer as most patients are exposed to medications with pharmacogenomics implications during treatment.
Insights
Most metastatic colorectal cancer patients receive medications influenced by genetic variants, yet genetic testing is not standard. This study reveals widespread exposure to pharmacogenomic (PGx) drugs, highlighting the potential impact of increased PGx testing.
Area of Science:
- Oncology
- Pharmacogenomics
- Clinical Practice
Background:
- Current clinical guidelines for metastatic colorectal cancer (mCRC) recommend drugs affected by genetic variants but do not advocate for genetic testing.
- Real-world data on pharmacogenomic (PGx) medication use in mCRC patients is limited.
Purpose of the Study:
- To analyze real-world treatment patterns and characterize pharmacogenomic (PGx) medication exposure in patients with metastatic colorectal cancer.
- To explore the potential impact of increasing PGx testing at diagnosis.
Main Methods:
- Utilized a cancer registry and claims dataset to analyze treatment patterns in a cohort of 6957 mCRC patients.
- Examined a subset of 2223 patients with retail pharmacy claims to assess non-chemotherapy PGx medication exposure.
Main Results:
- 86.9% of patients were exposed to at least one chemotherapy with PGx guidelines.
- 79.2% of patients received at least one non-chemotherapy medication with PGx guidelines.
- PGx-associated drug exposure was linked to demographic factors (age, race, education, rurality) and clinical factors (medication use, comorbidities).
Conclusions:
- The majority of metastatic colorectal cancer patients are treated with medications that have pharmacogenomic implications.
- Increased pharmacogenomic testing at diagnosis could significantly influence treatment decisions for mCRC patients.
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