The RAS testing in real world management of metastatic colorectal cancer: The results of Italian Laboratories Survey

Approximately 15-30 % of patients with colorectal cancer (CRC) present with metastases at diagnosis, while up to 50 % will develop metastases during follow-up. The integration of targeted drugs into standard chemotherapy has significantly improved clinical outcomes, with anti-EGFR monoclonal antibodies playing a crucial role in the treatment of RAS wild-type metastatic CRC. In this context, high-quality RAS testing is essential. A national survey was carried out among 60 Italian laboratories to assess the state of the art for RAS testing. Based on the reported frequency of RAS mutations, laboratories were classified as "in range" (n. 35; RAS mutation frequency >42 % and <56 %) or "outliers" (n. 25; ≤42 % or ≥56 %). Considering the type of institutions, in Community Hospitals the percentage of 'outliers' is significantly higher than in Universities and National Cancer Institutes. Among the laboratories processing fewer than 150 samples per year, 'outliers' are more frequently detected in the group using next generation sequencing (NGS) as prevalent methodology (n = 10) than in the real time PCR (RT-PCR) group (n = 4). In contrast, within laboratories processing more than 150 samples per year, the number of 'within range' laboratories (n = 19) is more than twice that of 'outliers' (n = 8) in the NGS group. The survey underscores the need for continuous training of stakeholders involved in molecular testing and a multidisciplinary approach to patient management. The authors suggest a similar evaluation in other European countries noting that beyond infrastructure and technology, personnel training and improved communication skills are essential for optimizing biomarker testing and personalized treatment approaches.