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New research presented at the 2009 Gastrointestinal Cancers Symposium from January 15-17 in San Francisco addressed key issues in the management of these cancers. The features below highlight just some of the studies that emerged from the symposium.

Making the Case for Routine KRAS Testing

The Particulars: Researchers evaluated the cost savings associated with limiting first-line cetuximab treatment to patients with metastatic colorectal cancer (CRC) whose tumors have the normal KRAS gene and with avoiding unnecessary treatment in patients whose tumors have a mutated KRAS gene.

Data Breakdown: The cost of testing all newly-diagnosed CRC patients for KRAS mutations was estimated to be about $13 million ($452 per patient). Newly-diagnosed patients treated with cetuximab received an estimated 24 doses, yielding total drug costs of $61,279 per patient. After conservatively estimating that 35.6% of patients’ tumors have KRAS mutations, the authors projected that the cost savings from treating only patients with normal KRAS would be $617 million. When the costs of KRAS testing were subtracted, researchers estimated a net savings of $604 million.

Take Home Pearl: Testing and treating patients with metastatic CRC based on their KRAS gene mutation status could yield significant cost savings for the U.S. healthcare system.

Predicting Esophageal Cancer Risk in GERD Patients

The Particulars: GERD has been identified in previous studies as a risk factor for esophageal cancer.

Data Breakdown: Patients with the mutated epidermal growth factor (EGF) gene variant called G/G and who had symptoms associated with GERD more than once a month were 10 times more likely to develop esophageal cancer than those who had the A/A (normal, or wild-type) variant of the EGF gene and did not have GERD. Esophageal cancer risk increased further in patients with the EGF gene mutation who suffered from GERD more frequently or for 15 years or longer.

Take Home Pearl: Specific mutations in the EGF gene appear to be associated with an increased risk of esophageal cancer in people with GERD, but further studies are warranted in larger and more diverse patient groups.

Slowing Cancer Growth in Malignant Neuroendocrine Tumors

The Particulars: The standard treatment for neuroendocrine tumors (NETs) of the midgut is surgery, but other therapeutic options (eg, hepatic embolization or radioligand therapy) have been associated with significant side effects. Octreotide LAR is currently approved by the FDA to treat certain pituitary gland disorders and to reduce diarrhea caused by other types of benign gastrointestinal tumors, but studies have indicated that the agent may be effective for treating malignant NETs.

Data Breakdown: About 70% of participants had surgery before enrollment to remove the primary tumor; the remainder had more advanced, inoperable disease. After 6 months of treatment with octreotide, 64% of patients had stable disease, comparing favorably to the 37.2% rate observed in patients who received placebo. The median time to tumor progression in the octreotide LAR group was 14.3 months, compared with 6.0 months for the placebo arm.

Take Home Pearls: Octreotide LAR appears to slow tumor progression in patients with malignant NETs of the midgut. The majority of patients from the trial are still living, but it is too early to determine an overall survival benefit.