ONCAlert | 2017 San Antonio Breast Cancer Symposium
Colorectal Cancer Case Studies

Tanios Bekaii-Saab, MD: Impeding RAS Mutation Testing

Tanios Bekaii-Saab, MD
Published Online:Apr 26, 2016
Case 2 examines a 52-year-old woman newly diagnosed with metastatic CRC who is genotyped as part of her initial work up.

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2


What are some issues that impede widespread adoption of recommended testing for RAS mutations? 

A lot of the factors relate to presence of tissue, availability of tissue, presence of adequate tissue, so tissue might be available but it's not adequate enough to allow testing. Logistical, and that's very important. Let's say a patient comes into a clinic at the university and has had their biopsy at their community hospital. By the time they see the oncologist and there's a treatment plan to be decided, the tissue is in a different place. By the time you get the tissue and you get it tested, that's 6 weeks. So logistically it's very challenging and the patients will not wait 4 to 6 weeks before they start their treatment, especially since there's no data that suggests that an EGFR inhibitor is superior to a VEGF inhibitor.

There is no urgent need to wait for the results of the test. That's one. Two, although most universities and large practices have their own testing, it still takes about a couple of weeks, which is reasonable to do the testing.  A lot of the community practices actually send out those to outside vendors, and that takes about 4 weeks to get back. It's logistical timing, presence of tissue to test for RAS, and those limit the percent of oncologists who end up doing this test.

Unresectable Colon Cancer: Case 2

52-year-old woman newly diagnosed with metastatic CRC and is genotyped as part of her initial work up.

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