This document summarizes findings from a study examining patient understanding of KRAS testing and its relationship to treatment decisions for metastatic colorectal cancer (mCRC). Most participants did not recall having the KRAS test but generally had positive views of genetic testing. While the KRAS test provided guidance on anti-EGFR therapy eligibility, imaging scans and physicians' treatment recommendations seemed more salient to patients' experiences. Patients prioritized physician expertise over test results and preferred physicians make treatment decisions.

1. Division of Research
Northern California
Patient Views of KRAS Testing
for Treatment of mCRC
Petra Liljestrand, Julie Harris, Gwen Alexander,
Katrina Goddard, Tia Kauffman, Tatjana Kolevska,
Catherine McCarty, Suzanne O‟Neill, Pamala Pawloski,
Alanna Rahm, Andrew Williams, Carol Somkin
May 2, 2012
Division of Research

2. Division of Research
BACKGROUND
• Purpose: To examine mCRC patients‟ understanding
of KRAS testing and anti-EGFR tx and how these
relate to:
• Treatment decisions, including preferences for aggressive
chemotherapy or palliative care
• Patient quality of life
• Companion physician study (n=34): How physicians
incorporate KRAS testing into the treatment process.
• Part of „CERGEN‟ study (Comparative Effectiveness
Research in Genomics & Personalized Medicine).

3. Division of Research
BACKGROUND
• KRAS (Kirsten ras) test: Tests molecular tumor
characteristics. Mutation (KRAS+) means patient
unlikely to respond to anti-EGFR tx.
• Anti-EGFR therapy may extend life, but is often
associated with severe side-effects.
• Guidelines/recommendations:
• Nov. 2008, NCCN statement
• Feb. 2009, ASCO provisional guidelines
• Jul. 2009, FDA added KRAS info to anti-EGFR labels

4. METHODS: Division of Research
• Qualitative, semi-structured interviews (n=21)
• In-person or telephone
• Duration: 45-60 min
• Inclusion criteria:
• KRAS tested May, 2010 through March, 2011
• Stage IV CRC
• At least one oncologist visit post KRAS test
• Exclusion criteria:
• No longer KPNC member
• Non-English speaker

5. PARTICIPANT Division of Research
DEMOGRAPHICS
KRAS+ KRAS-
(n=12) (n=9)
(unlikely to respond
to anti EGFR drugs)
Gender
Female 6 3
Male 6 6
Race
Asian 1 2
< (n=)
Black 1 1
Hispanic 1 2
White 8 4
Native Am 1 0

6. FINDINGS: KRAS TEST Division of Research
RECOLLECTION
• Six KRAS+ patients but only one KRAS- patient
recalled having the KRAS test.
• Two KRAS+ patients tested for eligibility for CT
• Few KRAS details recalled
“If I can remember, it‟s [U/I]. I think I‟m a wild type, but I
don‟t remember. At any rate, it‟s a mutation -- that …
predicts whether or not you‟ll respond to - I forget which
chemo, FOLFOX or FOLFIRI. And that‟s about all I can
remember.” (#99, KRAS+)

7. FINDINGS: KRAS TEST Division of Research
RECOLLECTION
• “She did test for different things...I think
Six KRAS+ patients but only one KRAS- patient
recalled having the KRAS test.
she did the KRAS. I‟meligibility for CT But I
• Two KRAS+ patients tested for
not sure.
remember, at the beginning, some - two
• Few KRAS details recalled
or three or four different tests, she did --
• for whatalmost half (5/12) of KRAS+ patients and
However, worked the best if you
most (5/9) of KRAS- patients (incl. 1 patient on
happened toNOT recall having the test.
anti-EGFR) did have certain conditions.”
(#83 , KRAS-)recalled other tests (e.g., scans)
• But, patients often
• The recall of one KRAS+ patient and several (3/9)
KRAS- patients (incl. 2 patients on anti-EGFR)
were unclear.

8. FINDINGS: ATTITUDES Division of Research
TOWARD KRAS
 The majority of participants, regardless of KRAS status,
expressed positive attitudes toward the test:
“I would approve it. I would go for it…at this point,
• „Scientific‟ and „accurate‟
I •mean, I‟m in aand thus „specific‟ - I just want to
Involves genetics position where
live. So side-effects tells me, most likely biopsies)
• Avoids what he or difficult procedures (e.g., I‟m going to
agree with him. I think he - you know, he‟s trying
 to do the best he can for me. So I would test:
Comfort w/ exclusion from treatment based on agree
• A
with few KRAS+ patients expressed disappointment in, the results
whatever he would decide.” (#135
• Some thought they might want anti-EGFR regardless, if no other
KRAS+) was available
treatment
• Some patients questioned test reliability
• Several expressed confidence in oncologist „fighting „ for them

9. Division of Research
CONCLUSIONS
• Most respondents did not recall the KRAS test.
However, more KRAS+ patients recalled the test.
• Respondents generally had positive attitudes toward the
test (their test or hypothetical situation).
• However, imaging scans, repeatedly measuring
progression of illness, seemed to carry more salience in
their treatment experience than did the KRAS test.
• In addition, confidence in their physician‟s optimism and
care were of greater consequence than the KRAS test.

10. Division of Research
DISCUSSION
Why the lack of KRAS salience?
A. Context of cancer care:
• Test concerns balanced with confidence in oncologist.
• Patients want to give input on treatment, but prefer oncologist to
make decisions.
• mCRC is not curable - threshold for accepting tx and toxicities, goes
up with advanced disease.
B. Nature of KRAS test:
• Test characteristics
• Patient faith in genetic tests

11. Division of Research
TEAM MEMBERS
Thank You!
KP Northern California HealthPartners Research Foundation.
Julie Harris PhD Randy Hurley MD
Tatjana Kolevska MD Andrew Nelson MA
Larry Kushi ScD Brian Owens CCRC
Anousheh Mirabedi MPH Pamala Pawloski PharmD
Carol Somkin PhD
Allegra Timperi BA Henry Ford Health Systems
Gwen Alexander PhD
KP Northwest Michelle Groesbeck
Katrina Goddard PhD Clara Hwang MD
Tia Kauffman MPH
Marshfield Clinic Research Foundation
KP Colorado Terrie Kitchner
Alex Menter MD Catherine McCarty PhD
Alanna Rahm PhD
Adedayo Onitilo MD
KP Hawaii Georgetown University
Jennifer Carney MD Suzanne O‟Neill PhD
YeeWha Daida
Stacey Honda MD PhD
Andrew Williams PhD