Biomarker-driven and evidence-based therapy for metastatic colorectal cancer (BEAT-CRC): A system-wide initiative to increase access to biomarker-driven therapy in a large practice network.

108 Background: Colorectal cancer (CRC) remains the second leading cause of cancer deaths worldwide, with ≥90% of these deaths caused by metastasis to distant organs. Greater than 50% of the patients with metastatic CRC (mCRC) will have an identifiable biomarker with treatment implications including but not limited to RAS (50-60%), BRAF (10%), deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) (4%), and ERBB2 amplification/HER2+ (3%). While the discrepancy in the need for biomarker examination and suboptimal real-world testing rates has been well-documented, particularly in community-based settings, there is limited information on how best to define strategies to overcome this. Methods: We implemented the Biomarker-driven and Evidence-bAsed Therapy for metastatic ColoRectal Cancer (BEAT-CRC) platform, a system-wide initiative to increase access to biomarker-driven therapy at University Hospitals Seidman Cancer Center (UH SCC), a large hybrid academic-community oncology network. This BEAT-CRC platform leverages an integrated electronic medical record module to identify newly diagnosed and recurrent metastatic CRC cases to track real-time biomarker testing status, initiate missing testing, and alert providers to actionable biomarker results for first-line therapy. Results: From May 2024 through September 2025, we screened an initial cohort of 900 patients including 141 patients with metastatic disease. We found that the baseline testing rates were ~99% for MMR IHC and lower for next-generation sequencing (NGS) (88%) and HER2 (17%). The BEAT-CRC intervention led to HER2 testing in an additional 103 patients (76%) and NGS in 16 patients (11%). Among those tested, 3 patients (2%) had HER2 positive disease and 12 patients (9%) had mismatch repair deficiency (MMRd). Conclusions: Following implementation of the BEAT-CRC platform, we increased HER2 testing by more than 4-fold (76% increase). Although NGS was already being performed at a high rate, we were able to implement NGS testing in an additional 11% of cases reviewed. Rates of HER2 positivity and MMRd were consistent with rates in the population. Next steps will include assessing rates of BRAF and RAS mutations in our cohort and analyzing the impact of this intervention on treatment patterns. Our ultimate goal is to provide tumor board recommendations to treating physicians based on biomarker testing results, including consideration of clinical trial enrollment.