e23082 Background: Molecular testing is paramount for treating patients (pts) with mCRC. Guidelines, including ASCO and NCCN, recommend testing for mismatch repair deficiency (dMMR)/microsatellite instability high (MSI-H), BRAF V600E mutation, RAS mutations, and HER2 amplification, as these molecular subtypes have profound therapeutic implications. This study evaluates molecular testing rates in a real-world cohort of pts with mCRC at an academic center, an academic affiliate site, and a community practice. Methods: In this retrospective study, a cohort of pts was obtained using COTA electronic health record data. The study included adults diagnosed with mCRC between January 1, 2022, and January 1, 2024, at Lombardi Comprehensive Cancer Center (LCCC), Non-Lombardi MedStar settings (NLM), and a nearby community oncology practice (COP). Data were extracted to review pt characteristics by age, sex, race, tumor location, comorbidity count, and vital status (alive/deceased), along with rates of guideline-recommended molecular testing (dMMR/MSI-H, BRAF V600E, RAS, and HER2). Results: 140 pts met the inclusion criteria. Pt characteristics were similar across settings. There was no statistically significant difference in adherence to guideline-recommended molecular testing across practice settings, with testing performed for dMMR/MSI-H in 93% of pts, RAS in 68%, BRAF in 64%, and HER2 in 54%. At last follow-up, mortality rates were 62%, 37%, and 32% at COP, LCCC, and NLM, respectively (p = 0.0096). Across all sites, the full panel of guideline-recommended molecular profiling occurred in 51% of pts. Conclusions: Community practices achieved molecular testing rates comparable to academic centers. However, testing was suboptimal across all settings, with only 51% of pts receiving full guideline-recommended molecular testing. Despite this, the community cohort had a higher mortality rate, which was statistically significant, and this implies that factors beyond pt characteristics and guideline-concordant testing play a role. Further studies are warranted to determine whether access to subspecialty care, multidisciplinary models, availability of clinical trials, or treatment sequence contributes to the observed disparity. mCRC Patient characteristics, guideline-recommended molecular testing and vital status. Characteristic LCCC (N=63) NLM (N=25) COP (N=52) P value Baseline characteristics Mean age, years 61 65 66 NS Age ≥50, % 60 80 83 NS Male, % 62 48 42 NS Non-Hispanic Black, % 46 44 48 NS No comorbidities, % 79 64 67 NS Guideline-recommended molecular testing RAS, % 61.9 68.0 73.1 0.444 BRAF V600E, % 55.6 64.0 73.1 0.151 MMR/MSI, % 90.5 96.0 92.3 0.847 HER2, % 49.2 52.0 59.6 0.530
Varughese et al. (Thu,) studied this question.