All patients with mCRC should be tested at diagnosis5,6

According to NCCN Guidelines®, BRAF and RAS genotyping should be conducted at diagnosis in all patients with mCRC5,6

Knowing the mutation status of a patient with mCRC can not only inform their prognosis, but also inform the optimal treatment plan. Testing at diagnosis can determine whether your patient has a RAS or BRAF mutation.5,6,11
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All patients with mCRC should be tested at diagnosis due to the strong prognostic value in determining the presence of a BRAF mutation5,6

mCRC, metastatic colorectal cancer; NCCN, National Comprehensive Cancer Network.


Test all patients for BRAF mutations regardless of tumor sidedness5,6

BRAF V600 mutations originate in both left- and right-sided colon cancer5,6,10,13
68% right-sided disease; 32% left-sided disease

How often do you test?

In your practice, how many mCRC patients do you test for BRAF mutations?

mCRC, metastatic colorectal cancer.

References:
1. Safaee Ardekani G, Jafarnejad SM, Tan L, Saeedi A, Li G. The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis. PLoS ONE. 2012;7(10):e47054. 2. Loupakis F, Ruzzo A, Cremolini C, et al. KRAS codon 61, 146 and BRAF mutations predict resistance to cetuximab plus irinotecan in KRAS codon 12 and 13 wild-type metastatic colorectal cancer. Br J Cancer. 2009;101(4):715-721. 3. De Roock W, Claes B, Bernasconi D, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis. Lancet Oncol. 2010;11(8):753-762. 4. Clinicaltrials.gov. US National Library of Medicine. S1406 phase II study of irinotecan and cetuximab with or without vemurafenib in BRAF mutant metastatic colorectal cancer. https://clinicaltrials.gov/ct2/show/results/NCT02164916. Accessed December 14, 2018. 5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.4.2018. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed December 19, 2018. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Rectal Cancer V.3.2018. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed December 19, 2018. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 7. Corcoran RB, Ebi H, Turke AB, et al. EGFR-mediated re-activation of MAPK signaling contributes to insensitivity of BRAF mutant colorectal cancers to RAF inhibition with vemurafenib. Cancer Discov. 2012;2(3):227-235. 8. National Cancer Institute. SEER cancer stat facts: colorectal cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed November 1, 2018. 9. Zadlo, J. Cost-effectiveness of new and emerging treatment options for the treatment of metastatic colorectal cancer. Am J Manag Care. 2018;24(suppl 7):S118-S124. 10. Ursem C, Atreya CE, Van Loon K. Emerging treatment options for BRAF-mutant colorectal cancer. Gastrointest Cancer. 2018;8:13-23. 11. Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386-1422. 12. Dinu D, Dobre M, Panaitescu E, et al. Prognostic significance of KRAS gene mutations in colorectal cancer—preliminary study. J Med Life. 2014;7(4):581-587. 13. Tran B, Kopetz S, Tie J, et al. Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer. Cancer. 2011;117(20):4623-4632.