Real-world genomic testing performance in colorectal cancer (CRC): The MultiTEAM Systems Framework Precision Oncology Reflex Testing (TEAMSPORT).
Authors: Li Haoran , Caine Carolyn Frances , Halder Barsha , Zhang Wei , Madan Rashna , Godwin Andrew K. , Katz Aaron J , Thompson Jeffrey , Onasch Whitney Katherine , Ferenczi Zseraldina , Kasi Anup , Al-Rajabi Raed Moh'd Taiseer , Baranda Joaquina Celebre , Sun Weijing , Ellis Shellie D. 
Published: January 2025

108

Background:
Genomic testing plays a pivotal role in personalizing treatment for CRC patients. Despite recommendations from NCCN, adoption remains uneven. Research indicates that only 64.7% of patients with metastatic CRC (mCRC) underwent molecular testing nationwide. TEAMSPORT seeks to address this gap by evaluating the feasibility of reflex testing and examining how pathology and oncology teams integrate genomic testing into routine practice.
Methods:
This quasi-experimental study tracks testing over time. Eligible patients were 18 years or older, with a histological diagnosis of adenocarcinoma, who received treatment at the University of Kansas Health System (TUKHS). Exclusion criteria included patients discharged to hospice after diagnosis, those whose last contact with TUKHS occurred within 30 days of diagnosis, and patients who passed away within 30 days of diagnosis. Testing rates were calculated as the number of tests performed divided by the number of testing opportunities, where "testing opportunities" refer to NCCN-recommended tests based on cancer stage. An intervention to increase adherence to NCCN-recommended testing began in December 2022.
Results:
From January 2022 to December 2023, 564 colorectal cancer (CRC) cases were eligible for genomic testing, resulting in 1,525 testing opportunities. In localized CRC, testing rates steadily improved, from 92% in January-June 2022 to 98% by July-December 2023 for patients diagnosed outside of TUKHS. At TUKHS, the rates remained high, reaching 100% in the first two periods and staying over 90% in subsequent periods. Patients with mCRC saw similar trends, particularly in the control arm where rates went from 61% to 71%. Specific molecular NCCN-recommended tests were assessed. At TUKHS, testing rates were high for microsatellite instability (MSI - 98%) which is caused by deficiency of the DNA mismatch repair (dMMR) system. Lower testing rates were observed for other markers like
KRAS
(70%),
BRAF
(67%) and
HER2
(48%). Testing rates were assessed based on primary insurance. At TUKHS, the testing rates for Medicaid patients reached 94%, private insurance patients at 78%, and Tricare/VA at 100%. Outside of TUKHS, Medicaid patients had lower testing rates at 21%, private insurance patients at 74%, and CMS patients at 66%. Time to test by processing lab will be presented at the meeting.
Conclusions:
Despite the high testing rates for MSI/dMMR, the overall genomic testing in CRC remains imperfect, with lower rates for
BRAF
and
HER2
. This discrepancy may be related to the fact that targeted therapies for
BRAF
and
HER2
are not yet part of first-line treatment for CRC. Causes for the discrepancy in testing rates by primary insurance have yet to be determined. Future research should address these gaps to enhance precision oncology in CRC management.