KRAS基因检测干预西妥昔单抗治疗转移性结直肠癌的成本-效果探讨

Investigation on cost-effectiveness of cetuximab treatment against metastatic colorectal cancer by KRASgene intervention

目的:通过评价KRAS基因检测用于西妥昔单抗治疗转移性结直肠癌(metastatic colorectal cancer,mCRC)的国内外药物经济学研究,探讨其临床疗效及成本效果。方法:从Pubmed、CNKI等大型数据库对2006—2016年期间国内外公开发表的有关KRAS基因检测干预西妥昔单抗治疗的药物经济学评价文献进行检索,对研究内容及结果进行分析及综述。结果:纳入分析的7篇文献表明,与西妥昔单抗(无KRAS检测)相比,KRAS基因检测干预西妥昔单抗治疗mCRC可显著降低成本或提高质量调整生命年(quality adjusted life year,QALY),改善成本效果,具有优势;且额外进行BRAF及RAS基因检测可进一步改善KRAS检测干预西妥昔单抗治疗的成本效果。结论:KRAS等基因突变检测干预西妥昔单抗治疗相比无KRAS检测为具有优势,且对于指导西妥昔单抗治疗方案的合理选择及实现肿瘤精准医疗有重大实践意义,或将成为未来肿瘤学研究趋势。

OBJECTIVE To discuss cost-effectiveness and clinical effectiveness of Kirsten ras oncogene（KRAS）intervention through comprehensive assessment of KRASintervention in cetuximab treatment against metastatic colorectal cancer（mCRC）.METHODS English and Chinese literatures about economic evaluations of cetuximab treatment of mCRC patients under KRAS gene intervention were systemically researched in databases of PubMed and CNKI.RESULTS According to seven literatures analyzed,compared with cetuximab treatment without KRASgene mutation testing,cost decreased or quality adjusted life year（QALY）increased after KRASgene intervention was added into cetuximab treatment.Testing of BRAFand RASgene could further improve cost-effectiveness of cetuximab treatment in mCRC patients under KRASgene intervention.CONCLUSIONApplication of KRASgene intervention prior to treatment with cetuximab is found to be more economically favorable,and has great practical significance in reasonable selection of cetuximab treatment and the realization of precision medicine against cancer.It might develop into the mainstream of oncology researches in future.