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Favazza LA, Parseghian CM, Kaya C, Nikiforova MN, Roy S, Wald AI, Landau MS, Proksell SS, Dueker JM, Johnston ER, Brand RE, Bahary N, Gorantla VC, Rhee JC, Pingpank JF, Choudry HA, Lee K, Paniccia A, Ongchin MC, Zureikat AH, Bartlett DL, Singhi AD. KRAS amplification in metastatic colon cancer is associated with a history of inflammatory bowel disease and may confer resistance to anti-EGFR therapy. Mod Pathol 2020; 33:1832-1843. [PMID: 32376853 PMCID: PMC7483889 DOI: 10.1038/s41379-020-0560-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Mutations in RAS occur in 30-50% of metastatic colorectal carcinomas (mCRCs) and correlate with resistance to anti-EGFR therapy. Consequently, mCRC biomarker guidelines state RAS mutational testing should be performed when considering EGFR inhibitor treatment. However, a small subset of mCRCs are reported to harbor RAS amplification. In order to elucidate the clinicopathologic features and anti-EGFR treatment response associated with RAS amplification, we retrospectively reviewed a large cohort of mCRC patients that underwent targeted next-generation sequencing and copy number analysis for KRAS, NRAS, HRAS, BRAF, and PIK3CA. Molecular testing was performed on 1286 consecutive mCRC from 1271 patients as part of routine clinical care, and results were correlated with clinicopathologic findings, mismatch repair (MMR) status and follow-up. RAS amplification was detected in 22 (2%) mCRCs and included: KRAS, NRAS, and HRAS for 15, 5, and 2 cases, respectively (6-21 gene copies). Patients with a KRAS-amplified mCRC were more likely to report a history of inflammatory bowel disease (p < 0.001). In contrast, mutations in KRAS were associated with older patient age, right-sided colonic origin, low-grade differentiation, mucinous histology, and MMR proficiency (p ≤ 0.017). Four patients with a KRAS-amplified mCRC and no concomitant RAS/BRAF/PIK3CA mutations received EGFR inhibitor-based therapy, and none demonstrated a clinicoradiographic response. The therapeutic impact of RAS amplification was further evaluated using a separate, multi-institutional cohort of 23 patients. Eight of 23 patients with KRAS-amplified mCRC received anti-EGFR therapy and all 8 patients exhibited disease progression on treatment. Although the number of KRAS-amplified mCRCs is limited, our data suggest the clinicopathologic features associated with mCRC harboring a KRAS amplification are distinct from those associated with a KRAS mutation. However, both alterations seem to confer EGFR inhibitor resistance and, therefore, RAS testing to include copy number analyses may be of consideration in the treatment of mCRC.
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Affiliation(s)
- Laura A. Favazza
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Christine M. Parseghian
- Department of Gastrointestinal Medical Oncology, Division
of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX,
USA
| | - Cihan Kaya
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Marina N. Nikiforova
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Somak Roy
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Abigail I. Wald
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Michael S. Landau
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Siobhan S. Proksell
- Department of Medicine, Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Jeffrey M. Dueker
- Department of Medicine, Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Elyse R. Johnston
- Department of Medicine, Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Randall E. Brand
- Department of Medicine, Division of Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Nathan Bahary
- Department of Medicine, Hillman Cancer Center, University
of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vikram C. Gorantla
- Department of Medicine, Hillman Cancer Center, University
of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John C. Rhee
- Department of Medicine, Hillman Cancer Center, University
of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James F. Pingpank
- Department of Surgery, Division of Hepatopancreatobiliary
Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Haroon A. Choudry
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Kenneth Lee
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Alessandro Paniccia
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Melanie C. Ongchin
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Amer H. Zureikat
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - David L. Bartlett
- Department of Surgery, Division of Gastrointestinal
Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA,
USA
| | - Aatur D. Singhi
- Department of Pathology, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
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Malapelle U, Sgariglia R, De Stefano A, Bellevicine C, Vigliar E, de Biase D, Sepe R, Pallante P, Carlomagno C, Tallini G, Troncone G. KRAS mutant allele-specific imbalance (MASI) assessment in routine samples of patients with metastatic colorectal cancer. J Clin Pathol 2015; 68:265-9. [PMID: 25609577 DOI: 10.1136/jclinpath-2014-202761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Patients with colorectal cancer harbouring KRAS mutations do not respond to antiepidermal growth factor receptor (anti-EGFR) therapy. Community screening for KRAS mutation selects patients for treatment. When a KRAS mutation is identified by direct sequencing, mutant and wild type alleles are seen on the sequencing electropherograms. KRAS mutant allele-specific imbalance (MASI) occurs when the mutant allele peak is higher than the wild type one. The aims of this study were to verify the rate and tissue distribution of KRAS MASI as well as its clinical relevance. METHODS A total of 437 sequencing electropherograms showing KRAS exon 2 mutation was reviewed and in 30 cases next generation sequencing (NGS) was also carried out. Five primary tumours were extensively laser capture microdissected to investigated KRAS MASI tissue spatial distribution. KRAS MASI influence on the overall survival was evaluated in 58 patients. In vitro response to anti-EGFR therapy in relation to different G13D KRAS MASI status was also evaluated. RESULTS On the overall, KRAS MASI occurred in 58/436 cases (12.8%), being more frequently associated with G13D mutation (p=0.05) and having a heterogeneous tissue distribution. KRAS MASI detection by Sanger Sequencing and NGS showed 94% (28/30) concordance. The longer overall survival of KRAS MASI negative patients did not reach statistical significance (p=0.08). In cell line model G13D KRAS MASI conferred resistance to cetuximab treatment. CONCLUSIONS KRAS MASI is a significant event in colorectal cancer, specifically associated with G13D mutation, and featuring a heterogeneous spatial distribution, that may have a role to predict the response to EGFR inhibitors. The foreseen implementation of NGS in community KRAS testing may help to define KRAS MASI prognostic and predictive significance.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alfonso De Stefano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoles, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Dario de Biase
- Department of Medicine (DIMES)-Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Romina Sepe
- CNR/IEOS, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, Naples, Italy
| | - Pierlorenzo Pallante
- CNR/IEOS, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoles, Italy
| | - Giovanni Tallini
- Department of Medicine (DIMES)-Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Anti-EGFR MoAb treatment in colorectal cancer: limitations, controversies, and contradictories. Cancer Chemother Pharmacol 2014; 74:1-13. [PMID: 24916545 DOI: 10.1007/s00280-014-2489-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
Anti-epidermal growth-factor receptor (EGFR) monoclonal antibody (MoAb) treatment for chemotherapy refractory or metastatic colorectal cancer has obtained great achievement. However, not every colorectal patient responds to such molecular-targeted agent well. Biomarkers associated with anti-EGFR resistance are not limited to KRAS mutation up to now. It was recently reported that cross-talking molecular effectors interacted with EGFR-related pathway were also negative predictor for anti-EGFR treatment. However, the limited data, controversial results, and contradictories between in vitro and clinical studies restrict the clinical application of these new biomarkers. Although the current theory of tumor microenvironment supported the application of multi-target treatment, the results from the clinical studies were less than expected. Moreover, WHO or RECIST guideline for response assessment in anti-EGFR MoAb treatment was also queried by recent AIO KRK-0306 trial. This review focuses on these controversies, contradictories, and limitations, in order to uncover the unmet needs in current status of anti-EGFR MoAb treatment in colorectal cancer.
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