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Nicolazzo C, Magri V, Marino L, Belardinilli F, Di Nicolantonio F, De Renzi G, Caponnetto S, De Meo M, Giannini G, Santini D, Cortesi E, Gazzaniga P. Genomic landscape and survival analysis of ctDNA “neo-RAS wild-type” patients with originally RAS mutant metastatic colorectal cancer. Front Oncol 2023; 13:1160673. [PMID: 37064137 PMCID: PMC10093715 DOI: 10.3389/fonc.2023.1160673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundThe term “neo-RAS wild-type” refers to the switch to RAS wild-type disease in plasma circulating tumor DNA (ctDNA) from originally RAS mutant colorectal cancers. Consistently, the hypothesis to re-determine RAS mutational status in ctDNA at disease progression in RAS mutant mCRC opened to a new perspective for clinically-based selection of patients to be treated with EGFR inhibitors. Currently, the genomic landscape of “neo-RAS wild-type” is unknown. This is a prospective study aimed to investigate clinical and genomic features associated with RAS mutation clearance in a large cohort of RAS mutant mCRC patients who converted to RAS wild- type in liquid biopsy at failure of first-line treatments. Secondary aim was to investigate the long term prognostic significance of “true neo-RAS wild- type”.Patients and methods70 patients with stage IV RAS mutant colorectal cancer were prospectively enrolled. Plasma samples were collected at progression from first-line treatment. RAS/BRAF mutations in plasma were assessed by RT-PCR. In RAS/BRAF wild-type samples, ctDNA was used to generate libraries using a 17 genes panel whose alteration has clinical relevance. To investigate the prognostic significance of RAS mutation clearance, test curves for PFS and OS were represented by Kaplan-Meier estimator plot and Log-rank test.ResultsThe most commonly detected actionable mutations in “neo-RAS wild-type” were: PIK3CA (35.7%); RET (11.9%); IDH1 (9.5%); KIT (7%); EGFR (7%); MET (4.7%); ERBB2 (4.7%); FGFR3 (4.7%). Both OS and post-progression survival were longer in patients with “neo-RAS wild-type” compared to those who remained RAS mutant (p<0.001 for both).ConclusionsDe-novo-targetable mutations occured in a large percentage of “neo-RAS wild-type”, being PIK3CA the most commonly detected. RAS mutation clearance in ctDNA is associated with long- term improvement of overall survival.
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Affiliation(s)
- Chiara Nicolazzo
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Magri
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Luca Marino
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Francesca Belardinilli
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Gianluigi De Renzi
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Caponnetto
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Michela De Meo
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Giannini
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Enrico Cortesi
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Paola Gazzaniga
- Lab. Liquid Biopsy, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Paola Gazzaniga,
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Bouchahda M, Saffroy R, Karaboué A, Hamelin J, Innominato P, Saliba F, Bosselut N, Lemoine A, Lévi F. Reply to P. Gazzaniga et al. JCO Precis Oncol 2021; 5:391-392. [DOI: 10.1200/po.20.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mohamed Bouchahda
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Raphael Saffroy
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Abdoulaye Karaboué
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Jocelyne Hamelin
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Pasquale Innominato
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Faouzi Saliba
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Nelly Bosselut
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Antoinette Lemoine
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Francis Lévi
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
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