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Original Study| Volume 19, ISSUE 3, P219-225, September 2020

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KRAS G12C Metastatic Colorectal Cancer: Specific Features of a New Emerging Target Population

      Abstract

      Background

      Kirsten rat sarcoma viral oncogene (KRAS) G12C mutation occurs in about 4% of colorectal cancers (CRCs). Recently, KRAS G12C was identified to be a potential drug target and predictor of response to the novel on AMG510 target treatment. We described the clinicopathologic features and prognosis of KRAS G12C-mutated metastatic CRCs compared to other KRAS mutation.

      Patients and Methods

      Clinicopathologic features and outcome data of KRAS-mutated metastatic CRC (mCRC) patients referred to 3 Italian oncology units from January 2010 to December 2018 were collected. A cohort of KRAS-mutant mCRC patients referred to the Department of Medical Oncology at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (Italy) within the same time frame was included as external validation.

      Results

      A total of 839 KRAS-mutated mCRC cases were included in the main patient population. A total of 145 patients (17%) had KRAS G12C mutation. Our analyses showed that patients harboring KRAS G12C mutation were more likely to be men and to present lung and liver metastases, and were less likely to have peritoneal spread. KRAS G12C mutation was associated with shorter overall survival compared to other KRAS mutations (hazard ratio, 1.32; 95% confidence interval, 1.07-1.63; P = .009). Such results were confirmed in the external validation cohort.

      Conclusion

      The knowledge of the distinctive traits of KRAS G12C-mutated CRC patients is crucial to future translational research studies, clinical trial design, and proper interpretation of results.

      Keywords

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      References

        • Conlin A.
        • Smith G.
        • Carey F.A.
        • Wolf C.R.
        • Steele R.J.
        The prognostic significance of K-ras, p53, and APC mutations in colorectal carcinoma.
        Gut. 2005; 54: 1283-1286
        • Janes M.R.
        • Zhang J.
        • Li L.S.
        • et al.
        Targeting KRAS mutant cancers with a covalent G12C-specific inhibitor.
        Cell. 2018; 172: 578-589.e517
        • Govindan R.
        • Fakih M.
        • Price T.
        • et al.
        Phase 1 study of AMG 510, a novel molecule targeting KRAS G12C mutant solid tumors.
        Ann Oncol. 2019; 30: v159-v193
        • Serebriiskii I.G.
        • Connelly C.
        • Frampton G.
        • et al.
        Comprehensive characterization of RAS mutations in colon and rectal cancers in old and young patients.
        Nat Commun. 2019; 10: 3722
        • Andreyev H.J.
        • Norman A.R.
        • Cunningham D.
        • Oates J.R.
        • Clarke P.A.
        Kirsten ras mutations in patients with colorectal cancer: the multicenter “Rascal” study.
        J Natl Cancer Inst. 1998; 90: 675-684
        • Jones R.P.
        • Sutton P.A.
        • Evans J.P.
        • et al.
        Specific mutations in KRAS codon 12 are associated with worse overall survival in patients with advanced and recurrent colorectal cancer.
        Br J Cancer. 2017; 116: 923-929
        • Modest D.P.
        • Ricard I.
        • Heinemann V.
        • et al.
        Outcome according to KRAS-, NRAS- and BRAF-mutation as well as KRAS mutation variants: pooled analysis of five randomized trials in metastatic colorectal cancer by the AIO colorectal cancer study group.
        Ann Oncol. 2016; 27: 1746-1753
        • Jones S.
        • Lambert S.
        • Williams G.T.
        • Best J.M.
        • Sampson J.R.
        • Cheadle J.P.
        Increased frequency of the k-ras G12C mutation in MYH polyposis colorectal adenomas.
        Br J Cancer. 2004; 90: 1591-1593
        • Cremolini C.
        • Loupakis F.
        • Antoniotti C.
        • et al.
        FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study.
        Lancet Oncol. 2015; 16: 1306-1315
        • Sorbye H.
        • Dragomir A.
        • Sundstrom M.
        • et al.
        High BRAF mutation frequency and marked survival differences in subgroups according to KRAS/BRAF mutation status and tumor tissue availability in a prospective population-based metastatic colorectal cancer cohort.
        PLoS One. 2015; 10: e0131046
        • Hallin J.
        • Engstrom L.D.
        • Hargis L.
        • et al.
        The KRAS(G12C) inhibitor MRTX849 provides insight toward therapeutic susceptibility of KRAS-mutant cancers in mouse models and patients.
        Cancer Discov. 2020; 10: 54-71
        • Xue J.Y.
        • Zhao Y.
        • Aronowitz J.
        • et al.
        Rapid non-uniform adaptation to conformation-specific KRAS(G12C) inhibition.
        Nature. 2020; 577: 421-425
        • Hata A.N.
        • Shaw A.T.
        Resistance looms for KRAS(G12C) inhibitors.
        Nat Med. 2020; 26: 169-170
        • Nagasaka M.
        • Li Y.
        • Sukari A.
        • Ou S.I.
        • Al-Hallak M.N.
        • Azmi A.S.
        KRAS G12C game of thrones: which direct KRAS inhibitor will claim the iron throne?.
        Cancer Treat Rev. 2020; 84: 101974
        • Canon J.
        • Rex K.
        • Saiki A.Y.
        • et al.
        The clinical KRAS(G12C) inhibitor AMG 510 drives anti-tumour immunity.
        Nature. 2019; 575: 217-223