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Association details:
Biomarker:KRAS mutation
Cancer:Colorectal Cancer
Drug:Erbitux (cetuximab) (EGFR inhibitor)
Direction:Resistant
Evidence:
Evidence Level:
Resistant: B - Late Trials
New
Title:

Expanded Low Allele Frequency RAS and BRAF V600E Testing in Metastatic Colorectal Cancer as Predictive Biomarkers for Cetuximab in the Randomized CO.17 Trial

Excerpt:
CO.17 trial compared cetuximab versus best supportive care (BSC) in RAS/BRAF-unselected mCRC. 17 trial using BEAMing for KRAS/NRAS (codons 12/13/59/61/117/146) and BRAF V600E. Cetuximab did not improve OS/PFS for KRAS-, NRAS-, or BRAF-mutated tumors...
DOI:
10.1158/1078-0432.CCR-20-2710
Trial ID:
Evidence Level:
Sensitive: C2 – Inclusion Criteria
New
Title:

Phase Fase II examination of irinotecan, cetuximab and everolimus for patients resistente to chemoptherapy with metastatic colorectal cancer and KRAS mutation or with KRAS wildtype after progression on therapy with irinotecan og cetuximab – effect and biological markers.

Excerpt:
...Patients with KRAS mutation in their primary tumour or metastasis.5. ...
Evidence Level:
Sensitive: C2 – Inclusion Criteria
New
Title:

Irinotecan Hydrochloride With FOLFIRI and Cetuximab as First-Line Therapy in Treating Patients With RAS Wild-Type Colorectal Cancer

Excerpt:
...- RAS wild-type status (by a Clinical Laboratory Improvement Amendments [CLIA] certified assay that includes all known mutations in Kirsten rat sarcoma viral oncogene homolog [KRAS], Harvey rat sarcoma viral oncogene homolog [HRAS], and neuroblastoma RAS viral (v-ras) oncogene homolog [NRAS])...
Trial ID:
More C2 evidence
Evidence Level:
Resistant: C3 – Early Trials
Title:

Chemotherapy (doublet or triplet) plus targeted therapy by RAS status as conversion therapy in colorectal cancer patients with initially unresectable liver-only metastases. The UNICANCER PRODIGE-14 randomised clinical trial

Published date:
01/06/2022
Excerpt:
PRODIGE 14 was an open-label, multicenter, randomised Phase 2 trial. CRC patients with initially defined unresectable liver-only metastases received either, 2-CTx (FOLFOX or FOLFIRI) or 3-CTx (FOLFIRINOX), plus bevacizumab/cetuximab by RAS status. We failed to increase from 50 to 70% the R0/R1 liver-resection rate with the use of 3-CTx combined with bevacizumab or cetuximab by RAS status in CRC patients with initially unresectable liver metastases.
Secondary therapy:
FOLFIRINOX
DOI:
10.1038/s41416-021-01644-y
Evidence Level:
Resistant: C3 – Early Trials
Source:
Title:

Tetraspanin 6 is a regulator of carcinogenesis in colorectal cancer

Published date:
09/14/2021
Excerpt:
CONTRADICTING EVIDENCE:...Tspan6-positive patients with tumors in the proximal colon (right-sided) and those with KRAS mutations had a better response to Cetuximab than the patients that expressed low Tspan6 levels.
DOI:
https://doi.org/10.1073/pnas.2011411118
Evidence Level:
Resistant: C3 – Early Trials
Title:

O-6 Gene alterations in ctDNA related to the resistance mechanism of anti-EGFR antibodies and clinical efficacy outcomes of anti-EGFR antibody rechallenge plus trifluridine/tipiracil in metastatic colorectal cancer patients in WJOG8916G trial

Published date:
07/04/2021
Excerpt:
...We conducted a phase II trial (WJOG8916G) to evaluate the efficacy and safety of the combination of trifluridine/tipiracil and cetuximab rechallenge in patients (pts) with metastatic colorectal cancer (mCRC)…RAS, BRAF, and PIK3CA muts in ctDNA were associated with worse clinical efficacy outcomes in mCRC patients receiving anti-EGFR antibody rechallenge plus trifluridine/tipiracil.
Secondary therapy:
trifluridine/tipiracil
DOI:
https://doi.org/10.1016/j.annonc.2021.05.010
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

KRAS mutations as an independent prognostic factor in patients with advanced colorectal cancer treated with cetuximab

Excerpt:
A KRAS mutation was present in 27% of the patients and was associated with resistance to cetuximab (0% v 40% of responders among the 24 mutated and 65 nonmutated patients, respectively; P < .001) and a poorer survival (median PFS: 10.1 v 31.4 weeks in patients without mutation; P = .0001; median OS: 10.1 v 14.3 months in patients without mutation; P = .026).
DOI:
10.1200/JCO.2007.12.5906
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer

Excerpt:
Conversely, for patients with tumor KRAS mutations, the response rate for cetuximab plus FOLFOX-4 was lower, compared with FOLFOX-4 alone (33% v 49%; OR = 0.51; 95% CI, 0.22 to 1.15; ECOG PS–adjusted CMH test, P = .106).
Secondary therapy:
FOLFOX4
DOI:
10.1200/JCO.2008.20.8397
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

Emergence of KRAS mutations and acquired resistance to anti-EGFR therapy in colorectal cancer

Excerpt:
Analysis of metastases from patients who developed resistance to cetuximab or panitumumab showed the emergence of KRAS amplification in one sample and acquisition of secondary KRAS mutations in 60% (6/10) of the cases.
DOI:
10.1038/nature11156
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

FOLFOX4 Plus Cetuximab for Patients With Previously Untreated Metastatic Colorectal Cancer According to Tumor RAS and BRAF Mutation Status: Updated Analysis of the CECOG/CORE 1.2.002 Study

Excerpt:
Compared with patients with RAS wt/BRAF wt tumors (n = 124; median overall survival, 28.5 months), those with RAS mutations (n = 10; median, 16.3 months; hazard ratio, 0.43; 95% confidence interval, 0.20-0.89; P = .020) or BRAF mutations (n = 14; median, 11.7 months; hazard ratio, 0.23; 95% confidence interval, 0.12-0.41; P < .0001) had worse overall survival, which remained significant (P < .04) when adjusting for differences in baseline characteristics among the mutation subgroups.
Secondary therapy:
FOLFOX4
DOI:
10.1016/j.clcc.2014.12.003
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis

Excerpt:
KRAS mutants did not derive benefit compared with wild types, with a response rate of 6.7% (17/253) versus 35.8% (126/352; odds ratio [OR] 0.13, 95% CI 0.07-0.22; p<0.0001), a median PFS of 12 weeks versus 24 weeks (hazard ratio [HR] 1.98, 1.66-2.36; p<0.0001), and a median overall survival of 32 weeks versus 50 weeks (1.75, 1.47-2.09; p<0.0001).
DOI:
10.1016/S1470-2045(10)70130-3
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

Oncogenic Activation of the RAS/RAF Signaling Pathway Impairs the Response of Metastatic Colorectal Cancers to Anti–Epidermal Growth Factor Receptor Antibody Therapies

Excerpt:
RAS/RAF mutations are negatively associated with response to cetuximab or panitumumab...The presence of K-RAS mutations was not significantly linked to objective response to therapy, with a trend toward a negative association with response (1 of 11 mutations versus 15 of 37 mutations for responders versus nonresponders; P = 0.073).
DOI:
10.1158/0008-5472.CAN-06-4158
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

Mutations of KRAS/NRAS/BRAF predict cetuximab resistance in metastatic colorectal cancer patients

Excerpt:
In contrast, BRAF mutations (0% for responders vs. 26.1% for non-responders, p = 0.0044) and KRAS (0% for responders vs. 21.7% for non-responders, p = 0.0117) were observed exclusively in non-responders. Three of the 4 subjects with NRAS mutations were non-responders (p = 0.3053) while both PTEN mutations were detected in responders (p = 0.4993). Collective mutation frequencies of KRAS, NRAS, and BRAF combined were higher in non-responders (p = 0.0001).
DOI:
10.18632/oncotarget.8076
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

The First-in-class Anti-EGFR Antibody Mixture Sym004 Overcomes Cetuximab Resistance Mediated by EGFR Extracellular Domain Mutations in Colorectal Cancer

Excerpt:
Acquired resistance to cetuximab was associated with the emergence of mutations, which occurred mainly in KRAS, NRAS, and EGFR genes (Table 2).
DOI:
10.1158/1078-0432.CCR-15-2400
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

Efficacy according to biomarker status of cetuximab plus FOLFOX-4 as first-line treatment for metastatic colorectal cancer: the OPUS study

Excerpt:
Conversely, patients whose tumors carried mutations in KRAS who received cetuximab plus FOLFOX-4 had a decreased odds of response (34% versus 53%; odds ratio 0.459, P = 0.0290) and a higher risk of disease progression (median PFS time 5.5 versus 8.6 months; HR 1.720, P = 0.0153) compared with those who received FOLFOX-4 alone.
DOI:
10.1093/annonc/mdq632
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

PTEN Expression and KRAS Mutations on Primary Tumors and Metastases in the Prediction of Benefit From Cetuximab Plus Irinotecan for Patients With Metastatic Colorectal Cancer

Excerpt:
KRAS was mutated in 35 (40%) of 88 available primary tumors. Only two (6%) of 35 responders were found in this group compared with 13 (25%) of 53 that had KRAS wild type (OR, 0.186; 95% CI, 0.039 to 0.886; P = .024)...Patients with KRAS wild-type tumors had significantly longer mPFS and mOS than those with KRAS mutated tumors (mPFS: 4.2 v 3.1 months; HR, 0.45; 95% CI, 0.27 to 0.74; P = .003; mOS: 13.5 v 6.1 months; HR, 0.45; 95% CI, 0.22 to 0.65; P = .0004).
DOI:
10.1200/JCO.2008.20.2796
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

Prognostic and predictive value of common mutations for treatment response and survival in patients with metastatic colorectal cancer

Excerpt:
Among 92 patients treated using chemotherapy and cetuximab as salvage therapy, KRAS mutation was associated with lack of response (P=0.002) and shorter PFS (P=0.09). BRAF (P=0.0005) and PIK3CA (P=0.01) mutations also predicted reduced PFS in response to cetuximab salvage therapy.
DOI:
10.1038/sj.bjc.6605164
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

PIK3CA Mutations in Colorectal Cancer Are Associated with Clinical Resistance to EGFR-Targeted Monoclonal Antibodies

Excerpt:
PIK3CA mutations were significantly associated with clinical resistance to panitumumab or cetuximab; none of the mutated patients achieved objective response (P = 0.038)...Patients with PIK3CA mutations displayed a worse clinical outcome also in terms of progression-free survival (P = 0.035).
DOI:
10.1158/0008-5472.CAN-08-2466
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

Wild-type BRAF is required for response to panitumumab or cetuximab in metastatic colorectal cancer

Excerpt:
KRAS mutations were present in 30% of the patients and were associated with resistance to cetuximab or panitumumab (P = .011)
DOI:
10.1200/JCO.2008.18.0786
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

Circulating tumor DNA sequencing in colorectal cancer patients treated with first-line chemotherapy with anti-EGFR

Excerpt:
Tissue KRAS/NRAS wild-type mCRC patients were enrolled and treated with first-line cetuximab-containing chemotherapy….Among 93 patients, 84 (90.3%) had at least 1 somatic mutation in baseline ctDNA samples (average 2.74). Five patients with KRAS or NRAS hotspot mutation in the ctDNA showed significantly worse progression-free survival (PFS) (p = 0.029).
Secondary therapy:
Chemotherapy
DOI:
10.1038/s41598-021-95345-4
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

Activating KRAS Mutations and Overexpression of Epidermal Growth Factor Receptor as Independent Predictors in Metastatic Colorectal Cancer Patients Treated With Cetuximab

Excerpt:
Furthermore, patients with nonactivating KRAS mutants in tumors had a significantly better PFS and OS than patients with activating KRAS mutants (both P < 0.05).
DOI:
10.1097/SLA.0b013e3181bc9d96
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

K-ras mutations and benefit from cetuximab in advanced colorectal cancer

Excerpt:
The effect of cetuximab on overall survival was significantly greater among the patients with wild-type K-ras tumors than among those with mutated K-ras tumors (P=0.01 for the interaction between K-ras–mutation status and the assigned treatment)...The effect of cetuximab on progression-free survival was significantly greater among the patients with wild-type K-ras tumors than among those with mutated K-ras tumors...
DOI:
10.1056/NEJMoa0804385.
Trial ID:
Evidence Level:
Resistant: C3 – Early Trials
New
Title:

A Molecularly Annotated Platform of Patient-Derived Xenografts (“Xenopatients”) Identifies HER2 as an Effective Therapeutic Target in Cetuximab-Resistant Colorectal Cancer

Excerpt:
At the 6-week time point, disease stabilization changed to tumor shrinkage in 3 cases and developed into disease progression in 7 cases....Our results prospectively validated observations in patients: none of the 7 NRAS- and 3 BRAF-mutant cases (10.6% and 4.5%, respectively) or the 4 cases with KRAS rare mutations (6.1%) responded to cetuximab with tumor shrinkage or stabilization.
DOI:
10.1158/2159-8290.CD-11-0109
Evidence Level:
Resistant: C3 – Early Trials
New
Source:
Title:

KRAS Mutation Status Is Predictive of Response to Cetuximab Therapy in Colorectal Cancer

Excerpt:
A KRAS mutation was found in 13 tumors (43%) and was significantly associated with the absence of response to cetuximab (KRAS mutation in 0% of the 11 responder patients versus 68.4% of the 19 nonresponder patients; P = 0.0003). The overall survival of patients without KRAS mutation in their tumor was significantly higher compared with those patients with a mutated tumor (P = 0.016; median, 16.3 versus 6.9 months).
DOI:
10.1158/0008-5472.CAN-06-0191
Evidence Level:
Resistant: D – Preclinical
New
Source:
Title:

Dasatinib sensitizes KRAS mutant colorectal tumors to cetuximab

Excerpt:
In vitro, using poly-D-lysine/laminin plates, KRAS mutant cell lines were resistant to cetuximab, whereas KRAS wild-type lines showed sensitivity to cetuximab...KRAS mutant xenografts showed resistance to cetuximab therapy, whereas KRAS wild type demonstrated an antitumor response when treated with cetuximab.
DOI:
10.1038/onc.2010.430