Molecular biomarkers and histological parameters impact on survival and response to first- line systemic therapy of metastatic colorectal cancer patients

The five-year KRAS, NRAS and BRAF analysis results and treatment patterns in daily clinical practice in Slovenia in 1st line treatment of metastatic colorectal (mCRC) patients with RAS wild-type tumour (wtRAS) - a real- life data report 2013-2018

BACKGROUND

We preformed a Phase IV non-interventional study to assess KRAS, NRAS and BRAF status in metastatic colorectal cancer (mCRC) patients suitable for 1^st line treatment and to evaluate the decisions for 1^st line treatment considering the treatment goals in the RAS wild type (wt) patients. The aim of our study was also to evaluate the influence of a waiting period for biomarkers analysis on the start of first-line treatment.

PATIENTS AND METHODS

Patients with histologically confirmed mCRC adenocarcinoma suitable for first-line treatment fulfilling all inclusion criteria were included in the study. The KRAS, NRAS and BRAF analysis was performed from tissue samples of primary tumor site or metastatic site. All included patients have given consent to participate in the study by signing the informed consent form.

RESULTS

From April 2013 to March 2018 at the Institute of Oncology Ljubljana 650 patients were included, 637 of them were treated with first- line systemic treatment according to RAS and BRAF status. Remaining 13 patients with mCRC did not receive systemic first-line treatment. The distribution of patients with KRAS mutated and wild-type tumors, was almost equal, 48.8% and 47.9% respectively, 89 % of the patients had wt NRAS tumours and 86.1% had wt BRAF tumours. The most frequently prescribed treatment was bevacizumab-based therapy (53.1%), either in combination with doublet chemotherapy or with mono-chemotherapy. EGFR inhibitors cetuximab and panitumumab were prescribed in wt RAS mCRC patients (30.9%). The waiting period for biomarkers analysis was two weeks.

CONCLUSIONS

Our real-world data, single centre 5-year analysis showed that the distribution between wild type and mutated type tumors of the patients with mCRC was approximately the same, as worldwide, so the Slovenian population with mCRC has the same ratio distribution of KRAS, NRAS and BRAF wild and mutated genes. We concluded that a two-week waiting period for biomarkers analysis did not influence the first line treatment decision, so it was in the accordance with the worldwide treatment guidelines based on evidence-based medicine.

KRAS A146 Mutations Are Associated With Distinct Clinical Behavior in Patients With Colorectal Liver Metastases

Somatic KRAS mutations occur in approximately half of the patients with metastatic colorectal cancer (mCRC). Biologic tumor characteristics differ on the basis of the KRAS mutation variant. KRAS mutations are known to influence patient prognosis and are used as predictive biomarker for treatment decisions. This study examined clinical features of patients with mCRC with a somatic mutation in KRAS G12, G13, Q61, K117, or A146.

Patients with mCRC and a KRAS A146 mutation are characterized by high tumor burden and poor prognosis

Consensus molecular subtypes (CMS) in metastatic colorectal cancer - personalized medicine decision

Background

Colorectal cancer (CRC) is one of the most common types of cancer in the world. Metastatic disease is still incurable in most of these patients, but the survival rate has improved by treatment with novel systemic chemotherapy and targeted therapy in combination with surgery. New knowledge of its complex heterogeneity in terms of genetics, epigenetics, transcriptomics and microenvironment, including prognostic and clinical characteristics, led to its classification into various molecular subtypes of metastatic CRC, called consensus molecular subtypes (CMS). The CMS classification thus enables the medical oncologists to adjust the treatment from case to case. They can determine which type of systemic chemotherapy or targeted therapy is best suited to a specific patient, what dosages are needed and in what order.

Conclusions

CMS in metastatic CRC are the new tool to include the knowledge of molecular factors, tumour stroma and signalling pathways for personalized, patient-orientated systemic treatment in precision medicine.

Prognostic and clinicopathological significance of long non-coding RNA UCA1 in colorectal cancer: Results from a meta-analysis

OBJECTIVE

Urothelial cancer-associated 1 (UCA1), an oncogenic long non-coding RNA, was aberrantly upregulated in colorectal cancer (CRC). This study aimed to further explore the clinical value of UCA1 in CRC.

METHODS

Eligible studies were retrieved by searching Pubmed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang databases. Pooled hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were applied to assess the prognostic role and clinical significance of UCA1.

RESULTS

A total of 7 eligible studies with 775 cancer patients were recruited in the meta-analysis. The results showed that UCA1 overexpression was significantly correlated with poor overall survival in patients with CRC (HR = 2.25, 95% CI: 1.77-2.87, P < .001). There was also a significantly negative association between high UCA1 levels and tumor differentiation (OR = 2.84, 95% CI: 1.87-4.31, P < .001), lymph node metastasis (OR = 3.48, 95% CI: 2.24-5.41, P < .001), distant metastasis (OR = 2.67, 95% CI: 1.32-5.38, P = .006), tumor node metastasis stage (OR = 3.01, 95% CI: 2.16-4.18, P < .001), tumor invasion depth (OR = 2.18, 95% CI: 1.03-4.61, P = .04), and tumor size (OR = 2.27, 95% CI: 1.56-3.32, P < .001).

CONCLUSIONS

Our study revealed that UCA1 overexpression was associated with poor prognosis and more advanced clinicopathological features, suggesting that UCA1 may serve as an indicator for unfavorable outcome of patients with CRC.