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Luchini C, Paolino G, Mattiolo P, Piredda ML, Cavaliere A, Gaule M, Melisi D, Salvia R, Malleo G, Shin JI, Cargnin S, Terrazzino S, Lawlor RT, Milella M, Scarpa A. KRAS wild-type pancreatic ductal adenocarcinoma: molecular pathology and therapeutic opportunities. J Exp Clin Cancer Res 2020; 39:227. [PMID: 33115526 PMCID: PMC7594413 DOI: 10.1186/s13046-020-01732-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease, whose main molecular trait is the MAPK pathway activation due to KRAS mutation, which is present in 90% of cases.The genetic landscape of KRAS wild type PDAC can be divided into three categories. The first is represented by tumors with an activated MAPK pathway due to BRAF mutation that occur in up to 4% of cases. The second includes tumors with microsatellite instability (MSI) due to defective DNA mismatch repair (dMMR), which occurs in about 2% of cases, also featuring a high tumor mutational burden. The third category is represented by tumors with kinase fusion genes, which marks about 4% of cases. While therapeutic molecular targeting of KRAS is an unresolved challenge, KRAS-wild type PDACs have potential options for tailored treatments, including BRAF antagonists and MAPK inhibitors for the first group, immunotherapy with anti-PD-1/PD-L1 agents for the MSI/dMMR group, and kinase inhibitors for the third group.This calls for a complementation of the histological diagnosis of PDAC with a routine determination of KRAS followed by a comprehensive molecular profiling of KRAS-negative cases.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Maria L Piredda
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Alessandro Cavaliere
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Marina Gaule
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Davide Melisi
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Roberto Salvia
- Department of Surgery, University of Verona, 37134, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, University of Verona, 37134, Verona, Italy
| | - Jae Il Shin
- Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100, Novara, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100, Novara, Italy
| | - Rita T Lawlor
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy.
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
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