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Isnaldi E, Garuti A, Cirmena G, Scabini S, Rimini E, Ferrando L, Lia M, Murialdo R, Tixi L, Carminati E, Panaro A, Gallo M, Grillo F, Mastracci L, Repetto L, Fiocca R, Romairone E, Zoppoli G, Ballestrero A. Clinico-pathological associations and concomitant mutations of the RAS/RAF pathway in metastatic colorectal cancer. J Transl Med 2019; 17:137. [PMID: 31036005 PMCID: PMC6489172 DOI: 10.1186/s12967-019-1879-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Over the past few years, next-generation sequencing (NGS) has become reliable and cost-effective, and its use in clinical practice has become a reality. A relevant role for NGS is the prediction of response to anti-EGFR agents in metastatic colorectal cancer (mCRC), where multiple exons from KRAS, NRAS, and BRAF must be sequenced simultaneously. METHODS We optimized a 14-amplicon NGS panel to assess, in a consecutive cohort of 219 patients affected by mCRC, the presence and clinico-pathological associations of mutations in the KRAS, NRAS, BRAF, and PIK3CA genes from formalin-fixed, paraffin-embedded specimens collected for diagnostics and research at the time of diagnosis. RESULTS We observed a statistically significant association of RAS mutations with sex, young age, and tumor site. We demonstrated that concomitant mutations in the RAS/RAF pathway are not infrequent in mCRC, and as anticipated by whole-genome studies, RAS and PIK3CA tend to be concurrently mutated. We corroborated the association of BRAF mutations in right mCRC tumors with microsatellite instability. We established tumor side as prognostic parameter independently of mutational status. CONCLUSIONS To our knowledge, this is the first monocentric, consecutively accrued clinical mCRC cancer cohort tested by NGS in a real-world context for KRAS, NRAS, BRAF, and PIK3CA. Our study has highlighted in clinical practice findings such as the concomitance of mutations in the RAS/RAF pathway, the presence of multiple mutations in single gene, the co-occurrence of RAS and PIK3CA mutations, the prognostic value of tumor side and possible associations of sex with specific mutations.
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Affiliation(s)
- Edoardo Isnaldi
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Anna Garuti
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Gabriella Cirmena
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Stefano Scabini
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Edoardo Rimini
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Lorenzo Ferrando
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Michela Lia
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Roberto Murialdo
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Lucia Tixi
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Enrico Carminati
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Andrea Panaro
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Maurizio Gallo
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
| | - Federica Grillo
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Luca Mastracci
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Lazzaro Repetto
- Department of Oncology, Ospedale Civile “G Borea”, Sanremo, Italy
| | - Roberto Fiocca
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Emanuele Romairone
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Gabriele Zoppoli
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine (Di.M.I.), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
- Ospedale Policlinico San Martino IRCCS Per l’Oncologia, Genoa, Italy
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Ishige T, Itoga S, Sato K, Kitamura K, Nishimura M, Sawai S, Matsushita K, Suzuki K, Ota S, Miyauchi H, Matsubara H, Nakatani Y, Nomura F. High-throughput screening of extended RAS mutations based on high-resolution melting analysis for prediction of anti-EGFR treatment efficacy in colorectal carcinoma. Clin Biochem 2014; 47:340-3. [PMID: 25262986 DOI: 10.1016/j.clinbiochem.2014.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/11/2014] [Accepted: 09/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Recent studies have demonstrated that, in advanced colorectal carcinoma (CRC) patients, extended RAS (in KRAS exons 2-4 and NRAS exons 2-4) and BRAF mutations are negative predictors for anti-EGFR treatment efficacy and negative prognostic factor, respectively. Thus, high-throughput and cost-effective methods for identification of the mutation status are required. DESIGN AND METHODS We developed a PCR-high-resolution melting (HRM)-based method for screening extended RAS and BRAF mutations, and relative frequency of mutations in formalin-fixed paraffin-embedded samples of CRC was analyzed. RESULTS Among 93 CRC samples, 29 harbored mutations in KRAS exon 2, and 9 harbored mutations in BRAF exon 15. Analysis of 55 KRAS exon 2 and BRAF exon 15 wild-type CRC samples identified the following mutations: 1/55 in exon 3 and 2/55 in exon 4 of KRAS; 1/55 in exon 2, 3/55 in exon 3, and 0/55 in exon 4 of NRAS. CONCLUSIONS Our PCR-HRM method will enable rapid determination of the extended RAS and BRAF mutation status prior to anti-EGFR treatment in the clinical setting.
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Affiliation(s)
- Takayuki Ishige
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan.
| | - Sakae Itoga
- Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Kenichi Sato
- Department of Medical Technology and Sciences, International University of Health and Welfare, Fukuoka, Japan
| | - Kouichi Kitamura
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Motoi Nishimura
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Setsu Sawai
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Kazuyuki Matsushita
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
| | - Kazufumi Suzuki
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Ota
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Hideaki Miyauchi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Fumio Nomura
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Laboratory Medicine and Clinical Genetics, Chiba University Hospital, Chiba, Japan
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