Abstract
It is well known that activating mutations in the KRAS and NRAS genes are associated with poor response to anti-EGFR therapies in patients with metastatic colorectal cancer (mCRC). Approximately half of the patients with wild-type (WT) KRAS colorectal carcinoma do not respond to these therapies. This could be because the treatment decision is determined by the mutational profile of the primary tumor, regardless of the presence of small tumor subclones harboring RAS mutations in lymph nodes or liver metastases. We analyzed the mutational profile of the KRAS, NRAS, BRAF and PI3KCA genes using low-density microarray technology in samples of 26 paired primary tumors, 16 lymph nodes and 34 liver metastases from 26 untreated mCRC patients (n=76 samples). The most frequent mutations found in primary tumors were KRAS (15%) and PI3KCA (15%), followed by NRAS (8%) and BRAF (4%). The distribution of the mutations in the 16 lymph node metastases analyzed was as follows: 4 (25%) in KRAS gene, 3 (19%) in NRAS gene and 1 mutation each in PI3KCA and BRAF genes (6%). As expected, the most prevalent mutation in liver metastasis was in the KRAS gene (35%), followed by PI3KCA (9%) and BRAF (6%). Of the 26 cases studied, 15 (58%) displayed an overall concordance in the mutation status detected in the lymph node metastases and liver metastases compared with primary tumor, suggesting no clonal evolution. In contrast, the mutation profiles differed in the primary tumor and lymph node/metastases samples of the remaining 11 patients (48%), suggesting a spatial and temporal clonal evolution. We confirm the presence of different mutational profiles among primary tumors, lymph node metastases and liver metastases. Our results suggest the need to perform mutational analysis in all available tumor samples of patients before deciding to commence anti-EGFR treatment.
Highlights
Sporadic colorectal cancer is the third most frequently diagnosed cancer worldwide and the third most common cause of cancer-related death [1]
It is well known that activating mutations in the KRAS and NRAS genes are associated with poor response to anti-EGFR therapies in patients with metastatic colorectal cancer
Up to 50% of the patients with wild-type (WT) KRAS colorectal carcinoma do not respond to this therapy, possibly because the decision to treat is determined by the mutational profile of the primary tumor, regardless of the presence of small tumor subclones harboring RAS mutations in lymph nodes or liver metastases
Summary
Sporadic colorectal cancer (sCRC) is the third most frequently diagnosed cancer worldwide and the third most common cause of cancer-related death [1]. Up to 50% of the patients with wild-type (WT) KRAS colorectal carcinoma do not respond to this therapy, possibly because the decision to treat is determined by the mutational profile of the primary tumor, regardless of the presence of small tumor subclones harboring RAS mutations in lymph nodes or liver metastases. Most studies have employed primary tumor samples from sCRC patients to define the mutations of KRAS, NRAS, BRAF and PI3KCA genes [9, 10]. The precise patterns of intratumoral clonal evolution estimated from the mutational profile of the genes associated with the EGFR signaling pathway, and their relationship with the neoplastic clones present in primary vs lymph node metastases vs metastatic tumor samples (intertumoral heterogeneity) remain controversial. It is important to identify intratumoral and intertumoral heterogeneity since both could affect the response to targeted therapies
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