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Ann Surg Oncol. 2010 Apr;17(4):1168-76. doi: 10.1245/s10434-009-0811-z. Epub 2009 Nov 20.

KRAS mutation in colon cancer: a marker of resistance to EGFR-I therapy.

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  • 1School of Medicine, University of Massachusetts, Worcester, MA, USA.

Abstract

INTRODUCTION AND DESIGN:

The introduction of the epidermal growth factor receptor inhibitors (EGFR-I) has increased the treatment options available for patients with metastatic colorectal cancer (mCRC). Two EGFR-I agents currently approved for the treatment of mCRC are the fully human monoclonal antibody panitumumab and the mouse-human chimeric monoclonal antibody cetuximab. While these agents have demonstrated activity across multiple lines of therapy, early studies suggested that clinical benefit was confined to a subset of patients treated. Mutation of the KRAS oncogene has emerged as a powerful negative predictive biomarker to identify patients with mCRC who do not benefit from EGFR-I therapy. Multiple retrospective analyses have demonstrated that clinical benefit from treatment with EGFR-I is limited to patients with tumors harboring the wild-type KRAS gene. In this review, the KRAS pathway and studies evaluating KRAS as a prognostic marker in CRC are discussed along with advances in KRAS gene mutation testing. Clinical trials evaluating the role of KRAS status in response to EGFR-I monotherapy or in combination with chemotherapy are also highlighted along with ongoing studies evaluating the role of EGFR-I treatment on curative resections rates.

RESULTS AND CONCLUSION:

Future studies investigating EGFR-I therapy in mCRC should incorporate KRAS mutation testing into the study protocol in order to more accurately determine the patient population that will obtain clinical benefit from these novel agents.

PMID:
19936839
[PubMed - indexed for MEDLINE]
PMCID:
PMC2840670
Free PMC Article

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