Association of prognostic value of primary tumor location in stage III colon cancer with RAS and BRAF mutational status.

Authors

Julien Taieb

Julien Taieb

Hopital Européen Georges Pompidou, Paris, France

Julien Taieb , Hampig Raphael Kourie , Jean-François Emile , Karine Le Malicot , Ralyath Balogoun , Josep Tabernero , Enrico Mini , Gunnar Folprecht , Jean-Luc Van Laethem , Claire Mulot , Olivier Bouche , Thomas Aparicio , Pierre Michel , Josef Thaler , John A. Bridgewater , Eric Van Cutsem , Géraldine Perkins , Ramon Salazar , Come Lepage , Pierre Laurent-Puig

Organizations

Hopital Européen Georges Pompidou, Paris, France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon, Versailles University and Hospital Ambroise Pare, AP-HP, Boulogne, France, FFCD, Dijon, France, Université Paris Descartes, Sorbonne Paris Cité, France; Assistance Publique Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, INSERM UMR-S1147, Paris, France, Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain, Section of Internal Medicine, University of Florence, Florence, Italy, University Hospital Carl Gustav Carus, Dresden, Germany, Erasme Hospital, Brussels, Belgium, Paris Descartes University, Paris, France, CHU Robert Debre, Reims, France, Department of Gastroenterology, Saint Louis Hospital, Paris, France, Digestive Oncology Unit, Iron Group, Rouen Hospital, University of Normandy, Rouen, France, Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria, University College London Cancer Institute, London, United Kingdom, University Hospitals Leuven, Leuven, Belgium, Department of Gastroenterology and GI Oncology, Hopital Européen Georges Pompidou, Paris, France, Institut Català D'Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain, CHU Le Bocage HGE, INSERM U866, Dijon, France

Research Funding

Pharmaceutical/Biotech Company

Background: Recent data suggest that the anatomic site of colon primary tumor may be an important factor in the interpretation of molecular markers with clinical outcome in metastatic colon cancer (CC) patients (pts). We assessed here the prognostic value of primary location in fully resected stage III CC pts and its relationship to MSI, RAS and BRAF mutational status. Methods: Pts enrolled in the PETACC-8 trial were analyzed. We categorized tumor site as located proximal (left-sided) or distal (right-sided) to the splenic flexure. The association between tumor location and disease free survival (DFS), survival after relapse (SAR) and overall survival (OS) were assessed by Cox models and adjusted for clinical and pathological features, MSI, BRAF and RASmutation status. The outcome of pts receiving FOLFOX or FOLFOX and cetuximab in the adjuvant setting were also determined according to tumor site. Results: Among the 1869 pts with full molecular data available, 755 (40%) had a right-sided tumor, 164 (10%) were MSI, 942 (50%) were mutated for RAS and 212 (11%) were mutated for BRAF. Right-sided tumor was not prognostic for DFS in the whole population but was associated to a shorter SAR (HR: 1.54 [1.23 - 1.93], p = 0.001) and OS (HR: 1.25 [1.02 - 1.54], p = 0.03). Same results were observed for MSS and for MSI pts. However, when looking at pts mutated for RAS or BRAF(MUT) and those double wild type (DWT) for those mutations, we found that right-sided tumors, when compared to left-sided tumors, was associated with a worst DFS in DWT patients (HR:1.39[1.01-1.92], p = 0.04) and a better DFS in MUT patients (HR:0.77[0.63-0.95], p = 0.01). These results were found independently of the treatment received and no beneficial effect of cetuximab on DFS or OS was observed in left-sided tumors. Conclusions: In the whole study population of stage III CC pts, though right-sided tumor location influences OS as previously reported, it does not seem to influence DFS but only SAR, when disease becomes metastatic. Interestingly, sidedness seems to influence DFS when splitting the population in MUT or DWT for RAS and BRAF, with a worst DFS for right-sided tumors in DWT and a worst DFS for left-sided tumors in RAS or BRAF mutants. Clinical trial information: 2005-003463-23.

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Clinical Trial Registration Number

2005-003463-23

Citation

J Clin Oncol 35, 2017 (suppl; abstr 3515)

DOI

10.1200/JCO.2017.35.15_suppl.3515

Abstract #

3515

Poster Bd #

138

Abstract Disclosures