Expanded RAS and BRAF V600 testing as predictive biomarkers for single agent cetuximab in the randomized phase III CO.17 trial.

Authors

Jonathan M. Loree

Jonathan M. Loree

BC Cancer, Vancouver, BC, Canada

Jonathan M. Loree , Anthony Dowers , Dongsheng Tu , Christopher J. O'Callaghan , Dan Edelstein , Hannah Quinn , Derek J. Jonker , Chris Karapetis , Timothy Jay Price , John Raymond Zalcberg , Malcolm J. Moore , Paul Michael Waring , Hagen F. Kennecke , Stanley R. Hamilton , Scott Kopetz

Organizations

BC Cancer, Vancouver, BC, Canada, Melbourne University, Melbourne, Australia, Canadian Cancer Trials Group, Kingston, ON, Canada, Sysmex Inostics, Baltimore, MD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada, Flinders Medical Centre, Adelaide, Australia, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia, Peter MacCallum Cancer Centre, Melbourne, Australia, BC Cancer Agency, Vancouver, BC, Canada, The University of Melbourne, Parkville, Australia, The University of Texas MD Anderson Cancer Center, Houston, TX

Research Funding

NIH

Background: KRAS/NRAS (RAS) testing of exons 2, 3 and 4 is standard prior to anti-EGFR treatment in metastatic colorectal cancer and many consider BRAFV600 (BRAF) mutations predictive. CO.17 was a randomized phase III trial comparing cetuximab vs best supportive care (BSC) in unselected patients (pts). Re-analysis tested only KRAS exon 2, thus the benefit of cetuximab in RAS/BRAF wild type (WT) pts is unclear. Methods: We retrospectively performed expanded RAS/BRAF testing using a highly sensitive digital PCR method (BEAMing; 1% allele frequency detection limit) on micro-dissected archival tissue from 248 CO.17 pts. Additional pts without available archival tissue, with prior Sanger sequencing or therascreen results were included in analyses if mutations were previously detected (n = 77). Overall survival (OS), progression free survival (PFS), and response rates (RR) were compared by molecular profile. Results: Of 248 sequenced pts, 139 (56%) were RAS mutant, with 112 (45%) exon 2, 11 (4%) exon 3 and 6 (2%) exon 4 KRAS mutant, and 10 (4%) NRAS mutant pts. Seven (3%) BRAF mutant, and 97 (30%) confirmed RAS/BRAF WT pts were identified. Results are summarized below. A test of interaction indicated RAS status was predictive for PFS (p = 0.0001) and OS (p = 0.037) and BRAF status neared significance as a predictive marker for PFS (p = 0.089) but not OS (p = 0.24). Conclusions: These updated results demonstrate an improved PFS (HR 0.25 vs 0.40 previously) and OS (HR 0.51 vs 0.55 previously) for cetuximab in RAS/BRAF WT pts compared to prior analyses that included only KRAS exon 2 mutation status. We provide an estimate of single agent cetuximab efficacy for future anti-EGFR re-challenge studies and demonstrate further support that BRAF mutations may predict lack of benefit from anti-EGFR therapy. Clinical trial information: NCT00079066

GroupPFS
(months)
OS
(months)
RR
(%)
Cetuximab + BSCBSCHR
(95% CI)
P
Cetuximab + BSCBSCHR
(95% CI)
P
Cetuximab + BSCBSCP
RAS Mutant1.81.81.04 (0.79,1.37)5.04.70.91 (0.68-1.23)1.9%0%0.24
n=2130.250.55
BRAF Mutant1.61.50.75 (0.26,2.19)2.13.00.71 (0.22-2.27)0%0%1.0
n=150.600.56
RAS & BRAF WT5.41.80.25 (0.15,0.41)10.14.80.51 (0.32-0.81)18.5%0%0.002
n=97<0.00010.004

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2019 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Cancers of the Colon, Rectum, and Anus

Sub Track

Translational Research

Clinical Trial Registration Number

NCT00079066

Citation

J Clin Oncol 37, 2019 (suppl 4; abstr 537)

DOI

10.1200/JCO.2019.37.4_suppl.537

Abstract #

537

Poster Bd #

E20

Abstract Disclosures