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
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
Group | PFS (months) | OS (months) | RR (%) | ||||||
---|---|---|---|---|---|---|---|---|---|
Cetuximab + BSC | BSC | HR (95% CI) P | Cetuximab + BSC | BSC | HR (95% CI) P | Cetuximab + BSC | BSC | P | |
RAS Mutant | 1.8 | 1.8 | 1.04 (0.79,1.37) | 5.0 | 4.7 | 0.91 (0.68-1.23) | 1.9% | 0% | 0.24 |
n=213 | 0.25 | 0.55 | |||||||
BRAF Mutant | 1.6 | 1.5 | 0.75 (0.26,2.19) | 2.1 | 3.0 | 0.71 (0.22-2.27) | 0% | 0% | 1.0 |
n=15 | 0.60 | 0.56 | |||||||
RAS & BRAF WT | 5.4 | 1.8 | 0.25 (0.15,0.41) | 10.1 | 4.8 | 0.51 (0.32-0.81) | 18.5% | 0% | 0.002 |
n=97 | <0.0001 | 0.004 |
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