APC as a high-utility mutational biomarker that may identify subpopulations of patients with mutantRAS/BRAF and right-sided colorectal cancer (CRC) who derive benefit from EGFR inhibitors (EGFRi).

Authors

null

Ramya Thota

Intermountain Health, Murray, UT

Ramya Thota , Timothy Yeatman , Nishant Gandhi , Mingli Yang , Michael Schell , Lance Pflieger , Andrey Loboda , Michael Nebozhyn , Andrew Elliott , Joanne Xiu , George W. Sledge Jr., Moh'd M. Khushman , Emil Lou , Sanjay Goel , Warren Jack Pledger

Organizations

Intermountain Health, Murray, UT, University of South Florida, Tampa, FL, Caris Life Sciences Research and Development, Phoenix, AZ, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, Phenome Health, Seattle, WA, Merck Research Laboratories, Boston, MA, Merck Research Laboratories, West Point, PA, Caris Life Sciences, Irving, TX, Caris Life Sciences, Phoenix, AZ, Washington University in St. Louis, Siteman Cancer Center, St. Louis, MO, University of Minnesota, Minneapolis, MN, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, Tampa General Hospital, Tampa, FL

Research Funding

NCI
NCI

Background: Although, EGFRi including Cetuximab (CTX) and Panitumumab (PMB) is restricted to KRAS wild-type (KRASWT) tumors, ~50% of patients still fail to respond to therapy. Using a transcriptional signature as a surrogate for cetuximab response, we previously reported that mutations in APC (APCMUT) and TP53(TP53MUT) might predict cetuximab sensitivity, particularly in RASWT tumors (Yang M. et al., 2019). The current study aimed to use real world EGFRi treatment and survival data to independently validate these mutations as predictive, high-utility biomarkers of benefit to specific subpopulations of CRC. Methods: CTX/PMB-treated CRC specimens (n=1846) with clinical outcomes and NextGen Sequencing of DNA (592-gene panel or whole exome sequencing) were tested at Caris Life Sciences (Phoenix, AZ). All analyses were performed in MSS tumors, determined by immunohistochemistry of MMR proteins and/or NGS. Tumors with likely pathogenic mutations in KRAS, NRAS or BRAF were considered as RASMUT/BRAFMUT, or RASWT/BRAFWT if no mutation was detected for each gene. Survival on EGFRi was calculated from the initiation of EGFRi to last contact (E-OS) or last dose of EGFRi (E-TOT) using Kaplan-Meir method. Results: While concurrent TP53MUT/APCMUT were associated with improved E-OS compared to TP53MUT alone (hazard ratio [HR]=0.565, p<0.00001), APCMUT tumors were associated with improved E-OS independent of TP53 mutation status. Compared to APCWT, APCMUT were associated with longer E-OS in RAS/BRAF mutant as well as wild-type subpopulations and in left- and right- sided tumors. Furthermore, APCMUT were associated with improved E-TOT in PMB treated tumors independent of RAS/BRAF mutation status and tumor sidedness (HR range:0.59-0.75, all p<0.05). Conclusions: Our data suggests that the simple application of a high-utility mutational biomarker (APC), may increase the eligibility for successful EGFRi therapy in a substantial subpopulation of RAS/BRAF mt patients as well as right-sided CRC, potentially altering the standard of care. Further validation of this biomarker in a prospective clinical trial is warranted.

Median overall survival (days) of patients with CRC on EGFRi therapy.

HR (95% CI)APCMUTAPCWTP-value
RASWT/BRAFWT
(n=1454)
0.586 (0.499-0.688)766(n=1197)488(n=257)<0.00001
RASMUT/BRAFMUT
(n=355)
0.622 (0.477-0.811)558(n=235)355(n=120)<0.001
Left sided CRC (n=1201)0.645 (0.535-0.778)729 (n=1019)540 (n=182)<0.00001
Right sided CRC
(n=311)
0.609 (0.452-0.82)551 (n= 215)393 (n=96)<0.001

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

2024 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

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

Track

Colorectal Cancer,Anal Cancer

Sub Track

Patient-Reported Outcomes and Real-World Evidence

Citation

J Clin Oncol 42, 2024 (suppl 3; abstr 56)

DOI

10.1200/JCO.2024.42.3_suppl.56

Abstract #

56

Poster Bd #

D19

Abstract Disclosures

Similar Abstracts

Abstract

2023 ASCO Annual Meeting

Frequency of KRAS, NRAS, and BRAF mutations in colorectal cancer in an Argentinian population.

First Author: Agustín Barbier

Abstract

2022 ASCO Gastrointestinal Cancers Symposium

A phase 1b/2 study of VS-6766 in combination cetuximab in patients (pts) with advanced KRAS mt colorectal cancer (CRC).

First Author: Ardaman Shergill