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Wild-Type BRAF Is Required for Response to Panitumumab or Cetuximab in Metastatic Colorectal Cancer
Open accessAbstract
Purpose: Cetuximab or panitumumab are effective in 10% to 20% unselected metastatic colorectal cancer (CRC) patients. KRAS mutations account for approximately 30% to 40% patients who are not responsive. The serine-threonine kinase BRAF is the principal effector of KRAS. We hypothesized that, in KRAS wild-type patients, BRAF mutations could have a predictive/prognostic value. Patients and Methods: We retrospectively analyzed objective tumor responses, time to progression, overall survival (OS), and the mutational status of KRAS and BRAF in 113 tumors from cetuximab- or panitumumab-treated metastatic CRC patients. The effect of the BRAF V600E mutation on cetuximab or panitumumab response was also assessed using cellular models of CRC. Results: KRAS mutations were present in 30% of the patients and were associated with resistance to cetuximab or panitumumab (P = .011). The BRAF V600E mutation was detected in 11 of 79 patients who had wild-type KRAS. None of the BRAF-mutated patients responded to treatment, whereas none of the responders carried BRAF mutations (P = .029). BRAF-mutated patients had significantly shorter progression-free survival (P = .011) and OS (P < .0001) than wild-type patients. In CRC cells, the introduction of BRAF V600E allele impaired the therapeutic effect of cetuximab or panitumumab. Treatment with the BRAF inhibitor sorafenib restored sensitivity to panitumumab or cetuximab of CRC cells carrying the V600E allele. Conclusion: BRAF wild-type is required for response to panitumumab or cetuximab and could be used to select patients who are eligible for the treatment. Double-hit therapies aimed at simultaneous inhibition of epidermal growth factor receptor and BRAF warrant exploration in CRC patients carrying the V600E oncogenic mutation.
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“Although therapies targeting EGFR have some efficacy in CRCs without KRAS mutations (1, 5–8)”
From mTOR Inhibition Specifically Sensitizes Colorectal Cancers with KRAS or BRAF Mutations to BCL-2/BCL-XL Inhibition by Suppressing MCL-1 (2014) · cites this paper as [8]
In the citing paper
“However, the predictive impact of BRAF mutations is tempered by their low prevalence and is further biased by the prominent role of mutant BRAF as a negative prognostic biomarker [54]. Overall, the predictive power of this alteration remains immature and requires further prospective endorsement before clinical applicability [20, 33, 52, 55].”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
In the citing paper
“Mutations of BRAF, which encodes the cytoplasmic serine/threonine kinase immediately downstream of RAS, are found in 4–13 % of advanced CRCs and are usually mutually exclusive with KRAS mutations [20, 52].”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
In the citing paper
“preclinical studies have provided a proof of principle that the combined inhibition of EGFR and BRAF can be synergistic in BRAF-mutant CRCs”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
In the citing paper
“The BRAF V600E mutation has been described as a predictor of tumor aggressiveness in metastatic disease [33, 52, 53]”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
In the citing paper
“the best responses of CRC cell xenografts to such combinations were only disease stabilizations or mild tumor regressions [52, 58-60].”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
In the citing paper
“and also of low RRs to cetuximab and panitumumab [18, 20, 52, 53].”
From Primary and acquired resistance to EGFR-targeted therapies in colorectal cancer: impact on future treatment strategies (2014) · cites this paper as [52]
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“Mutations inRAS (KRAS orNRAS ) are known predictive markers for lack of response,(2-4) whereas BRAF mutations confer poorer prognosis and resistance to anti-epidermal growth factor receptor (EGFR) therapy given beyond first-line treatment.(5) PIK3CA mutation may predict beneficial effect for adjuvant aspirin therapy a…”
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“Patients with wild-type KRAS tumors would benefit from EGFR antibodies [20], while those with mutated KRAS may have a low response rate and poor outcome [21, 22].”
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KRAS and BRAF mutations in anal carcinoma
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The Multidisciplinary Management of Colorectal Cancer: Present and Future Paradigms
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“[22] who retrospectively analysed 113 patients with mCRC for BRAF mutations, and found that mutant BRAF mCRC was refractory to cetuximab and panitumumab therapy and, therefore, had significantly shorter disease-free (p = 0.”
MethodMutation pattern of KRAS and BRAF oncogenes in colorectal cancer patients
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“therapy requires the presence of the wild-type allele [8], testing for the mutation would have an impact on therapeutic outcome and on planning individualized therapy concepts.”
BackgroundLynch syndrome: clinical, pathological, and genetic insights
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“It has been shown in vitro that resistance to cetuximab in colorectal cancer cell lines with mutant B-Raf can be reversed by combining cetuximab with a B-Raf kinase inhibitor sorafenib [234].”
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“The overall BRAF V600E mutational rate was 3% compared to approximately 8-10% reported in the literature [2,4,7,12,20-23].”
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“[44] Di Nicolantonio F, Martini M, Molinari F, et al.”
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“29,36 Di Nicolantonio et al discovered that HT-29 and COLO-205 (both BRAF V600E mutation and wild-type for KRAS) were highly resistant to cetuximab or panitumumab therapy, and the BRAF inhibitor sorafenib could restore sensitivity to anti-EGFR therapy.”
InfluentialYamamoto, I., Nosho, K., Kanno, S., Igarashi, H., Kurihara, H., Ishigami, K., Ishiguro, K., Mitsuhashi, K., Maruyama, R., Koide, H., et al. (2017) · Oncotarget · doi:10.18632/oncotarget.14863 · Cited by 21
“BRAF has also been reported to demonstrate a correlation between mutation and resistance to treatment with anti-EGFR therapy [4, 5, 7, 10, 13, 36].”
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“(6 – 8).”
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“In addition, both KRAS and BRAF are currently being targeted as potential prognostic and predictive biomarkers in patients with metastatic disease treated with anti-EGFR therapies.(11,12) As there are no available data on the molecular features of colorectal tumours in Peruvian patients, we decided to explore several…”
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“Patients with this mutation have poorer prognosis and appear to respond less robustly to the anti-EGFR antibodies [10].”
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Self-citationRAS, BRAF, and TP53 Gene Mutations in Taiwanese Colorectal Cancer Patients
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“Of the KRAS wild-type mCRC patients, about 15 % have BRAF mutations [14, 17]; therefore, BRAF V600E mutations could account for an additional 15 % of patients who are KRAS wild-type, but are nonresponsive to anti-EGFR therapy [14, 17].”
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“14 %).(10,14,15) A pCR after neoadjuvant CRT has been shown to be associated with excellent long-term survival, with low rates of local and distant recurrences, and this is further supported by our data.”
Result
Metadata
- Authors
- Di Nicolantonio, F., Martini, M., Molinari, F., Sartore-Bianchi, A., Arena, S., Saletti, P., De Dosso, S., Mazzucchelli, L., Frattini, M., Siena, S., & Bardelli, A.
- Affiliations
- From the Laboratory of Molecular Genetics, The Oncogenomics Center, Institute for Cancer Research and Treatment, University of Torino Medical School, Candiolo; The Falck Division of Medical Oncology, Ospedale Niguarda Ca’ Granda; Italian Foundation for Cancer Research–Institute of Molecular Oncology, Milan, Italy; Laboratory of Molecular Diagnostic, Istituto Cantonale di Patologia, Locarno; and Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Venue
- Journal of Clinical Oncology
- Published
- 2008-12-10
- Volume
- 26
- Issue
- 35
- Pages
- 5705-5712
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2131413118
- Cited by
- 1,591
- References
- 38
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 25 · 2023: 32 · 2022: 35 · 2021: 48 · 2020: 71 · 2019: 54 · 2018: 57 · 2017: 67 · 2016: 126 · 2015: 108 · 2014: 147 · 2013: 146 · 2012: 148
- FWCI
- 87.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- Oncosuisse
- Regione Piemonte
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- BRAF wild-type, BRAF V600E mutation, KRAS mutation, cetuximab, panitumumab, metastatic colorectal cancer, EGFR inhibitors, treatment resistance, sorafenib, predictive biomarkers, progression-free survival, overall survival
- MeSH terms
- Cetuximab, Sorafenib, Panitumumab, Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Antineoplastic Agents, Benzenesulfonates, Cell Survival, Dose-Response Relationship, Drug, Female, Humans, Italy, Male, Middle Aged, Mutation, Neoplasm Metastasis, Niacinamide, Phenylurea Compounds, Proto-Oncogene Proteins, Pyridines, Retrospective Studies, Switzerland, Time Factors, Biomarkers, Tumor, Colorectal Neoplasms, Gene Expression Regulation, Neoplastic, Proto-Oncogene Proteins p21(ras), Treatment Outcome, Disease-Free Survival, Patient Selection, ras Proteins, Drug Resistance, Neoplasm, HT29 Cells, Gene Expression Profiling, Protein Kinase Inhibitors, Proto-Oncogene Proteins B-raf, Antibodies, Monoclonal, Humanized, ErbB Receptors
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