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Value of Mismatch Repair, KRAS , and BRAF Mutations in Predicting Recurrence and Benefits From Chemotherapy in Colorectal Cancer

Open access
Hutchins, Gordon, Southward, Katie, Handley, Kelly, Magill, Laura, Beaumont, Claire, Stahlschmidt, Jens, Richman, Susan, Chambers, Philip, Seymour, Matthew, Kerr, David, Gray, Richard, Quirke, Philip·2011·Journal of Clinical Oncology

Abstract

Purpose: It is uncertain whether modest benefits from adjuvant chemotherapy in stage II colorectal cancer justify the toxicity, cost, and inconvenience. We investigated the usefulness of defective mismatch repair (dMMR), BRAF, and KRAS mutations in predicting tumor recurrence and sensitivity to chemotherapy. Patients and Methods: Immunohistochemistry for dMMR and pyrosequencing for KRAS/BRAF were performed for 1,913 patients randomly assigned between fluorouracil and folinic acid chemotherapy and no chemotherapy in the Quick and Simple and Reliable (QUASAR) trial. Results: Twenty-six percent of 695 right-sided colon, 3% of 685 left-sided colon, and 1% of 407 rectal tumors were dMMR. Similarly, 17% of right colon, 2% of left colon, and 2% of rectal tumors were BRAF mutant. KRAS mutant tumors were more evenly distributed: 40% right colon, 28% left colon, and 36% rectal tumors. Recurrence rate for dMMR tumors was half that for MMR-proficient tumors (11% [25 of 218] v 26% [438 of 1,695] recurred; risk ratio [RR], 0.53; 95% CI, 0.40 to 0.70; P < .001). Risk of recurrence was also significantly higher for KRAS mutant than KRAS wild-type tumors (28% [150 of 542] v 21% [219 of 1,041]; RR, 1.40; 95% CI, 1.12 to 1.74; P = .002) but did not differ significantly between BRAF mutant and wild-type tumors (P = .36). No marker predicted benefit from chemotherapy with efficacy not differing significantly by MMR, KRAS, or BRAF status. The prognostic value of MMR and KRAS was similar in the presence and absence of chemotherapy. Conclusion: MMR assays identify patients with a low risk of recurrence. KRAS mutational analysis provides useful additional risk stratification to guide use of chemotherapy.

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Metadata

Authors
Hutchins, G., Southward, K., Handley, K., Magill, L., Beaumont, C., Stahlschmidt, J., Richman, S., Chambers, P., Seymour, M., Kerr, D., Gray, R., & Quirke, P.
Venue
Journal of Clinical Oncology
Published
2011-04-01
Volume
29
Issue
10
Pages
1261-1270
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
OpenAlex
W2171235660
Cited by
681
References
5
FWCI
22.61
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Value of Mismatch Repair, KRAS , and BRAF Mutations in Predicting Recurrence and Benefits From Chemotherapy in Colorectal Cancer. https://app.cochat.ai/papers/10.1200/jco.2010.30.1366
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Hutchins, G., Southward, K., Handley, K., Magill, L., Beaumont, C., Stahlschmidt, J., Richman, S., Chambers, P., Seymour, M., Kerr, D., Gray, R., & Quirke, P. (2011). Value of Mismatch Repair, KRAS , and BRAF Mutations in Predicting Recurrence and Benefits From Chemotherapy in Colorectal Cancer. Journal of Clinical Oncology. https://doi.org/10.1200/jco.2010.30.1366

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