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Validation of HER2 Amplification as a Predictive Biomarker for Anti–Epidermal Growth Factor Receptor Antibody Therapy in Metastatic Colorectal Cancer
Abstract
Purpose: HER2 amplification has been implicated in resistance to therapy with anti–epidermal growth factor receptor antibodies (anti-EGFRabs) in metastatic colorectal cancer (mCRC). The purpose of the study was to validate the predictive impact of HER2 amplification in mCRC. Patients and Methods: We analyzed patients with RAS/BRAF wild-type mCRC across two distinct cohorts. In cohort 1 (n = 98), HER2 amplification was tested in tumor tissue using dual in situ hybridization ( HER2 amplification: HER2/CEP17 ratio, 2.0 or greater). Cohort 2 (n = 70) included 16 patients with HER2 amplification and 54 HER2 nonamplified controls identified by next-generation sequencing ( HER2 amplification: four or more copies) who had received prior anti-EGFRabs. The primary end point was progression-free survival (PFS) on treatment with anti-EGFRab therapy, which was estimated and compared using the Kaplan-Meier method and log-rank test. Results: Median PFS in cohort 1 on anti-EGFRab–based therapy was significantly shorter in patients with HER2 amplification compared with HER2 nonamplified patients (2.8 v 8.1 months, respectively; hazard ratio [HR], 7.05; 95% CI, 3.4 to 14.9; P < .001). These findings were validated in cohort 2 (median PFS for HER2 amplified v nonamplified: 2.8 v 9.3 months, respectively; HR, 10.66; 95% CI, 4.5 to 25.1; P < .001). The median PFS on therapy without anti-EGFRabs was similar among HER2-amplified and nonamplified patients in both cohort 1 (9.7 v 11.1 months, respectively; HR, 1.01; 95% CI, 0.4 to 2.4; P = .97) and cohort 2 (9.6 v 11.3 months, respectively; HR, 1.21; 95% CI, 0.5 to 3.1; P = .66). In multivariable analyses, HER2 amplification emerged as a single independent predictor of poor PFS on anti-EGFRab therapy in both cohort 1 (HR, 6.48; 95% CI, 3.1 to 13.6; P < .001) and cohort 2 (HR, 10.1; 95% CI, 4.3 to 23.9; P < .001). Conclusion: HER2 amplification in RAS/RAF wild-type mCRC seems to be a predictive biomarker for lack of efficacy of anti-EGFRab therapy. Screening patients with RAS/BRAF wild-type mCRC for HER2 amplification should be considered before anti-EGFRab treatment to guide therapy and to identify patients for early referral to clinical trials.
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“the prognostic relevance of ERBB2 amplification itself in mCRC remains controversial.42 43 45”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [43]
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Metadata
- Authors
- Raghav, K., Loree, J. M., Morris, J. S., Overman, M. J., Yu, R., Meric-Bernstam, F., Menter, D., Korphaisarn, K., Kee, B., Muranyi, A., Singh, S., Routbort, M., Chen, K., Shaw, K. R. M., Katkhuda, R., Shanmugam, K., Maru, D., Fakih, M., & Kopetz, S.
- Affiliations
- City Of Hope National Medical Center (US)
- Kanwal Raghav, Jonathan M. Loree, Jeffrey S. Morris, Michael J. Overman, Ruoxi Yu, Funda Meric-Bernstam, David Menter, Krittiya Korphaisarn, Brian Kee, Mark Routbort, Ken Chen, Kenna R.M. Shaw, Riham Katkhuda, Dipen Maru, and Scott Kopetz, The University of Texas MD Anderson Cancer Center, Houston, TX; Andrea Muranyi, Shalini Singh, and Kandavel Shanmugam, Ventana Medical Systems, Tucson, AZ; and Marwan Fakih, City of Hope Comprehensive Cancer Center, Duarte, CA.
- ORCID
- Venue
- JCO Precision Oncology
- Published
- 2019-12
- Volume
- 3
- Issue
- 3
- Pages
- 1-13
- ISSN
- 2473-4284 (ISSN-L)
- OpenAlex
- W2912216712
- Cited by
- 132
- References
- 31
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 24 · 2023: 20 · 2022: 20 · 2021: 9 · 2020: 8 · 2019: 15
- FWCI
- 5.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JCO Precision Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Keywords
- HER2 amplification, metastatic colorectal cancer, anti-EGFR antibody therapy, predictive biomarkers, progression-free survival, RAS/BRAF wild-type, treatment resistance, HER2/CEP17 ratio, next-generation sequencing, anti-EGFR therapy, biomarker validation, prognostic factors
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