KRAS Mutations Predict Response and Outcome in Advanced Lung Adenocarcinoma Patients Receiving First-Line Bevacizumab and Platinum-Based Chemotherapy
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Bevacizumab, combined with platinum-based chemotherapy, has been widely used in the treatment of advanced-stage lung adenocarcinoma (LADC). Although KRAS (V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog) mutation is the most common genetic alteration in human LADC and its role in promoting angiogenesis has been well established, its prognostic and predictive role in the above setting remains unclear. The association between KRAS exon 2 mutational status and clinicopathological variables including progression-free survival and overall survival (PFS and OS, respectively) was retrospectively analyzed in 501 Caucasian stage IIIB-IV LADC patients receiving first-line platinum-based chemotherapy (CHT) with or without bevacizumab (BEV). EGFR (epidermal growth factor receptor)-mutant cases were excluded. Of 247 BEV/CHT and 254 CHT patients, 95 (38.5%) and 75 (29.5%) had mutations in KRAS, respectively. KRAS mutation was associated with smoking (p = 0.008) and female gender (p = 0.002) in the BEV/CHT group. We found no difference in OS between patients with KRAS-mutant versus KRAS wild-type tumors in the CHT-alone group (p = 0.6771). Notably, patients with KRAS-mutant tumors demonstrated significantly shorter PFS (p = 0.0255) and OS (p = 0.0186) in response to BEV/CHT compared to KRAS wild-type patients. KRAS mutation was an independent predictor of shorter PFS (hazard ratio, 0.597; p = 0.011) and OS (hazard ratio, 0.645; p = 0.012) in the BEV/CHT group. G12D KRAS-mutant patients receiving BEV/CHT showed significantly shorter PFS (3.7 months versus 8.27 months in the G12/13x group; p = 0.0032) and OS (7.2 months versus 16.1 months in the G12/13x group; p = 0.0144). In this single-center, retrospective study, KRAS-mutant LADC patients receiving BEV/CHT treatment exhibited inferior PFS and OS compared to those with KRAS wild-type advanced LADC. G12D mutations may define a subset of KRAS-mutant LADC patients unsuitable for antiangiogenic therapy with BEV.
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In lung adenocarcinoma, chemotherapy combination with anti-VEGF antibody is effective in KRAS wild-type tumors exclusively.
“On the contrary, in case of lung adenocarcinoma, chemotherapy combination with anti-VEGF antibody is effective in KRAS wild-type tumors exclusively [70].”
From Hypoxia Signaling in Cancer: From Basics to Clinical Practice (2021) · cites this paper as [70]
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- Authors
- Ghimessy, Á. K., Gellert, Á., Schlegl, E., Hegedus, B., Raso, E., Barbai, T., Timar, J., Ostoros, G., Megyesfalvi, Z., Gieszer, B., Moldvay, J., Renyi-Vamos, F., Lohinai, Z., Hoda, M. A., Klikovits, T., Klepetko, W., Laszlo, V., & Dome, B.
- Affiliations
- Semmelweis University (HU)
- Department of Tumor Biology, National Koranyi Institute of Pulmonology–Semmelweis University, 1122 Budapest, Hungary
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
- 2nd Department of Pathology, Semmelweis University, 1091 Budapest, Hungary
- Országos Korányi Tbc és Pulmonológiai Intézet (HU)
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, 1122 Budapest, Hungary
- Comprehensive Cancer Center Vienna (AT)
- ORCID
- Venue
- Cancers
- Publisher
- MDPI AG
- Published
- 2019-10-09
- Volume
- 11
- Issue
- 10
- Pages
- 1514
- ISSN
- 2072-6694 (ISSN-L)
- PMC
- PMC6827133
- OpenAlex
- W2980109711
- Cited by
- 27
- References
- 65
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 5
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Cancers (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Hungarian National Research, Development and Innovation Office (KH130356, K109626, and SNN114490, BD; NVKP-16-1-2016-0020, JT; KH126753, OG)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- KRAS mutation, lung adenocarcinoma, bevacizumab, platinum-based chemotherapy, first-line therapy, predictive biomarkers, prognostic factors, progression-free survival, overall survival, G12D mutation, smoking, EGFR mutation, angiogenesis, advanced lung cancer, treatment response prediction, EGFR tyrosine kinase inhibitor resistance, EGFR tyrosine kinase inhibitors
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