title: Implications for KRAS status and EGFR-targeted therapies in metastatic CRC.
abstract: EGFR regulates cancer-cell proliferation, apoptosis and tumor-induced neoangiogenesis, and has been validated as a relevant therapeutic target in several human cancers, including metastatic colorectal cancer (mCRC). The anti-EGFR monoclonal antibodies cetuximab and panitumumab are available for the treatment of patients with mCRC. Although EGFR is expressed in approximately 85% of patients with mCRC, the clinical efficacy of treatment with anti-EGFR antibodies is limited to a subset of patients. A series of potential biomarkers that could be useful in predicting response to EGFR inhibitors has been investigated. In patients with mCRC, activating mutations within KRAS can predict resistance to anti-EGFR monoclonal antibodies. Activating mutations in KRAS, which could result in EGFR-independent intracellular signal transduction activation, are found in approximately 35-40% of patients with mCRC. These mutations are almost exclusively detected in codons 12 and 13 of exon 2. KRAS mutations have been significantly associated with lack of response to cetuximab or panitumumab therapy in patients with mCRC, which suggests that EGFR-independent, constitutive activation of the RAS signaling pathway could impair response to anti-EGFR drugs. We summarize the experimental and clinical evidence supporting the use of KRAS testing for the optimal selection of patients with mCRC to be treated with anti-EGFR monoclonal antibodies.
authors.affiliation: Cell Biology and Biotherapy Unit, INT-Fondazione Pascale, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Normanno
authors.forename: Sabine
authors.initials: S
authors.lastname: Tejpar
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
authors.forename: Antonella
authors.initials: A
authors.lastname: De Luca
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
mesh_terms: D000595:Amino Acid Sequence; D019943:Amino Acid Substitution; D000911:Antibodies, Monoclonal / Q000235:genetics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001224:Aspartic Acid / Q000378:metabolism; D001483:Base Sequence; D014408:Biomarkers, Tumor / Q000235:genetics; D000068818:Cetuximab; D003062:Codon; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D019008:Drug Resistance, Neoplasm / Q000235:genetics; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005091:Exons; D011905:Genes, ras; D006801:Humans; D008969:Molecular Sequence Data; D009362:Neoplasm Metastasis; D000077544:Panitumumab; D018579:Patient Selection; D017354:Point Mutation; D015398:Signal Transduction / Q000235:genetics; D014633:Valine / Q000378:metabolism; D018631:ras Proteins / Q000235:genetics / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D003062:Codon; D001224:Aspartic Acid; D000077544:Panitumumab; D066246:ErbB Receptors; D018631:ras Proteins; D014633:Valine; D000068818:Cetuximab