title: Experiences from treatment-predictive KRAS testing; high mutation frequency in rectal cancers from females and concurrent mutations in the same tumor.
abstract: BACKGROUND
  KRAS mutations represent key alterations in colorectal cancer development and lead to constitutive EGFR signaling. Since EGFR inhibition represents a therapeutic strategy in advanced colorectal cancer, KRAS mutation analysis has quickly been introduced as a treatment-predictive test.
  
  
  METHODS
  We used a real-time PCR based method to determine KRAS mutations in 136 colorectal cancers with mutations identified in 53 (39%) tumors.
  
  
  RESULTS
  KRAS mutations were significantly more often found in rectal cancer (21/38, 55%) than in colon cancer (32/98, 33%) (P = 0.02). This finding was explained by marked differences mutation rates in female patients who showed mutations in 33% of the colon cancers and in 67% of the rectal cancers (P = 0.01). Concurrent KRAS mutations were identified in three tumors; two colorectal cancers harbored Gly12Asp/Gly13Asp and Gly12Cys/Gly13Asp and a third tumor carried Gly12Cys/Gly12Asp in an adenomatous component and additionally acquired Gly12Val in the invasive component.
  
  
  CONCLUSIONS
  The demonstration of a particularly high KRAS mutation frequency among female rectal cancer patients suggests that this subset is the least likely to respond to anti-EGFR therapies, whereas the observation of concurrent KRAS mutations imply that repeated KRAS targeting may occur during tumor progression in a subset of colorectal cancers.
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Lund university, Lund, Sweden. mats.jonsson@med.lu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Jönsson
authors.forename: Anna
authors.initials: A
authors.lastname: Ekstrand
authors.forename: Thomas
authors.initials: T
authors.lastname: Edekling
authors.forename: Jakob
authors.initials: J
authors.lastname: Eberhard
authors.forename: Dorthe
authors.initials: D
authors.lastname: Grabau
authors.forename: David
authors.initials: D
authors.lastname: Borg
authors.forename: Mef
authors.initials: M
authors.lastname: Nilbert