title: Coexistence of two different mutations in codon 12 of the Kras gene in colorectal cancer: Report of a case supporting the concept of tumoral heterogeneity.
abstract: Evaluation of the mutational status of KRAS is a crucial step for the correct therapeutic approach in treating advanced colorectal cancer as the identification of wild-type KRAS tumors leads to more specific and less toxic treatments for patients. Although several studies have highlighted the differences between primary and metastatic tumors, the possibility of two or more mutations in the same codon has seldom been reported. The present study reports an additional case of an advanced adenocarcinoma of the colon showing two somatic mutations (p.G12D and p.G12V) in the same codon (codon 12) of exon 2 of the KRAS gene, thus supporting the possibility of two differing clonal origins of the tumor. Although the clinical significance of multiple mutations remains unknown at present, based on the limited data available in the literature, this rare event appears to be associated with a more aggressive disease, as in the present case. This case report demonstrates the existence of intratumoral heterogeneity and the coexistence of distinct clones within a tumor that may have profound clinical implications for disease progression and therapeutic responses.
authors.affiliation: Laboratory of Clinical Research and Molecular Diagnostics, IRCCS-CROB Hospital, Rionero In Vulture, Potenza;
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Improta
authors.forename: Angela
authors.initials: A
authors.lastname: Zupa
authors.forename: Luciana
authors.initials: L
authors.lastname: Possidente
authors.forename: Alfredo
authors.initials: A
authors.lastname: Tartarone
authors.forename: Piernicola
authors.initials: P
authors.lastname: Pedicini
authors.forename: Antonio
authors.initials: A
authors.lastname: Nappi
authors.forename: Sergio
authors.initials: S
authors.lastname: Molinari
authors.forename: Filippo
authors.initials: F
authors.lastname: Fraggetta
authors.forename: Giulia
authors.initials: G
authors.lastname: Vita
keywords: KRAS; colorectal cancer; multiple mutations; tumoral heterogeneity