Abstract 5403: Genetic, immunologic and prognostic heterogeneity in CRC patients with KRAS mutations
Authors: Wen Zhengqi , Zhang Hushan , Zhou Ruize , Liu Xihong , Li Wenliang 
Published: June 2022

Genetic, immunologic and prognostic heterogeneity in CRC patients with KRAS mutations Background Currently, most patients with mCRC are treated with a combination of a cytotoxic and a biologic agent. Several factors should be put into account which influencing the treatment strategy for patients with mCRC. including tumor resectability, prior systemic therapy; tumor location (left or right), and molecular characteristics such as mutation in gene Kirsten rat sarcoma viral oncogene homolog (KRAS). It has been demonstrated to be a tightly associated with poor response to anti-EGFR treatment, and even poor response to immune checkpoint inhibitors for patients with colorectal cancer. Therefore, KRAS mutational status testing has been highlighted in recent years. Methods This study queried the data from Formalin-Fixed Paraffin-Embedded (FFPE) tissues of 2,294 CRC patients which underwent a targeted next-generation sequencing assay performed by 3DMed Clinical Laboratory Inc., a College of American Pathologists (CAP) certified and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory of 3D Medicines Inc. between January, 2017 and June, 2020 in China, to obtain a comprehensive molecular profile of KRAS mutations. Co-occurring genomic alterations, tumor mutational burden (TMB), microsatellite instability (MSI) status and PD-L1 expression (Dako 22C3 or VentanaSP263, TPS score) were analyzed. High TMB was defined as TMB ≥10 muts/Mb. Postoperative follow-up data for 27 patients were collected and analyzed. Results KRAS mutation account for 48.7% Chinese CRC patients. In addition, proportions of KRAS mutation in different exons were counted. KRAS mutation in CRC mainly occurred in exon2 (84.0%), exon3 (6.1%), exon4 (7.4%), and exon5 (0.7%). KRAS mutation in exon2, the main mutations were G12D (35.4%), G12V (20.8%), G13D (21.9%), G12C (5.9%) ad G12S (5.8%). while in exon3 and exon4, the main mutations were Q61H (50.7%) and A146T (73.2%), respectively. The proportion of MSI-H in CRC patients with and without KRAS mutation were very close. While it seemed that there were more MSI-H patients in KRAS exon3 and exon4 mutation. In addition, PD-L1 expression was detected in 1220 tumor samples by means of IHC. Among these available tumor samples, level of PD-L1expression were similar among patients without KRAS mutation, KRAS mutation in different exons, but it reveled that there were very small part of patient with strong positive PD-L1 level (TPS≥50). In addition, different prognosis were found among different mutations of KRAS exon2, in detail, worse PFS was showed in CRC patients with KRAS mutation in exon2 G12D than G12V and G13D. Conclusions CRC patients with KRAS mutations in different exons and different site have different genetic and prognostic characteristics, these patients should be managed differently in clinical practice.

Citation Format: Zhengqi Wen, Hushan Zhang, Ruize Zhou, Xihong Liu, Wenliang Li. Genetic, immunologic and prognostic heterogeneity in CRC patients with KRAS mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5403.