To give or not to give anti-epidermal growth factor receptor (EGFR) monoclonal antibodies to patients with KRAS G13D mutation in advanced colorectal cancer

摘要

Recent retrospective analyses of clinical trials in metastatic colorectal cancer reveal a clear lack of efficacy for the anti-epidermal growth factor receptor (EGFR) monoclonal antibodies cetuximab and panitumumab in patients with KRAS mutated tumors. As a result, in 2009 the US Food and Drug Administration updated the labels of cetuximab and panitumumab to exclude treatment of metastatic colorectal cancer with KRAS mutations. However many of these retrospective analyses grouped codon 12 and codon 13 mutations together without subgroup analyses. KRAS mutation frequency in patients with colorectal cancer is approximately 40%, with relative and absolute incidences of the codon G13D mutation of 19.5% and 8%, respectively.3 Different codon mutations have become increasingly important with the arrival of data indicating that perhaps all KRAS mutations are not created equal in terms of their biological effects.