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- Title
The treatment paradigm of right-sided metastatic colon cancer: harboring BRAF mutation makes the difference.
- Authors
Roberto, Michela; Marchetti, Paolo; Arrivi, Giulia; Di Pietro, Francesca Romana; Cascinu, Stefano; Gelsomino, Fabio; Caputo, Francesco; Cerma, Krisida; Ghidini, Michele; Ratti, Margherita; Pizzo, Claudio; Ficorella, Corrado; Parisi, Alessandro; Cortellini, Alessio; Urbano, Federica; Calandrella, Maria Letizia; Botticelli, Andrea; Dell'Aquila, Emanuela; Minelli, Alessandro; Fulgenzi, Claudia
- Abstract
Purpose: BRAF mutations represent the main negative prognostic factor for metastatic colorectal cancer and a supposed negative predictive factor of response to standard chemotherapy. We have explored survival difference in right-sided colon cancer (RCC) patients according to BRAF mutations, with the aim to identify any predictive factors of response to targeted-based therapy. Methods: A retrospective study of RCC patients, with BRAF known mutation status, treated with chemotherapy (CT) from October 2008 to June 2019 in 5 Italian centers, was conducted. Results: We identified 207 advanced RCC patients: 20.3% BRAF mutant and 79.7% BRAF wild type (wt). BRAF-mutant cancers were more likely to be pT4 (50.0% v 25.7%, p = 0.016), undifferentiated (71.4% v 44.0%, p = 0.004), KRAS wt (90.5% v 38.2%, p < 0.001), and MSI-H (41.7% v 16.2%, p = 0.019) tumors, with synchronous (52.4% v 31.5%, p = 0.018) and peritoneal metastases (38.1% v 22.4%, p = 0.003). Median overall survival (OS) was 16 v 27 months in BRAF mutant and BRAF wt (P = 0.020). In first-line setting, BRAF-mutant showed a 2ys OS of 80% in clinical trials, 32% in anti-VEGF, 14% in epidermial growth factor receptor (EGFR), and 0% in chemotherapy alone regimens (P = 0.009). BRAF-mutant patients demonstrated worse survival, regardless of targeted therapy administered. However, survival difference was statistically significant in the anti-EGFR-treated subgroup (16 v 28 months, P = 0.005 in BRAF mutant v BRAF wt, respectively). Conclusions: Our study demonstrated that BRAF status makes the difference in treatment's outcome. Therefore, the anti-EGFR should not be excluded in all advanced RCC but considered on a case-by-case basis.
- Subjects
COLON cancer; METASTASIS; TREATMENT effectiveness; CLINICAL trials; THERAPEUTICS; BRAF genes
- Publication
International Journal of Colorectal Disease, 2020, Vol 35, Issue 8, p1513
- ISSN
0179-1958
- Publication type
Article
- DOI
10.1007/s00384-020-03589-9