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Published on: July 17, 2019
Frequency of KRAS, BRAF, and NRAS mutations in colorectal cancer
Cecily P Vaughn1, Scott D Zobell, Larissa V Furtado
1ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
Abstract:
Mutational analysis of KRAS codons 12 and 13 is standard for patients with metastatic colorectal cancer since mutations in these codons predict lack of response to anti-EGFR therapies. However, even among patients whose tumors are wildtype for KRAS codons 12 and 13, only a subset respond to therapy. Since additional activating mutations downstream of EGFR may also play a role in treatment resistance, we sought to establish the frequency of these mutations. We evaluated 2121 colorectal tumors for mutations in codons 12 and 13 of the KRAS gene. A subset of these samples, comprised of 513 samples wildtype for KRAS codons 12 and 13, were tested for mutations in codons 61 and 146 of KRAS, codon 600 of BRAF, and codons 12, 13, and 61 of NRAS. Mutation status was determined by targeted pyrosequencing. Mutations in KRAS codon 12 or 13 were identified in 900/2121 (42.4%) samples. Of the 513 wildtype samples tested for additional mutations, 78 samples were mutant for BRAF, 19 for KRAS codon 61, 17 for KRAS codon 146, and 26 for NRAS. In total, 140/513 (27.3%) tumors wildtype for KRAS codons 12 and 13 harbored a mutation in another of the RAS pathway genes. While further study is needed to determine the full therapeutic implications of mutations in these codons, mutational testing of these codons may be useful for identifying a significant proportion of patients who may also be resistant to anti-EGFR therapies.
Insights
Mutations in KRAS codons 12/13 are standard for colorectal cancer patients. Testing additional RAS pathway genes like BRAF and NRAS in KRAS wildtype tumors identified resistance mutations in 27.3% of patients.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Mutational analysis of KRAS codons 12 and 13 is standard for metastatic colorectal cancer (mCRC) patients, predicting response to anti-EGFR therapies.
- A subset of patients with wildtype KRAS codons 12 and 13 still exhibit resistance to anti-EGFR therapy, suggesting other mutations may be involved.
Purpose of the Study:
- To determine the frequency of mutations in other RAS pathway genes (KRAS codons 61 and 146, BRAF codon 600, NRAS codons 12, 13, and 61) in mCRC patients wildtype for KRAS codons 12 and 13.
- To assess the potential role of these additional mutations in resistance to anti-EGFR therapies.
Main Methods:
- Evaluated 2121 colorectal tumors for mutations in KRAS codons 12 and 13.
- Utilized targeted pyrosequencing to analyze mutations in KRAS codons 61 and 146, BRAF codon 600, and NRAS codons 12, 13, and 61 in 513 samples wildtype for KRAS codons 12 and 13.
Main Results:
- Mutations in KRAS codons 12 or 13 were found in 42.4% (900/2121) of samples.
- In the subset of 513 wildtype samples, 140 (27.3%) harbored mutations in other RAS pathway genes: BRAF (78), KRAS codon 61 (19), KRAS codon 146 (17), and NRAS (26).
Conclusions:
- A significant proportion (27.3%) of KRAS wildtype mCRC tumors harbor mutations in other RAS pathway genes.
- Mutational testing of these additional codons may help identify patients resistant to anti-EGFR therapies, warranting further investigation into their therapeutic implications.
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