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Should KRAS mutation still be used as a routine predictor of response to EGFR-TKIs in advanced non-small-cell lung

Min Ying1, Xiaoxia Zhu, Kexu Chen

  • 1Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.

Journal of Cancer Research and Clinical Oncology
|January 12, 2015
PubMed
Abstract

Insights

KRAS mutations may predict poor response to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in advanced non-small-cell lung cancer (NSCLC). However, KRAS testing has limited value when EGFR status is known.

Area of Science:

  • Oncology
  • Molecular Biology
  • Clinical Trials

Background:

  • Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are a standard treatment for advanced non-small-cell lung cancer (NSCLC).
  • The predictive role of KRAS mutation status for EGFR-TKI efficacy remains controversial in unselected NSCLC patients.

Purpose of the Study:

  • To conduct a meta-analysis evaluating KRAS status as a predictor of response to EGFR-TKIs in advanced NSCLC.
  • To perform a subset analysis in EGFR wild-type advanced NSCLC patients.

Main Methods:

  • Systematic literature searches were performed.
  • Meta-analysis of prospective intervention trials (n=1,859) and retrospective studies.
  • Endpoints included overall survival (OS), progression-free survival (PFS), and overall response rate (ORR).

Main Results:

  • KRAS mutation was associated with shorter OS and PFS and lower ORR in unselected advanced NSCLC patients.
  • In second- or later-line EGFR-TKI treatment, KRAS mutation predicted poorer survival but not response.
  • In EGFR wild-type patients, KRAS mutation did not impact outcomes with EGFR-TKIs.

Conclusions:

  • KRAS mutations may serve as a negative predictor for clinical benefit from EGFR-TKIs in advanced NSCLC.
  • KRAS testing has limited utility for patient selection when EGFR status is considered.

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