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KRAS Allelic Variants in Biliary Tract Cancers
Gordon Taylor Moffat1, Zishuo Ian Hu2, Funda Meric-Bernstam3
1Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
KRAS allelic variants are common in biliary tract cancers (BTCs), particularly in perihilar and extrahepatic subtypes. The G12D variant showed the longest median overall survival, offering potential therapeutic targets for this patient group.
Area of Science:
- Oncology
- Genomics
- Cancer Research
Background:
- Biliary tract cancers (BTCs) exhibit actionable molecular alterations, including KRAS variants, which are present in 20-30% of cases.
- Multiple KRAS inhibitors are under clinical investigation, highlighting the therapeutic potential of targeting these mutations.
Purpose of the Study:
- To characterize the genomic landscape, immunophenotype, and survival outcomes of KRAS-mutated BTCs.
- To determine the median overall survival (mOS) for common KRAS allelic variants in BTC patients.
Main Methods:
- A retrospective, multicenter cohort study analyzed clinical and next-generation sequencing data from 7457 BTC patients (2017-2022).
- Median overall survival was calculated for patients with KRAS-mutated BTCs, with specific analysis of common allelic variants.
Main Results:
- KRAS mutations were prevalent in perihilar (28.6%) and extrahepatic (36.1%) cholangiocarcinoma.
- The G12D variant (41% of KRAS mutations) had the highest mOS (25.1 months), followed by Q61H (22.8 months) and G12V (17.8 months).
- KRAS-mutated BTCs generally had low tumor mutational burden and a more immune-inflamed microenvironment compared to wild-type tumors.
Conclusions:
- KRAS allelic variants are common and potentially actionable genomic alterations in BTCs, especially in perihilar and extrahepatic subtypes.
- These findings contribute to understanding the genomic and immune profiles of KRAS-mutated BTCs, aiding in personalized therapy planning.
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