Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers

A secondary analysis of 2 randomized clinical trials

Frank A Sinicrope, Qian D Shi, Carmen J. Allegra, Thomas Christopher Smyrk, Stephen N Thibodeau, Richard M. Goldberg, Jeffrey P. Meyers, Kay L. Pogue-Geile, Greg Yothers, Daniel J. Sargent, Steven Robert Alberts

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

IMPORTANCE: The association of biomarkers with patient survival after recurrence (SAR) of cancer is poorly understood but may guide management and treatment. OBJECTIVE: To determine the association of DNA mismatch repair (MMR) status and somatic mutation in the B-Raf proto-oncogene (c.1799T>A [V600E]; BRAFV600E) or exon 2 of the KRAS proto-oncogene (KRAS) in the primary tumor with SAR in patients with stage III colon carcinomas treated with adjuvant chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: Patients with resected stage III colon cancers were randomized to adjuvant FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) chemotherapy with or without cetuximab (North Central Cancer Treatment Group N0147 trial) or adjuvant FOLFOX chemotherapy with or without bevacizumab (National Surgical Adjuvant Breast and Bowel Project C-08 trial). Associations of biomarkers with SAR were analyzed using Cox proportional hazards models adjusted for clinicopathologic features and time to recurrence (data collected February 10, 2004, to August 7, 2015). MAIN OUTCOMES AND MEASURES: The primary study outcome was survival after recurrence of cancer. A secondary outcome measure was the effect of the site of the primary tumor on the association of biomarkers with SAR. RESULTS: Among 871 patients with cancer recurrence in the N0147 trial (472 men [54.2%] and 399 women [45.8%]; mean [SD] age, 57.8 [11.2] years) and 524 in the C-08 trial (269 men [51.3%] and 255 women [48.7%]; mean [SD] age, 57.0 [11.7] years), multivariable analysis revealed that patients whose tumors had deficient vs proficient MMR had significantly better SAR (adjusted hazard ratio [AHR], 0.70; 95% CI, 0.52-0.96; P = .03). Patients whose tumors harbored mutant BRAFV600E (AHR, 2.45; 95% CI, 1.85-3.25; P < .001) or mutant KRAS (AHR, 1.21; 95% CI, 1.00-1.47; P = .052) had worse SAR compared with those whose tumors had wild-type copies of both genes, although only results for BRAFV600E achieved statistical significance. Significant interactions were found for MMR (P = .03) and KRAS (P =.02) by primary tumor site for SAR. Improved SAR was observed for patients with deficient MMR tumors of the proximal vs distal colon (AHR, 0.57; 95% CI, 0.40-0.83; P = .003), and worse SAR was observed for tumors of the distal colon with mutant KRAS in codon 12 (AHR, 1.76; 95% CI, 1.30-2.38; P < .001) and codon 13 (AHR, 1.76; 95% CI, 1.08-2.86; P = .02). CONCLUSIONS AND RELEVANCE: In patients with recurrence of stage III colon cancer, deficient MMR was significantly associated with better SAR, and this benefit was limited to primary tumors of the proximal colon. Mutations in BRAFV600E were significantly associated with worse SAR, and worse SAR for BRAFV600E or KRAS mutant tumors was more strongly associated with distal cancers. These biomarkers have implications for patient management at recurrence. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00079274 and NCT00096278.

Original languageEnglish (US)
Pages (from-to)472-480
Number of pages9
JournalJAMA oncology
Volume3
Issue number4
DOIs
StatePublished - 2017

Fingerprint

DNA Mismatch Repair
Colonic Neoplasms
Randomized Controlled Trials
Recurrence
Mutation
Survival
Neoplasms
Colon
Biomarkers
oxaliplatin
Leucovorin
Proto-Oncogenes
Outcome Assessment (Health Care)
Adjuvant Chemotherapy
Codon

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers : A secondary analysis of 2 randomized clinical trials. / Sinicrope, Frank A; Shi, Qian D; Allegra, Carmen J.; Smyrk, Thomas Christopher; Thibodeau, Stephen N; Goldberg, Richard M.; Meyers, Jeffrey P.; Pogue-Geile, Kay L.; Yothers, Greg; Sargent, Daniel J.; Alberts, Steven Robert.

In: JAMA oncology, Vol. 3, No. 4, 2017, p. 472-480.

Research output: Contribution to journalArticle

Sinicrope, Frank A ; Shi, Qian D ; Allegra, Carmen J. ; Smyrk, Thomas Christopher ; Thibodeau, Stephen N ; Goldberg, Richard M. ; Meyers, Jeffrey P. ; Pogue-Geile, Kay L. ; Yothers, Greg ; Sargent, Daniel J. ; Alberts, Steven Robert. / Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers : A secondary analysis of 2 randomized clinical trials. In: JAMA oncology. 2017 ; Vol. 3, No. 4. pp. 472-480.
@article{9dd864976e1f4595bf3fa43b256e1f2e,
title = "Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers: A secondary analysis of 2 randomized clinical trials",
abstract = "IMPORTANCE: The association of biomarkers with patient survival after recurrence (SAR) of cancer is poorly understood but may guide management and treatment. OBJECTIVE: To determine the association of DNA mismatch repair (MMR) status and somatic mutation in the B-Raf proto-oncogene (c.1799T>A [V600E]; BRAFV600E) or exon 2 of the KRAS proto-oncogene (KRAS) in the primary tumor with SAR in patients with stage III colon carcinomas treated with adjuvant chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: Patients with resected stage III colon cancers were randomized to adjuvant FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) chemotherapy with or without cetuximab (North Central Cancer Treatment Group N0147 trial) or adjuvant FOLFOX chemotherapy with or without bevacizumab (National Surgical Adjuvant Breast and Bowel Project C-08 trial). Associations of biomarkers with SAR were analyzed using Cox proportional hazards models adjusted for clinicopathologic features and time to recurrence (data collected February 10, 2004, to August 7, 2015). MAIN OUTCOMES AND MEASURES: The primary study outcome was survival after recurrence of cancer. A secondary outcome measure was the effect of the site of the primary tumor on the association of biomarkers with SAR. RESULTS: Among 871 patients with cancer recurrence in the N0147 trial (472 men [54.2{\%}] and 399 women [45.8{\%}]; mean [SD] age, 57.8 [11.2] years) and 524 in the C-08 trial (269 men [51.3{\%}] and 255 women [48.7{\%}]; mean [SD] age, 57.0 [11.7] years), multivariable analysis revealed that patients whose tumors had deficient vs proficient MMR had significantly better SAR (adjusted hazard ratio [AHR], 0.70; 95{\%} CI, 0.52-0.96; P = .03). Patients whose tumors harbored mutant BRAFV600E (AHR, 2.45; 95{\%} CI, 1.85-3.25; P < .001) or mutant KRAS (AHR, 1.21; 95{\%} CI, 1.00-1.47; P = .052) had worse SAR compared with those whose tumors had wild-type copies of both genes, although only results for BRAFV600E achieved statistical significance. Significant interactions were found for MMR (P = .03) and KRAS (P =.02) by primary tumor site for SAR. Improved SAR was observed for patients with deficient MMR tumors of the proximal vs distal colon (AHR, 0.57; 95{\%} CI, 0.40-0.83; P = .003), and worse SAR was observed for tumors of the distal colon with mutant KRAS in codon 12 (AHR, 1.76; 95{\%} CI, 1.30-2.38; P < .001) and codon 13 (AHR, 1.76; 95{\%} CI, 1.08-2.86; P = .02). CONCLUSIONS AND RELEVANCE: In patients with recurrence of stage III colon cancer, deficient MMR was significantly associated with better SAR, and this benefit was limited to primary tumors of the proximal colon. Mutations in BRAFV600E were significantly associated with worse SAR, and worse SAR for BRAFV600E or KRAS mutant tumors was more strongly associated with distal cancers. These biomarkers have implications for patient management at recurrence. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00079274 and NCT00096278.",
author = "Sinicrope, {Frank A} and Shi, {Qian D} and Allegra, {Carmen J.} and Smyrk, {Thomas Christopher} and Thibodeau, {Stephen N} and Goldberg, {Richard M.} and Meyers, {Jeffrey P.} and Pogue-Geile, {Kay L.} and Greg Yothers and Sargent, {Daniel J.} and Alberts, {Steven Robert}",
year = "2017",
doi = "10.1001/jamaoncol.2016.5469",
language = "English (US)",
volume = "3",
pages = "472--480",
journal = "JAMA oncology",
issn = "2374-2437",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers

T2 - A secondary analysis of 2 randomized clinical trials

AU - Sinicrope, Frank A

AU - Shi, Qian D

AU - Allegra, Carmen J.

AU - Smyrk, Thomas Christopher

AU - Thibodeau, Stephen N

AU - Goldberg, Richard M.

AU - Meyers, Jeffrey P.

AU - Pogue-Geile, Kay L.

AU - Yothers, Greg

AU - Sargent, Daniel J.

AU - Alberts, Steven Robert

PY - 2017

Y1 - 2017

N2 - IMPORTANCE: The association of biomarkers with patient survival after recurrence (SAR) of cancer is poorly understood but may guide management and treatment. OBJECTIVE: To determine the association of DNA mismatch repair (MMR) status and somatic mutation in the B-Raf proto-oncogene (c.1799T>A [V600E]; BRAFV600E) or exon 2 of the KRAS proto-oncogene (KRAS) in the primary tumor with SAR in patients with stage III colon carcinomas treated with adjuvant chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: Patients with resected stage III colon cancers were randomized to adjuvant FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) chemotherapy with or without cetuximab (North Central Cancer Treatment Group N0147 trial) or adjuvant FOLFOX chemotherapy with or without bevacizumab (National Surgical Adjuvant Breast and Bowel Project C-08 trial). Associations of biomarkers with SAR were analyzed using Cox proportional hazards models adjusted for clinicopathologic features and time to recurrence (data collected February 10, 2004, to August 7, 2015). MAIN OUTCOMES AND MEASURES: The primary study outcome was survival after recurrence of cancer. A secondary outcome measure was the effect of the site of the primary tumor on the association of biomarkers with SAR. RESULTS: Among 871 patients with cancer recurrence in the N0147 trial (472 men [54.2%] and 399 women [45.8%]; mean [SD] age, 57.8 [11.2] years) and 524 in the C-08 trial (269 men [51.3%] and 255 women [48.7%]; mean [SD] age, 57.0 [11.7] years), multivariable analysis revealed that patients whose tumors had deficient vs proficient MMR had significantly better SAR (adjusted hazard ratio [AHR], 0.70; 95% CI, 0.52-0.96; P = .03). Patients whose tumors harbored mutant BRAFV600E (AHR, 2.45; 95% CI, 1.85-3.25; P < .001) or mutant KRAS (AHR, 1.21; 95% CI, 1.00-1.47; P = .052) had worse SAR compared with those whose tumors had wild-type copies of both genes, although only results for BRAFV600E achieved statistical significance. Significant interactions were found for MMR (P = .03) and KRAS (P =.02) by primary tumor site for SAR. Improved SAR was observed for patients with deficient MMR tumors of the proximal vs distal colon (AHR, 0.57; 95% CI, 0.40-0.83; P = .003), and worse SAR was observed for tumors of the distal colon with mutant KRAS in codon 12 (AHR, 1.76; 95% CI, 1.30-2.38; P < .001) and codon 13 (AHR, 1.76; 95% CI, 1.08-2.86; P = .02). CONCLUSIONS AND RELEVANCE: In patients with recurrence of stage III colon cancer, deficient MMR was significantly associated with better SAR, and this benefit was limited to primary tumors of the proximal colon. Mutations in BRAFV600E were significantly associated with worse SAR, and worse SAR for BRAFV600E or KRAS mutant tumors was more strongly associated with distal cancers. These biomarkers have implications for patient management at recurrence. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00079274 and NCT00096278.

AB - IMPORTANCE: The association of biomarkers with patient survival after recurrence (SAR) of cancer is poorly understood but may guide management and treatment. OBJECTIVE: To determine the association of DNA mismatch repair (MMR) status and somatic mutation in the B-Raf proto-oncogene (c.1799T>A [V600E]; BRAFV600E) or exon 2 of the KRAS proto-oncogene (KRAS) in the primary tumor with SAR in patients with stage III colon carcinomas treated with adjuvant chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: Patients with resected stage III colon cancers were randomized to adjuvant FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) chemotherapy with or without cetuximab (North Central Cancer Treatment Group N0147 trial) or adjuvant FOLFOX chemotherapy with or without bevacizumab (National Surgical Adjuvant Breast and Bowel Project C-08 trial). Associations of biomarkers with SAR were analyzed using Cox proportional hazards models adjusted for clinicopathologic features and time to recurrence (data collected February 10, 2004, to August 7, 2015). MAIN OUTCOMES AND MEASURES: The primary study outcome was survival after recurrence of cancer. A secondary outcome measure was the effect of the site of the primary tumor on the association of biomarkers with SAR. RESULTS: Among 871 patients with cancer recurrence in the N0147 trial (472 men [54.2%] and 399 women [45.8%]; mean [SD] age, 57.8 [11.2] years) and 524 in the C-08 trial (269 men [51.3%] and 255 women [48.7%]; mean [SD] age, 57.0 [11.7] years), multivariable analysis revealed that patients whose tumors had deficient vs proficient MMR had significantly better SAR (adjusted hazard ratio [AHR], 0.70; 95% CI, 0.52-0.96; P = .03). Patients whose tumors harbored mutant BRAFV600E (AHR, 2.45; 95% CI, 1.85-3.25; P < .001) or mutant KRAS (AHR, 1.21; 95% CI, 1.00-1.47; P = .052) had worse SAR compared with those whose tumors had wild-type copies of both genes, although only results for BRAFV600E achieved statistical significance. Significant interactions were found for MMR (P = .03) and KRAS (P =.02) by primary tumor site for SAR. Improved SAR was observed for patients with deficient MMR tumors of the proximal vs distal colon (AHR, 0.57; 95% CI, 0.40-0.83; P = .003), and worse SAR was observed for tumors of the distal colon with mutant KRAS in codon 12 (AHR, 1.76; 95% CI, 1.30-2.38; P < .001) and codon 13 (AHR, 1.76; 95% CI, 1.08-2.86; P = .02). CONCLUSIONS AND RELEVANCE: In patients with recurrence of stage III colon cancer, deficient MMR was significantly associated with better SAR, and this benefit was limited to primary tumors of the proximal colon. Mutations in BRAFV600E were significantly associated with worse SAR, and worse SAR for BRAFV600E or KRAS mutant tumors was more strongly associated with distal cancers. These biomarkers have implications for patient management at recurrence. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00079274 and NCT00096278.

UR - http://www.scopus.com/inward/record.url?scp=85018560281&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018560281&partnerID=8YFLogxK

U2 - 10.1001/jamaoncol.2016.5469

DO - 10.1001/jamaoncol.2016.5469

M3 - Article

VL - 3

SP - 472

EP - 480

JO - JAMA oncology

JF - JAMA oncology

SN - 2374-2437

IS - 4

ER -