Gramaça J, Fernandes IG, Trabulo C, Gonçalves J, dos Santos RG, Baptista A, Pina I. Emerging role of liquid biopsy in rat sarcoma virus mutated metastatic colorectal cancer: A case report. World J Gastrointest Oncol 2024; 16(1): 234-243 [PMID: 38292846 DOI: 10.4251/wjgo.v16.i1.234]
Corresponding Author of This Article
João Gramaça, MD, Doctor, Centro Hospitalar Barreiro Montijo, Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, Setúbal, Barreiro 2830-003, Portugal. jpgramaca@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jan 15, 2024; 16(1): 234-243 Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.234
Emerging role of liquid biopsy in rat sarcoma virus mutated metastatic colorectal cancer: A case report
João Gramaça, Isabel Gomes Fernandes, Carolina Trabulo, Joana Gonçalves, Rita Gameiro dos Santos, Adriano Baptista, Idília Pina
João Gramaça, Centro Hospitalar Barreiro Montijo, Centro Hospitalar Barreiro Montijo, Setúbal, Barreiro 2830-003, Portugal
Isabel Gomes Fernandes, Carolina Trabulo, Joana Gonçalves, Rita Gameiro dos Santos, Adriano Baptista, Idília Pina, Medical Oncology Unit, Centro Hospitalar Barreiro Montijo, Setúbal, Barreiro 2830-003, Portugal
Author contributions: Gramaça J and Pina I contributed to conceptualization and manuscript design; Gramaça J, Fernandes IG, Trabulo C, Gonçalves J, dos Santos RG and Baptista A contributed to data collection and interpretation; Gramaça J contributed to manuscript drafting; Gramaça J contributed to critical revision of the article.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: Dr. Gramaça reports non-financial support from Merck KGaA, Darmstadt, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: João Gramaça, MD, Doctor, Centro Hospitalar Barreiro Montijo, Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, Setúbal, Barreiro 2830-003, Portugal. jpgramaca@gmail.com
Received: July 27, 2023 Peer-review started: July 27, 2023 First decision: September 5, 2023 Revised: September 28, 2023 Accepted: November 8, 2023 Article in press: November 8, 2023 Published online: January 15, 2024
Abstract
BACKGROUND
In patients with metastatic colorectal cancer (mCRC), the treatment options are limited and have been proved to be affected by rat sarcoma virus (RAS) mutational status. In RAS wild-type (wt) patients, the combination of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies with chemotherapy (CT) is more effective than CT alone. On the other hand, RAS-mutated patients are not eligible for treatment with anti-EGFR antibodies.
CASE SUMMARY
Eleven patients with initially RAS-mutated mCRC were followed from diagnosis to May 2022. At the time of cell-free DNA determination, five patients had undergone one CT line, five patients had undergone two CT lines, and one patient had undergone three CT lines (all in combination with bevacizumab). At the second and third treatment lines [second line (2L), third line (3L)], patients with neo-RAS wt received a combination of CT and cetuximab. In neo-RAS wt patients treated with anti-EGFR, our findings indicated an increase in progression-free survival for both 2L and 3L (14.5 mo, P = 0.119 and 3.9 mo, P = 0.882, respectively). Regarding 2L overall survival, we registered a slight increase in neo-RAS wt patients treated with anti-EGFR (33.6 mo vs 32.4 mo, P = 0.385). At data cut-off, two patients were still alive: A RAS-mutated patient undergoing 3L treatment and a neo-RAS wt patient who received 2L treatment with anti-EGFR (ongoing).
CONCLUSION
Our case series demonstrated that monitoring RAS mutations in mCRC by liquid biopsy may provide an additional treatment line for neo-RAS wt patients.
Core Tip: In patients with metastatic colorectal cancer (mCRC), the treatment options are limited and have been proved to be affected by rat sarcoma virus (RAS) mutational status. This manuscript describes a series of 11 RAS-mutated mCRC patients who were treated with a combination of chemotherapy and bevacizumab at first line. Four patients became neo-RAS wild-type after first or second line treatment and were treated with cetuximab, with advantages in terms of survival and disease progression.
