Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer

Purpose Panitumumab, a fully human antibody against the epidermal growth factor receptor ( EGFR), has activity in a subset of patients with metastatic colorectal cancer ( mCRC). Although activating mutations in KRAS, a small G-protein downstream of EGFR, correlate with poor response to anti-EGFR antibodies in mCRC, their role as a selection marker has not been established in randomized trials. Patients and Methods KRAS mutations were detected using polymerase chain reaction on DNA from tumor sections collected in a phase III mCRC trial comparing panitumumab monotherapy to best supportive care ( BSC). We tested whether the effect of panitumumab on progression- free survival ( PFS) differed by KRAS status. Results KRAS status was ascertained in 427 ( 92%) of 463 patients ( 208 panitumumab, 219 BSC). KRAS mutations were found in 43% of patients. The treatment effect on PFS in the wild- type ( WT) KRAS group ( hazard ratio [ HR], 0.45; 95% CI: 0.34 to 0.59) was significantly greater ( P < .0001) than in the mutant group ( HR, 0.99; 95% CI, 0.73 to 1.36). Median PFS in the WT KRAS group was 12.3 weeks for panitumumab and 7.3 weeks for BSC. Response rates to panitumumab were 17% and 0%, for the WT and mutant groups, respectively. WT KRAS patients had longer overall survival ( HR, 0.67; 95% CI, 0.55 to 0.82; treatment arms combined). Consistent with longer exposure, more grade III treatment-related toxicities occurred in the WT KRAS group. No significant differences in toxicity were observed between the WT KRAS group and the overall population. Conclusion Panitumumab monotherapy efficacy in mCRC is confined to patients with WT KRAS tumors. KRAS status should be considered in selecting patients with mCRC as candidates for panitumumab monotherapy.