Open Access Highly Accessed Research article

Experiences from treatment-predictive KRAS testing; high mutation frequency in rectal cancers from females and concurrent mutations in the same tumor

Mats Jönsson1, Anna Ekstrand1, Thomas Edekling2, Jakob Eberhard1, Dorthe Grabau3, David Borg1 and Mef Nilbert14*

Author affiliations

1 Department of Oncology, Institute of Clinical Sciences, Lund university, Lund, Sweden

2 Department of Oncology, Växjö Hospital, Växjö, Sweden

3 Department of Pathology, Institute of Clinical Sciences, Lund university, Lund, Sweden

4 Clinical Research Centre, Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark

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Citation and License

BMC Clinical Pathology 2009, 9:8  doi:10.1186/1472-6890-9-8

Published: 15 October 2009



KRAS mutations represent key alterations in colorectal cancer development and lead to constitutive EGFR signaling. Since EGFR inhibition represents a therapeutic strategy in advanced colorectal cancer, KRAS mutation analysis has quickly been introduced as a treatment-predictive test.


We used a real-time PCR based method to determine KRAS mutations in 136 colorectal cancers with mutations identified in 53 (39%) tumors.


KRAS mutations were significantly more often found in rectal cancer (21/38, 55%) than in colon cancer (32/98, 33%) (P = 0.02). This finding was explained by marked differences mutation rates in female patients who showed mutations in 33% of the colon cancers and in 67% of the rectal cancers (P = 0.01). Concurrent KRAS mutations were identified in three tumors; two colorectal cancers harbored Gly12Asp/Gly13Asp and Gly12Cys/Gly13Asp and a third tumor carried Gly12Cys/Gly12Asp in an adenomatous component and additionally acquired Gly12Val in the invasive component.


The demonstration of a particularly high KRAS mutation frequency among female rectal cancer patients suggests that this subset is the least likely to respond to anti-EGFR therapies, whereas the observation of concurrent KRAS mutations imply that repeated KRAS targeting may occur during tumor progression in a subset of colorectal cancers.