• Test Code:
    4224
  • Department:
  • Test Synonyms:
    Colon Cancer PanelBRAFKRASNRAS
  • CPT Code(s):
    81210 (BRAF)8127581403 (KRAS)81404 (NRAS)
Background:

It is well established that EGFR-targeted therapies such as cetuximab and panitumumab are ineffective against colorectal cancers harboring mutations in KRAS codons 12, 13 or 61. Recently, several studies have shown that other, more rare mutations in KRAS, as well as mutations in NRAS, also predict for resistance to these drugs.1-3 In addition, multiple studies have shown that BRAF mutation V600E correlates with a significantly worse prognosis and lack of response to cetuximab and panitumumab.4-5

 

Methodology:

  1. Microscopic examination of the specimen and macrodissection of tumor-rich areas
  2. DNA extraction and purification
  3. Next-generation DNA sequencing

Estimated sensitivity: at least 15% mutant allele; estimated specificity >99%

Specimen Requirements:

  • A paraffin block or
  • 10 unstained sections of tumor (4-5 microns) (15 sections for small biopsies)
  • Contact Client Services for shipping materials and procedures at (855) 535-1522.

A REQUISITION FORM MUST ACCOMPANY ALL SAMPLES.  Please include detailed clinical information.

Test Performed (Days):

Mon - Fri

Turn Around Time:

10-14 days

Shipment Sensitivity Requirements:

  • Keep specimen cool during transit. Do not ship on dry ice.
  • Please use the cold pack provided in the KDL shipping kit.
  • Ship the specimen overnight express, using the FedEx priority overnight label provided. 
  • Contact Client Services for shipping materials and procedures at (855) 535-1522.

References:

  1. Douillard et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med. 2013 Sep 12;369(11):1023-34. 
  2. Oliner et al.  Analysis of KRAS/NRAS and BRAF mutations in the phase III PRIME study of panitumumab (pmab) plus FOLFOX versus FOLFOX as first-line treatment (tx) for metastatic colorectal cancer (mCRC).  Journal of Clinical Oncology, 2013 ASCO Annual Meeting Abstracts. Vol 31, No 15_suppl (May 20 Supplement), 2013: 3511
  3. Stintzing et al.  Analysis of KRAS/NRAS and BRAF mutations in FIRE-3: A randomized phase III study of FOLFIRI plus cetuximab or bevacizumab as first-line treatment for wild-type (WT) KRAS (exon2) metastatic colorectal cancer (mCRC) patients. European Cancer Congress. Abstract 17. September, 2013.
  4. Lochhead et al. Microsatellite instability and BRAF mutation testing in colorectal cancer prognostication. J Natl Cancer Inst. 2013 Aug 7;105(15):1151-6.
  5. Toon et al. BRAFV600E immunohistochemistry in conjunction with mismatch repair status predicts survival in patients with colorectal cancer. Mod Pathol. 2013 Oct 25. [Epub ahead of print]

Additional Info:

The Knight Cancer Institute at Oregon Health & Science University is a pioneer in the field of precision cancer medicine. The institute's director, Brian Druker, M.D., helped prove it was possible to shut down just the cells that enable cancer to grow. This breakthrough has made once-fatal forms of the disease manageable and transformed how cancer is treated. The OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle – an honor earned only by the nation's top cancer centers. It is headquarters for one of the National Cancer Institute's largest research collaboratives, SWOG, in addition to offering the latest treatments and technologies as well as hundreds of research studies and clinical trials.

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