Endoscopy 2020; 52(S 01): S311
DOI: 10.1055/s-0040-1704999
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Endoscopic ultrasound ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

NEW INSIGHTS ON THE PROGNOSTIC VALUE OF KRAS MUTATIONAL STATUS EVALUATED ON EUS-GUIDED FINE-NEEDLE ASPIRATION SPECIMENS IN PATIENTS WITH UNRESECTABLE PANCREATIC CANCER

IM Cazacu
1   University of Medicine and Pharmacy Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
,
IFC Harbiyeli
1   University of Medicine and Pharmacy Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
,
BS Singh
2   MD Anderson Cancer Center, Department of Gastroenterology, Hepatology and Nutrition, Houston, United States of America
,
A Semaan
3   MD Anderson Cancer Center, Sheikh Ahmed Pancreatic Cancer Research Center, Houston, United States of America
,
MS Serbanescu
4   University of Medicine and Pharmacy Craiova, Department of Medical Informatics and Biostatistics, Craiova, Romania
,
A Maitra
3   MD Anderson Cancer Center, Sheikh Ahmed Pancreatic Cancer Research Center, Houston, United States of America
,
MS Bhutani
2   MD Anderson Cancer Center, Department of Gastroenterology, Hepatology and Nutrition, Houston, United States of America
,
A Saftoiu
1   University of Medicine and Pharmacy Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims The aim of this study was to investigate the prognostic role of KRAS mutational status within the primary tumor in patients with unresectable locally advanced/metastatic pancreatic ductal adenocarcinoma (PDAC).

Methods We retrospectively examined a cohort of 24 patients with unresectable PDAC who underwent EUS-guided fine needle aspiration (EUS-FNA) for diagnosis at our institution. FNAs were collected in RNAlater and stored at −80 C. The Exon-2 KRAS mutational status was evaluated on the EUS-FNA samples using droplet digital polymerase chain reaction (ddPCR). The Kaplan-Meier method, log-rank test, and the t-test were used to evaluate the impact of KRAS status on the overall survival (OS), adjusting for age, gender, stage of disease and treatment regimen.

Results Sixteen patients with PDAC whose tumors harbored KRAS mutations (G12D: 7; G12 V: 7; G12 R: 2) and 8 patients whose tumor were KRAS wild type were included in the study. 80% (8/10) of the patients with metastatic PDAC had a KRAS mutation. An analysis of OS showed a trend toward a longer OS in the wild type group (mutant KRAS, calculated median OS of 188 days vs. wild type KRAS, median OS of 304 days; P = 0.14). All patients received first-line gemcitabine-based chemotherapy. No significant difference was noticed in response to therapy between the KRAS wild type and mutant patients.

Conclusions Accurate determination of KRAS mutational status from EUS-FNA specimens has important clinical implications in the diagnostic, prognostic and therapeutic aspects of PDAC care. Patients with KRAS wild type tumors seems to have a longer OS and a better prognosis, independent of the therapeutic regimen. These findings provide further support for testing the KRAS mutation subtypes in advanced PDAC to evaluate prognosis. This may be an important factor in trial concepts and outcomes as well.