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

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