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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

4308 - RET rearrangements may arise following anti-EGFR therapy in advanced colorectal cancer


21 Oct 2018


Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology


Translational Research

Tumour Site

Colon and Rectal Cancer


Thereasa Rich


Annals of Oncology (2018) 29 (suppl_8): viii150-viii204. 10.1093/annonc/mdy281


T.A. Rich1, K. Clifton2, A. Grothey3, A. Hendifar4, D.H. Henry5, Y. Kagawa6, Y. Nakamura7, W. Okamoto8, B.R. Tan9, G. Sherrill10, T. Yoshino7, V.M. Raymond1, Y. Shiotsu1, R.B. Lanman1, V. Morris2

Author affiliations

  • 1 Medical Affairs, Guardant Health, 94063 - Redwood City/US
  • 2 Gastrointestinal Medical Oncology, MD Anderson Cancer Center, 77030 - Houston/US
  • 3 Division Of Medical Oncology, Mayo Clinic, 55905 - Rochester/US
  • 4 Department Of Internal Medicine/hematology/oncology, Cedars-Sinai Medical Center, 90048 - Los Angeles/US
  • 5 Department Of Medicine, University of Pennsylvania, 19106 - Philadelphia/US
  • 6 Department Of Surgery, Kansai Rosai Hospital, 6608511 - Amagasaki/JP
  • 7 Gastroenterology And Gastrointestinal Oncology, National Cancer Center Hospital East, 277-8577 - Kashiwa/JP
  • 8 Biobank Translational Research Support Section, Translational Research Management Division, Clinical research Support Office, National Cancer Center Hospital East, 277-8577 - Kashiwa/JP
  • 9 Department Of Medicine, Washington University, 63110 - Saint Louis/US
  • 10 Department Of Hematology/oncology, Cone Health Cancer Center, 27403 - Greensboro/US


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Abstract 4308


RET rearrangements (RETr) are uncommon yet emerging oncogenic targets found in RAS/BRAF wild-type colorectal cancers (CRCs), particularly right-sided, MSI-high tumors. We describe the molecular landscape of metastatic CRCs harboring a somatic RETr detected by next generation sequencing (NGS) of cell-free DNA (cfDNA). cfDNA data complement previous descriptions of RETr in tissue, which are limited by small series of patients (pts) and cfDNA also provides a summary of genomic alterations (alts) across multiple metastatic sites in pts typically exposed to one or more lines of therapy.


Between 2/2015-3/2018, somatic RETr were identified among 4,234 consecutive metastatic CRC pts with tumor DNA detected on a 68-73 gene cfDNA assay (Guardant360®, Redwood City, CA). This validated NGS assay evaluates single nucleotide variants, and select indels, fusions, and copy number gains with high sensitivity and analytic specificity. Relevant clinicopathologic correlates were obtained from clinicians.


Seventeen RETr were detected in 16 pts (0.4%). Functionally significant alts in other cancer genes were found in 88% of samples with a RETr (median 9.5 additional alts, max 23). There was a high co-occurrence of canonical KRAS alts (14 alts in 7/16 pts), 5 of whom also had alts in NRAS (n = 4pts), the EGFR extracellular domain (ECD, n = 4), and/or BRAF V600E (n = 3). For 4 pts with available comprehensive tissue NGS results, the RETr was detected in cfDNA only. Two also had KRAS, NRAS, and EGFR ECD alts, one had an EGFR activating alt, and the fourth had a FGFR3 fusion, all detected only in cfDNA. Prior to cfDNA collection, all 4 had progressed on anti-EGFR therapy after a median of 12mo (range 8-16mo) of treatment. Four additional RETr/KRAS+ pts had either a KRAS alt that was not detected in tissue (n = 2) or co-occurred with an ALK fusion and/or BRAF V600E in pts who had prior anti-EGFR therapy (n = 2).


RETr commonly co-occur with RAS/RAF alts in cfDNA, a novel observation. The alt pattern and clinicopatholgoic history suggest RETr contribute to acquired resistance to anti-EGFR therapy in metastatic CRC. Our data also raise the question of whether driver RETr may be associated with primary resistance to anti-EGFR therapy.

Clinical trial identification

Legal entity responsible for the study

Guardant Health.


Has not received any funding.

Editorial Acknowledgement


T.A. Rich, V.M. Raymond, Y. Shiotsu, R.B. Lanman: Employee, Stock owner: Guardant Health. Y. Kagawa, Y. Nakamura: Research support: Guardant Health. W. Okamoto: Research support: Guardant Health; Grant funding: MSD. T. Yoshino: Research support: Guardant Health; Grants: MSD KK, Sanofi KK, Sumitomo Dainippon Pharma Co Ltd, Chugai Pharmaceutical Co Ltd, GlaxoSmithKline KK, Nippon Boehringer Ingelheim Co Ltd; Consulting fees: Sanofi KK, Chugai Pharmaceuticals Co Ltd, Eli Lilly Japan, Merck Serono Co Ltd. All other authors have declared no conflicts of interest.

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