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Highly sensitive detection of the PIK3CA H1047R mutation in colorectal cancer using a novel PCR-RFLP method
© The Author(s). 2016
Received: 3 February 2016
Accepted: 28 June 2016
Published: 12 July 2016
The PIK3CA H1047R mutation is considered to be a potential predictive biomarker for EGFR-targeted therapies. In this study, we developed a novel PCR-PFLP approach to detect the PIK3CA H1047R mutation in high effectiveness.
A 126-bp fragment of PIK3CA exon-20 was amplified by PCR, digested with FspI restriction endonuclease and separated by 3 % agarose gel electrophoresis for the PCR-RFLP analysis. The mutant sequence of the PIK3CA H1047R was spiked into the corresponding wild-type sequence in decreasing ratios for sensitivity analysis. Eight-six cases of formalin-fixed paraffin-embedded colorectal cancer (CRC) specimens were subjected to PCR-RFLP to evaluate the applicability of the method.
The PCR-RFLP method had a capability to detect as litter as 0.4 % of mutation, and revealed 16.3 % of the PIK3CA H1047R mutation in 86 CRC tissues, which was significantly higher than that discovered by DNA sequencing (9.3 %). A positive association between the PIK3CA H1047R mutation and the patients’ age was first found, except for the negative relationship with the degree of tumor differentiation. In addition, the highly sensitive detection of a combinatorial mutation of PIK3CA, KRAS and BRAF was achieved using individual PCR-RFLP methods.
We developed a sensitive, simple and rapid approach to detect the low-abundance PIK3CA H1047R mutation in real CRC specimens, providing an effective tool for guiding cancer targeted therapy.
The phosphatidylinositol 3-kinases (PI3Ks) are a large family of lipid kinases, and play an important role in many cellular processes, such as cell survival, proliferation, and migration [1, 2]. PIK3CA, encoding for the catalytic subunit p110-alpha of class I PI3Ks, is a member of this lipid kinase family. It is reported that mutant PIK3CA contributes to tumorigenesis through increased tumor invasion, decreased apoptosis and loss of contact inhibition [3, 4]. More than 30 % of various human cancer types were found to contain mutations in the PIK3CA gene, and it is frequently mutated in cancers of the liver, breast, stomach, breast, lung, and colon [5, 6].
Recently, several studies have revealed that PIK3CA mutations are associated with a negative prediction for targeted therapy by anti-EGFR MoAb (panitumumab or cetuximab) [7, 8]. In the case of colorectal cancers (CRC), apart from KRAS and BRAF, which have been proven to be significant predictive markers of the anti-EGFR MoAb response , the PIK3CA exon-20 (H1047R) point mutation is likely to a potential predictive biomarker of personalized therapy for CRC [10, 11]. De Roock et al. showed that the PIK3CA H1047R mutation was associated with a worse outcome compared with wild-type, with a targeted therapy response rate of 0.0 % versus 36.8 %, respectively . Therefore, the effective detection of the PIK3CA H1047R mutation is increasingly important to accurately predict and guide individualized therapy.
To date, DNA sequencing is considered to be the gold standard for gene mutation screening, but it is mainly limited by low sensitivity (20–30 %) for the clinically low abundance mutations, resulting in incorrect groupings and improper clinical therapy . Although the rapidly developed next-generation sequencing technology provides increased detection sensitivity (5 %) , the advantages of this technology must be further elicited before it is routinely used. Other methods, such as HRM, have a higher sensitivity and less sample contamination, but the requirement for special equipment and an additional sequencing confirmation step limit their universal application in clinical settings [14, 15]. Digital PCR has the potential to offer more sensitive and considerably more reproducible clinical methods, but is as susceptible to upstream errors associated with factors such as sampling and extraction, and also suffers systematic bias . Thus, there is an urgent need to develop a method that possesses higher detection efficiency and is suited to routine usage in the laboratory to screen for low-abundance mutations.
Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis is a widely applied method to detect gene mutations, which allows distinguishing mutant-type and wild-type sequences via destructing or generating enzyme restriction sites through PCR and subsequent electrophoresis separation of differential fragments . Compared to other methods, PCR-RFLP offers a simple operation, higher sensitivity and reproducibility, and no complex equipment requirements [18, 19]. For KRAS exon-2 mutations, the sensitivity of the PCR-RFLP method was at least 0.1 % . More importantly, it is preferentially suitable to detect point mutations .
For CRC, RFLP methods have been used for the detection of targeted therapy-related KRAS and BRAF gene mutations, and the corresponding KRAS mutation assay kit is commercially available [20, 22]; however, no PCR-RFLP method has been developed for PIK3CA H1047R . Several clinical trials and retrospective studies have suggested that the combinatorial detection of KRAS and BRAF mutations could increase positive mutation detection and therefore improve therapy response rates . However, recent research showed that some patients carrying wild-type KRAS and BRAF still do not respond to anti-EGFR MoAbs, among which PIK3CA H1047R mutation carriers were found [24, 25]. Therefore, the combinatorial detection of these three gene mutations might increase the response rates. Tian et al. analyzed KRAS, BRAF and PIK3CA mutations in 381 CRC samples in combination, achieving improved treatment classification and increased response rates . In addition, the current evidence about relationship of PIK3CA mutation and the targeted therapeutic effect is mostly dependent on the relatively low sensitivity methods, such as direct sequencing, which may result in inaccurate information [27, 28]. Accordingly, in this study, we developed a specific, fast and simple PCR-RFLP method for detecting low-abundance PIK3CA H1047R mutations by creating an FspI restriction endonuclease recognition site to distinguish wild- and mutant-type PIK3CA H1047R . In sensitivity studies, the PCR-RFLP method presented the capability to detect as little as 0.4 % of the mutant-type fragment in the presence of the wild-type fragment. In 86 paraffin-embedded CRC tissues, the method could detect at least 1.5 % of the PIK3CA H1047R mutation, which was far below that of direct sequencing, and statistical analysis revealed that the PIK3CA H1047R mutation was associated with patients’ age and tumor differentiation. To explore the possibility of detecting multi-gene mutations in combination using PCR-RFLP, the mutations of three target-EGFR genes, including KRAS, BRAF and PIK3CA in CRC tissues were detected using individual PCR-RFLP methods.
The human colorectal cancer cell lines LoVo, SW620, LS174T, HT29, HCT-8 and Colo205 were maintained in RPMI1640 containing 10 % fetal bovine serum (FBS, Invitrogen, Carlsbad, CA, USA) and 100 units/ml penicillin-streptomycin (Sigma-Aldrich, St Louis, MO, USA), and the human colorectal cancer cell lines RKO, CL187, CX-1 and CloneA were maintained in high-glucose DMEM containing 100 units/mL penicillin-streptomycin and 10 % FBS. All of the cells were cultured at 37 °C under a 5 % CO2 atmosphere. LoVo and SW620 cells were known to be wild-type for PIK3CA H1047R , while LS174T and RKO cells possessed heterozygous mutations .
A total of 86 formalin-fixed paraffin-embedded (FFPE) tissue sections (5 μm) from CRC patients were supplied by China Medical University (Shenyang, China). The study was approved by the ethics committee of China Medical University and all of the patients who provided tumor samples provided written informed consent. The patients’ characteristics were collected from the 86 CRC patients, including age, tumor differentiation, gender, tumor size, tumor location, Dukes stage and lymph node status.
Genomic DNA extraction and PCR-RFLP analysis
Genomic DNA (gDNA) was extracted from the human colorectal cancer cell lines (1 × 106 cells) using the Genomic DNA Purification Kit (Promega, US) according to the manufacturer’s instructions. All DNA templates were eluted with 40 μl ddH2O and stored at −20 °C until use. The purity and concentration of extracted DNA were determined by spectrophotometry (NanoDrop 2000, Thermo Fisher Scientific Inc., USA). The DNA samples with absorption ratios of 260/280 nm greater than 1.8 were for subsequent analyses. Subsequently, PCR amplification was performed using 50 ng of gDNA as template for the analysis of PIK3CA H1047R mutation statuses.
Detection specificity of the PCR-RFLP method
In addition to the H1047R (CAT → CGT) mutation, PIK3CA exon-20 may clinically harbor the H1047L mutation (CAT → CTT) . To examine whether the PIK3CA H1047L mutation could also be resolved by our method, we synthesized the 126-bp sequence containing the H1047L mutant sequence. In addition, the sequences containing the wild-type exon-20 (CAT) and PIK3CA H1047R mutant (CGT) were also synthesized. These synthesized DNAs were amplified by PCR, digested with FspI, and then electrophoresed on a 3 % agarose gel.
Detection sensitivity of the PCR-RFLP method
To perform the sensitivity analysis, we obtained wild-type and homozygous mutant-type model sequences by separating heterozygous mutation-type PIK3CA H1047R derived from the LS174T cells’ genome using TA cloning. Firstly, the LS174T cells’ 126-bp PCR product was cloned into the TA vector using the TA cloning kit (Takara, Japan). Ten bacterial clones were selected and their plasmids were extracted using the QIAGEN Plasmid Mini kit (QIAGEN, Germany) according to the manufacturer’s instructions. After their inserts were sequenced, the homozygous mutant plasmid containing the PIK3CA gene was mixed with the wild-type plasmid at the decreasing ratios of 1:1, 1:2, 1:4, 1:16, 1:32, 1:64, 1:128, 1:256, and 1:512, respectively. Subsequently, the mixed plasmid was subjected to PCR-RFLP analysis.
GDNA extraction from FFPE tissue and mutation detection
FFPE tumor blocks were cut into 5-μm sections and the sections with tumor area more than 70 % were dissected for the study. For gDNA extraction, one 5-μm thick section was used for each case. GDNA was extracted from FFPE tissue samples using the FFPE DNA Kit (OMEGA, USA) according to the manufacturer’s instructions. All DNA templates were eluted with 20 μl ddH2O and stored at −20 °C until use.
For KRAS (107 bp)
For BRAF (224 bp)
After amplification, the fragment of 224 bp was digested by TspI. The wild-type BRAF exon-15 allele were cleaved into three fragments of 124-, 87- and 13-bp, while the mutant type yielded only two fragments of 211- and 13-bp.
To confirm the PCR-RFLP results, sequencing analysis was performed in all samples. All PCR products of the PIK3CA, KRAS and BRAF genes were directly sequenced to confirm the mutation status using ABI 3730xl DNA Analyzer (Sangon Biotechnology Co. Ltd., Shanghai, China).
For the samples that showed a mutation band in agarose gel electrophoresis but were not detectable by direct sequencing, clone sequencing was performed by the TA cloning kit.
Statistical analysis was carried out using IBM SPSS 20.0 (IBM Corporation, Armonk, NY, USA). Significant differences between groups were assessed using the χ2 test considering the P value as obtained by Fisher’s exact test. A P value of less than 0.05 was considered statistically significant differences.
Establishment of PCR-RFLP method for the detection of PIK3CA H1047R
To further study the applicability of the PCR-RFLP method, we used this method to detect six CRC cell lines whose PIK3CA gene status was not reported. Fig. 2b (top) shows that CloneA, HCT-8, CX-1, Colo205 and HT29 cells were cleaved into two fragments with sizes of 96 and 30 bp, which indicated that there were no PIK3CA H1047R mutations. For CL187 cells, a 126-bp fragment besides 96- and 30-bp fragments was detected, indicating the heterozygous-type PIK3CA H1047R . The results from PCR-RFLP used to detect the PIK3CA status in six CRC cell lines were completely consistent with those obtained by direct sequencing (Fig. 2b, bottom).
Specificity and sensitivity of the PCR-RFLP method
To assess the sensitivity of the method, we constructed the plasmids carrying the 126-bp fragment of wild-type and homozygous mutant-type PIK3CA and diluted the homozygous mutant plasmid in increasing concentrations of the wild-type plasmid to mimic tumor heterogeneity. As shown in Fig. 3b (top), the 126-bp fragment band representing the PIK3CA H1047R mutation gradually decreased with decreasing proportions of the mutant sequence, but it was still detectable, even at mutation concentrations as low as 1:256, indicating that the sensitivity of our PCR-RFLP method was approximately 0.4 %. In contrast, DNA sequencing was not able to detect the PIK3CA H1047R mutation when present at approximately 25 % (1:4) of the total mixture, suggesting that its detection sensitivity was approximately 25 % (Fig. 3b, bottom).
Detection of mutant PIK3CA H1047R in clinical CRC samples
Clinicopathological characteristics and PIK3CA H1047R mutation status in 86 CRC cases
Number of patients
Well or Moderate
A + B
C + D
Lymph node metastasis
Detection of the KRAS, BRAF and PIK3CA mutations in CRC specimens using the PCR-RFLP method
Gene status in different CRC FFPE samples by PCR-RFLP method
CRC is one of the most common human malignant diseases and is a leading cause of cancer-related deaths worldwide. Metastases are the major cause of death in CRC patients . Recently, targeted therapies against EGFR, such as cetuximab and panitumumab, have improved the survival of patients with metastatic CRC (mCRC) . However, less than 20 % of unselected mCRC patients can truly benefit from the anti-EGFR MoAb treatment , highlighting the need to determine those who are more likely to obtain a clinical benefit from this targeted therapy. KRAS is the first gene proven to be a predictive biomarker for resistance to the anti-EGFR MoAb treatment, and BRAF has also been demonstrated to be a response predictor . Recently, active PIK3CA mutations were found to be able to predict resistance to anti-EGFR MoAbs. There are two major mutational hotspots in exons 9 (E542K, E545K) and 20 (H1047R) of the PIK3CA gene, and recent studies have suggested that the PIK3CA H1047R mutation had a closer relationship with anti-EGFR MoAb treatment . Thus, the accurate identification of the PIK3CA H1047R mutation status is very crucial for guiding personalized therapy.
To effectively detect the PIK3CA H1047R mutation status, we developed a novel PCR-RFLP method by creating an FspI restriction site. The results showed that the PCR-RFLP method could distinguish the wild-type and mutant-type PIK3CA H1047R with complete agreement with the results obtained by DNA sequencing in different CRC cell lines. The specificity of the method was verified by the analysis of various patterns of the PIK3CA H1047 mutation, and its high detection sensitivity was demonstrated using various quantities of mutation fragments spiked into wild-type fragments, achieving a detection limit as low as 0.4 %, which is significantly superior to direct sequencing (25 %). Current data in clinical trials show that not all patients grouped as wild-type for defined genes benefit from molecular targeted therapies . There are several reasons for it, such as the presence of other undefined gene alterations [37, 38], but it is possible that the employed methods with the limited sensitivity may fail to detect the low-abundance mutations, resulting in incorrect classifications. Molinari et al. reported that compared with direct sequencing, 13 additional KRAS mutations were identified using highly sensitive methods, which all were non-responsive to anti-EGFR therapies . In this study, the PIK3CA H1047R mutation in 86 patients was analyzed by PCR-RFLP. As a result, we revealed the PIK3CA H1047R mutation in 16.3 % of the CRC samples and this ratio is significantly higher than the result we obtained using direct sequencing (9.3 %), and the lowest mutation was 1.5 %. The results demonstrated that our method could detect low-abundance PIK3CA H1047R mutations and thus offer accurate guidance for personalized treatment. In addition, the detection sensitivity is expected to increase further using PAGE electrophoresis-based silver staining instead of EB staining .
The results of the analysis of clinicopathological characteristics from 86 CRC tissues revealed a significant correlation between the PIK3CA H1047R mutation and the patient’s age. Patients over 60 years of age tend to show significantly more PIK3CA H1047R mutations than patients under 60 years of age (24.5 vs. 5.4 %, P = 0.018). To the best of our knowledge, this is the first report to reveal the significant association between the PIK3CA H1047R mutation and the patient’s age. This may possibly be due to the high detection sensitivity of the PCR-RFLP method because there was no consistent statistically significant difference found by direct sequencing. This result further suggests that a detection method that can resolve low abundance mutations might provide a better understanding of the clinical significance of a given gene mutation. Some previous studies found that the PIK3CA H1047R mutation is a late event of CRC progression . Additionally, according to the tumorigenesis theory, older patients tend to accumulate more types of gene mutations . Because older patients possibly encounter more PIK3CA H1047R mutations and do not respond to targeted therapy, an improved prognosis might be achieved by the preferential attention of the patient subpopulation at the early stage of CRC or below 60 years in clinically targeted therapy. Of course, much more data from clinical settings is needed to verify this conclusion. In addition, statistical analysis showed that patients with poorly differentiated tumors are much more likely to have the PIK3CA H1047R mutation (poor 52.6 % vs. moderate/well 6.0 %, P = 0.000), which is in agreement with a recent report . Other clinicopathological characters, such as Dukes stage, tumor size, tumor location, gender, and lymph node status showed no relationship with the PIK3CA H1047R mutation.
In CRC, KRAS and BRAF mutations have been proven to be predictors of the therapeutic efficiency of anti-EGFR therapy. In 2010, De Roock and co-workers  demonstrated that the PIK3CA H1047R mutation might be a new potential response predictor after KRAS and BRAF for resistance to anti-EGFR mAbs. However, until now, the clinical significance of PIK3CA mutations in terms of the prediction of the response to anti-EGFR therapy still remains incompletely understood, partly due to the lack of highly effective approaches for detecting related gene mutations in combination . To explore whether our PIK3CA H1047R -specific PCR-RFLP can be utilized together with the reported PCR-RFLP methods for KRAS and BRAF, the three gene mutations existing in six CRC specimens were analyzed in combination by individual PCR-RFLP. The results showed that four specimens, except for specimens 4 and 6, carried mutations in different genes, which all were confirmed by DNA sequencing (data not shown), indicating that the PCR-RFLP method is able to accurately detect multi-gene mutations in combination. Like other researchers, we also found that either PIK3CA or BRAF were present in some wild-type KRAS specimens, such as PIK3CA in specimen 3 and BRAF in specimen 5, suggesting that it is necessary in clinical practice to investigate the state of the other two genes in KRAS wild-type patients. In addition, several previous reports demonstrated that KRAS and BRAF are mutually exclusive in CRCs [43, 44]. In our study, we also did not find their co-existence, but the concomitant mutation in KRAS and PIK3CA was detected in specimen 2. Nevertheless, their effect on the response to targeted treatment still needs to be verified further. All of the mutations detected by PCR-RFLP were confirmed by direct sequencing except for PIK3CA in specimen 3, which was verified by clone sequencing later and displayed a lower mutant frequency of 2 %. Notably, this PIK3CA was the only detectable mutation in the specimen, which suggested that a combinatorial PCR-RFLP strategy with high sensitivity may provide more accurate information to understand the clinical significance of gene mutations in spite of limited specimen involvement.
In summary, we developed a novel PCR-RFLP method to detect the PIK3CA H1047R mutation by creating an FspI restriction endonuclease recognition site. This method is able to resolve wild-type and mutant-type PIK3CA H1047R with high specificity and sensitivity, allowing the low abundance mutation of 0.4 % to be detected. Additionally, this method has several advantages over other methods, such as simple operation and suitability in a routine laboratory. Using this method, 86 cases of CRC specimens were detected with high efficiency, with an excessively positive rate of PIK3CA H1047R mutations relative to that using DNA sequencing. Based on this, a positive correlation between the PIK3CA H1047R mutation and the patient’s age was found, which might be helpful in guiding targeted therapy. In addition, the approach was combined with PCR-RFLP methods for KRAS and BRAF together and achieved high sensitivity and the accurate detection of multiple gene mutations in parallel for CRC tissues. Overall, this method could become a promising tool for guiding personalized tumor therapy and exploring the clinical applicability of the PIK3CA H1047R mutation.
CRC, colorectal cancers; FBS, fetal bovine serum; FFPE, formalin-fixed paraffin-embedded; gDNA, genomic DNA; mCRC, metastatic CRC; PCR-RFLP, Polymerase chain reaction-restriction fragment length polymorphism; PI3Ks, phosphatidylinositol 3-kinases
The study was supported by the grants from the National Natural Science Foundation of China (Grant No. 21375149), Shenyang Science and Technology Bureau (Grant No. F13-220-9-29) and Program for Innovative Research Team in University of Ministry of Education of China (IRT13101).
Availability of data and materials
The dataset supporting the conclusions of this article is available at request from the corresponding author.
JF, WML and TTH designed the experiments. WML, TTH and LLZ conducted the experiments. WML, YMF and YYW collected and prepared the tissue samples from colorectal cancer patients. WML and JF analyzed the data obtained from the experiments. JF and WML wrote the manuscript. All authors read and approved the manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
The study was approved by the ethics committee of China Medical University and all of the patients who provided tumor samples provided written informed consent.
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- Manning BD, Cantley LC. AKT/PKB signaling: navigating downstream. Cell. 2007;129:1261–74.View ArticlePubMedPubMed CentralGoogle Scholar
- Engelman JA, Luo J, Cantley LC. The evolution of phosphatidylinositol 3-kinases as regulators of growth and metabolism. Nat Rev Genet. 2006;7:606–19.View ArticlePubMedGoogle Scholar
- Samuels Y, Wang Z, Bardelli A, Silliman N, Ptak J, Szabo S, et al. High frequency of mutations of the PIK3CA gene in human cancers. Science. 2004;304:554.View ArticlePubMedGoogle Scholar
- Samuels Y, Diaz LA, Jr Schmidt-Kittler O, Cummins JM, Delong L, Rago C, et al. Mutant PIK3CA promotes cell growth and invasion of human cancer cells. Cancer Cell. 2005;7:561–73.View ArticlePubMedGoogle Scholar
- Samuels Y, Ericson K. Oncogenic PI3K and its role in cancer. Curr Opin Oncol. 2006;18:77–82.View ArticlePubMedGoogle Scholar
- Karakas B, Bachman KE, Park BH. Mutation of the PIK3CA oncogene in human cancers. Br J Cancer. 2006;94:455–9.View ArticlePubMedPubMed CentralGoogle Scholar
- Sartore-Bianchi A, Martini M, Molinari F, Veronese S, Nichelatti M, Artale S, et al. PIK3CA mutations in colorectal cancer are associated with clinical resistance to EGFR-targeted monoclonal antibodies. Cancer Res. 2009;69:1851–7.View ArticlePubMedGoogle Scholar
- De Roock W, Claes B, Bernasconi D, De Schutter J, Biesmans B, Fountzilas G, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis. Lancet Oncol. 2010;11:753–62.View ArticlePubMedGoogle Scholar
- Lv ZC, Ning JY, Chen HB. Efficacy and toxixity of adding cetuximab to chemotherapy in the treatment of metastatic colorectal cancer: a meta-analysis from 12 randomized controlled trials. Tumour Biol. 2014;35:11741–50.View ArticlePubMedGoogle Scholar
- Papadatos-Pastons D, Rabbie R, Ross P, Sarker. The role of the PI3K pathway in colorectal cancer. Crit Rev Oncol Hematol. 2015;94:18–30.View ArticleGoogle Scholar
- Mao C, Yang ZY, Hu XF, Chen Q, Tang JL. PIK3CA exon 20 mutations as a potential biomarker for resistance to anti-EGFR monoclonal antibodies in KRAS wild-type metastatic colorectal cancer: a systematic review and meta-analysis. Ann Oncol. 2012;23:1518–25.View ArticlePubMedGoogle Scholar
- French D, Smith A, Powers MP, Wu AH. KRAS mutation detection in colorectal cancer by a commercially available gene chip array compare well with Sanger sequencing. Clin Chim Acta. 2011;412:1578–81.View ArticlePubMedGoogle Scholar
- Ihle MA, Fassunke J, Konig K, Grunewald I, Schlaak M, Kreuzberg N, et al. Comparison of high resolution melting analysis, pyrosequencing, next generation sequencing and immunohistochemistry to conventional Sanger sequencing for the detection of p.V600E and non-p.V600E BRAF mutation. BMC Cancer. 2014;14:13.View ArticlePubMedPubMed CentralGoogle Scholar
- Guedes JG, Veiga I, Rocha P, Pinto P, Pinto C, Pinheiro M, et al. High resolution melting analysis of KRAS, BRAF and PIK3CA in KRAS exon 2 wild-type metastatic colorectal cancer. BMC Cancer. 2013;13:169.View ArticlePubMedPubMed CentralGoogle Scholar
- Prajantasen T, Fucharoen S, Fucharoen G. High resolution melting analytical platform for rapid prenatal and postnatal diagnosis of β-thalassemia common among Southeast Asian population. Clin Chim Acta. 2015;441:56–62.View ArticlePubMedGoogle Scholar
- Huggett JF, Cowen S, Foy CA. Consideration for digital PCR as an accurate molecular diagnostic tool. Clin Chem. 2015;61:79–88.View ArticlePubMedGoogle Scholar
- Loda M. Polymerase chain reaction-based method for the detection of mutations in oncogenes and tumor suppressor genes. Hum Pathol. 1994;25:564–71.View ArticlePubMedGoogle Scholar
- Panyasai S, Fucharoen G, Fucharoen S. Known and new hemoglobin A2 variants in Thailand and implication for β-thalassemia screening. Clin Chim Acta. 2015;438:226–30.View ArticlePubMedGoogle Scholar
- Ota M, Fukushima H, Kulski JK, Inoko H. Single nucleotide polymorphism detection by polymerase chain reaction-restriction fragment length polymorphism. Nat Protoc. 2007;2:2857–64.View ArticlePubMedGoogle Scholar
- Nishikawa T, Maemura K, Hirata I, Matsuse R, Morikawa H, Toshina K, et al. A simple method of detecting K-ras point mutations in stool samples for colorectal cancer screening using one-step polymerase chain reaction/restriction fragment length polymorphism analysis. Clin Chim Acta. 2002;318:107–12.View ArticlePubMedGoogle Scholar
- Tan X, Wang H, Luo G, Ren S, Li W, Cui J, et al. Clinical significance of a point mutation in DNA polymerase beta (POLB) gene in gastric cancer. Int J Biol Sci. 2015;11:144–55.View ArticlePubMedPubMed CentralGoogle Scholar
- Hayashida N, Namba H, Kumagai A, Hayashi T, Ohtsuru A, Ito M, et al. A rapid and simple detection method for the BRAF (T1796A) mutation in fine-needle aspirated thyroid carcinoma cells. Thyroid. 2004;14:910–5.View ArticlePubMedGoogle Scholar
- Therkildsen C, Bermann TK, Henrichsen-Schnack T, Ladelund S, Nilbert M. The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: A systematic review and meta-analysis. Acta Oncol. 2014;53:852–64.View ArticlePubMedGoogle Scholar
- Pentheroudakis G, Kotoula V, De Roock W, Kouvatseas G, Papakostas P, Makatsoris T, et al. Biomarkers of benefit from cetuximab-based therapy in metastatic colorectal cancer: interaction of EGFR ligand expression with RAS/RAF, PIK3CA genotypes. BMC Cancer. 2013;13:49.View ArticlePubMedPubMed CentralGoogle Scholar
- Neumann J, Wehweck L, Maatz S, Engel J, Kirchner T, Jung A. Alterations in the EGFR pathway coincide in colorectal cancer and impact on prognosis. Virchows Arch. 2013;463:509–23.View ArticlePubMedGoogle Scholar
- Tian S, Simon I, Moreno V, Roepman P, Tabernero J, Snel M, et al. A combined oncogenic pathway signature of BRAF, KRAS and PIK3CA mutation improves colorectal cancer classification and cetuximab treatment prediction. Gut. 2013;62:540–9.View ArticlePubMedGoogle Scholar
- Lievre A, Bachet J, Le Corre D, Boige V, Landi B, Emile JF, et al. KRAS mutation status is predictive of response to cetuximab therapy in colorectal cancer. Cancer Res. 2006;66:3992–5.View ArticlePubMedGoogle Scholar
- Nicolantonio F, Martini M, Molinari F, Sartore-Bianchi A, Arena S, Saletti P, et al. Wild-type BRAF is required for response to panitumumab or cetuximab in metastatic colorectal cancer. J Clin Oncol. 2008;26:5705–12.View ArticlePubMedGoogle Scholar
- Ahmed D, Eide PW, Eilertsen IA, Danielsen SA, Eknæs M, Hektoen M, et al. Epigenetic and genetic features of 24 colon cancer cell lines. Oncogenesis. 2013;2:e71.View ArticlePubMedPubMed CentralGoogle Scholar
- Zhang H, Song J, Ren H, Xu Z, Wang X, Shan L, et al. Detection of low-abundance KRAS mutations in colorectal cancer using microfluidic capillary electrophoresis-based restriction fragment length polymorphism method with optimized assay conditions. PLoS One. 2013;8:e54510.View ArticlePubMedPubMed CentralGoogle Scholar
- Araujo PP, Marcello MA, Tincani AJ, Guilhen AC, Morari EC, Ward LS. MRNA BRAF expression helps to identify papillary thyroid carcinomas in thyroid nodules independently of the presence of BRAFV600E mutation. Pathol Res Pract. 2012;208:489–92.View ArticlePubMedGoogle Scholar
- Shah SA, Haddad R, Al-Sukhni W, Kim RD, Greig PD, Grant DR, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg. 2006;202:468–75.View ArticlePubMedGoogle Scholar
- Modest DP, Stintzing S, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, et al. Impact of subsequent therapies on outcome of the FIRE-3/AIO KRK0306 Trial: First-line therapy with FOLFIRI Plus Cetuximab or Bevacizumab in patients with KRAS wild-type tumors in metastatic colorectal cancer. J Clin Oncol. 2015;33:3718–26.View ArticlePubMedGoogle Scholar
- Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med. 2005;352:476–87.View ArticlePubMedGoogle Scholar
- Walther A, Johnstone E, Swanton C, Midgley R, Tomlinson I, Kerr D. Genetic prognostic and predictive markers in colorectal cancer. Nat Rev Cancer. 2009;9:489–99.View ArticlePubMedGoogle Scholar
- Yang ZY, Wu XY, Huang YF, Di MY, Zheng DY, Chen JZ, et al. Promising biomarker for predicting the outcomes of patients with KRAS wild-type metastatic colorectal cancer treated with anti-epidermal growth factor receptor monoclonal antibodies: a systematic review with meta-analysis. Int J Cancer. 2013;133:1914–25.View ArticlePubMedGoogle Scholar
- Tural D, Batur S, Erdamar S, Akar E, Kepil N, Mandel NM, et al. Analysis of PTEN, BRAF and PI3K status for determination of benefit from cetuximab therapy in metastatic colorectal cancer patients refractory to chemotherapy with wild-type KRAS. Tumour Biol. 2014;35:1041–9.View ArticlePubMedGoogle Scholar
- Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: can testing of tumor tissue for mutation in EGFR pathway downstream effector genes in patients with metastatic colorectal cancer improve health outcome by guiding decisions regarding anti-EGFR therapy? Genet Med. 2013;15:517–27.View ArticleGoogle Scholar
- Molinari F, Felicioni L, Buscarino M, De Dosso S, Buttitta F, Malatesta S, et al. Increased detection sensitivity for KRAS mutations enhances the prediction of anti-EGFR monoclonal antibody resistance in metastatic colorectal cancer. Clin Cancer Res. 2011;17:4901–14.View ArticlePubMedGoogle Scholar
- Wang Y, Chen J, Ding W, Yan B, Gao Q, Zhou J. Clinical features and gene mutations of lung cancer patients 30 years of age or younger. PLoS One. 2015;10:e0136659.View ArticlePubMedPubMed CentralGoogle Scholar
- Hechtman JF, Sadowska J, Huse JT, Borsu L, Yaeger R, Shia J, et al. AKT1 E17K in colorectal carcinoma is associated with BRAF V600E but not MSI-H status: a clinicopathologic comparison to PIK3CA helical and kinase domain mutants. Mol Cancer Res. 2015;13:1003–8.View ArticlePubMedPubMed CentralGoogle Scholar
- Prenen H, De Schutter J, Jacobs B, et al. PIK3CA mutations are not a major determinant of resistance to the epidermal growth factor receptor inhibitor cetuximab in metastatic colorectal cancer. Clin Cancer Res. 2009;15:3184–8.View ArticlePubMedGoogle Scholar
- Garcia-Albeniz X, Pericay C, Alonso-Espinaco V, Alonso V, Escudero P, Fernandez-Martos C, et al. Serum matrilysin correlates with poor survival independently of KRAS and BRAF status in refractory advanced colorectal cancer patients treated with irinotecan plus cetuximab. Tumour Biol. 2011;32:417–24.View ArticlePubMedGoogle Scholar
- Lurkin I, Stoehr R, Hurst CD, van Tilborg AA, Knoeles MA, Hartmann A, et al. Two multiplex assays that simultaneously identify 22 possible mutation sites in the KRAS, BRAF, NRAS and PIK3CA genes. PLoS One. 2010;4:e8802.View ArticleGoogle Scholar