The Rat Sarcoma virus (RAS) gene family is characterized by three genes (KRAS, NRAS and HRAS) encoding for closely related GTPase proteins responsible for the signal transduction within the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3 kinase (PI3K) pathways. KRAS mutations are the most important and frequent alterations in this family, accounting for 85% of RAS mutations observed in the oncologic population.
1. Introduction
The Rat Sarcoma virus (
RAS) gene family is characterized by three genes (
KRAS,
NRAS and
HRAS) encoding for closely related GTPase proteins responsible for the signal transduction within the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3 kinase (PI3K) pathways. This group of genes is associated with the control of cell growth, survival and differentiation
[1][2], and it is characterized by the most frequently observed genomic alterations in human cancers, being detected in approximately 19% of tumors
[3][4].
KRAS mutations are the most important and frequent alterations in this family, accounting for 85% of
RAS mutations observed in the oncologic population
[5]. More specifically,
KRAS exon 2, exon 3 and exon 4 mutations are present in 13.98%, 1.17% and 0.62% of all cancer types
[2][6], respectively, especially in pancreatic ductal adenocarcinoma (PDAC) (88% of patients), in colorectal cancer (CRC) (45–50% of cases) and in lung adenocarcinoma (AC) (30–35% of patients) (
Table 1)
[5][6][7][8].
Table 1. Cancers with the highest KRAS mutations frequencies.
Cancer |
KRAS Mutations Percentage |
PDAC |
88% |
CRC |
45–50% |
Lung AC |
30–35% |
2. KRAS Mutations in Lung Cancer
The protein encoded by
KRAS is a GTPase regulated by tyrosine kinase receptors that in turn activate the RAF/MEK/MAPK and PI3K/AKT signaling pathways, leading to a strong promotion of cell growth and replication that determines cell survival. The presence of mutations in
KRAS blocks this protein in the active GTP-bound conformation, thereby activating constitutively downstream signaling pathways, finally resulting in uncontrolled cell growth
[9]. Specifically, this continuous activation confers to cancer cells the ability to grow in lower glucose concentrations than those required for the growth of normal cells or cancer cells that do not have
KRAS mutations
[10][11]. As for other cancer types,
KRAS mutations in lung cancers typically occur in hot-spot codons of exons 2, 3 and 4.
2.1. KRAS Mutations in NSCLC
In general, lung cancer has a complex and heterogeneous background. Indeed, it can be histologically subdivided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), accounting for 85% and 15% of all lung neoplasia, respectively
[12]. NSCLCs are further subdivided into three histologic types: AC, squamous-cell carcinoma (SCC) and large-cell carcinoma (LCC), which represent 40%, 25–30% and 5–10% of all lung cancers, respectively
[8]. The occurrence of KRAS mutations differs based on the specific lung cancer type/subtype, being higher in NSCLC than in SCLC, and within NSCLC, KRAS mutations are more frequent in lung AC than SCC (
Table 2). Interestingly, a recent study established two different groups of KRAS-mutant NSCLC, KRAS-dependent and KRAS-independent according to their requirement for KRAS mutations to maintain oncogenicity. However, to date, these data are preliminary and need to be confirmed in larger cohorts
[9].
Table 2. Rates of KRAS mutations in NSCLC and subtypes.
2.1.1. KRAS Mutations in Lung Adenocarcinoma
In the AC subtype, almost 30–35% of cases are driven by a
KRAS mutation
[5][6][7][8], mainly in exon 2, with the c.34G > T (p.G12C) change being the most prevalent (
Table 3)
[13].
Table 3. Rates of KRAS exons 2, 3 and 4 mutations in NSCLC.
KRAS Mutations |
Frequencies |
Exon 2 codon 12 |
|
c.34G > T (p.G12C) |
40% |
c.35G > T (p.G12V) |
19–21% |
c.35G > A (p.G12D) |
15–17% |
c.35G > C (p.G12A) |
6% |
c.34G > A (p.G12S) |
4% |
c.34G > C (p.G12R) |
4% |
Exon 2 codon 13 |
|
c.37G > T (p.G13C) |
6.8% |
c.38G > A (p.G13D) |
0.8% |
c.37G > C (p.G13R) |
0.6% |
c.37G > A (p.G13S) |
NR |
Exon 3 codon 59 |
|
c.176C > A (p.A59E) |
NR |
c.176C > G (p.A59G) |
NR |
c.175G > A (p.A59T) |
NR |
Exon 3 codon 61 |
NR |
c.183A > C (p.Q61H) |
1.2% |
c.182A > T (p.Q61L) |
0.4% |
c.182A > G (p.Q61R) |
0.06% |
c.180_181delinsAA (p.Q61K) |
0.02% |
c.181C > G (p.Q61E) |
NR |
Exon 4 codon 146 |
|
c.436G > C (p.A146P) |
NR |
c.436G > A (p.A146T) |
NR |
c.437C > T (p.A146V) |
NR |