Mutation Combinations Database
Comprehensive guide to genetic mutation combinations in colorectal cancer, their clinical implications, and treatment recommendations.
Clinical Implications
Very rare in CRC (<1%). STK11 co-mutation impact less studied in CRC than NSCLC. KRAS G12C inhibitors remain primary treatment.
Recommended
Avoid
Clinical Implications
Rare but highly actionable. TRK inhibitors are tumor-agnostic approved.
Recommended
Clinical Implications
Rare but targetable. Zenocutuzumab shows promise.
Requires RNA-based NGS detection.
Recommended
Clinical Implications
Autosomal recessive. Biallelic mutations needed.
Recessive inheritance pattern.
Recommended
Clinical Implications
Rare but actionable with selective RET inhibitors.
Recommended
Clinical Implications
Trastuzumab Deruxtecan (T-DXd) 5.4 mg/kg - DESTINY-CRC02 demonstrated efficacy regardless of KRAS status. ORR ~38% in RAS mutant patients. NOTE: Tucatinib + Trastuzumab (MOUNTAINEER) requires RAS wild-type, NOT appropriate here.
Rare but actionable combination (<1% of mCRC). CRITICAL: Unlike other anti-HER2 approaches, T-DXd works in KRAS mutant tumors. DESTINY-CRC02 showed no difference in response between RAS WT and RAS mutant patients. Best results in IHC 3+. Monitor for ILD.
Recommended
Avoid
Clinical Implications
Very rare but highly actionable.
Identify through comprehensive NGS.
Recommended
Clinical Implications
Extremely rare. Case reports of responses.
Identified incidentally on NGS.
Recommended
Clinical Implications
Ultra-rare. ROS1 inhibitors may help.
Entrectinib covers ROS1 and NTRK.
Recommended
Clinical Implications
Very common combination. APC loss is an early event in most CRCs.
Recommended
Avoid
Clinical Implications
Most common combination. Standard RAS-mutant treatment.
Consider intensive therapy if fit.
Recommended
Avoid
Clinical Implications
Classic Vogelstein adenoma-carcinoma sequence.
Canonical CRC development pathway.
Recommended
Avoid
Clinical Implications
Double negative prognostic factors. Aggressive biology.
Poor prognosis warrants aggressive approach.
Recommended
Avoid
Clinical Implications
Emerging category. T-DXd trials ongoing in CRC.
Keep patients in mind for emerging trials.
Recommended
Clinical Implications
Does not preclude anti-EGFR if RAS/BRAF wild-type.
Prognosis depends on co-mutations.
Recommended
About This Database
This database contains clinically relevant mutation combinations in colorectal cancer. Each combination includes:
- Genes involved - The genetic alterations present
- Prognosis - Expected outcome classification
- Prevalence - How common in CRC patients
- Recommended treatments - Evidence-based options
- Treatments to avoid - Known ineffective therapies
- Evidence level - Strength of supporting data
Actionable combinations have FDA-approved targeted therapies or strong clinical trial evidence. Always consult with your oncologist for personalized treatment decisions.