Pancreatic Adenocarcinoma with Co-Occurrence of KRAS and EGFR Mutations: Case Report and Literature Review

Abstract

Introduction: Mutation in Kristin ras sarcoma virus (KRAS) oncogene is the main driver in pancreatic ductal adenocarcinoma (PDAC) and is present in nearly 90% of patients with PDAC. Epidermal growth factor receptor (EGFR) mutation is rare in PDAC and is mostly present in the absence of KRAS mutation. Co-occurrence of KRAS and EGFR mutations is extremely rare, and the value of EGFR inhibition in these cases is unknown.

Case presentation: Here, we present a case of metastatic PDAC with co-occurrence of KRAS G12V and EGFR L730R. Despite primary resistance to folinic acid, fluorouracil, irinotecan, oxaliplatin, and gemcitabine/nab-paclitaxel, this patient had a biochemical response (decrease in carbohydrate antigen 19-9) and disease control of 7 months on gemcitabine/erlotinib (an EGFR inhibitor). This outcome is remarkable in the late-line PDAC treatment setting and is unusual after the progression of the tumor on gemcitabine/nab-paclitaxel chemotherapy.

Conclusion: This case suggests that gemcitabine/erlotinib could be an effective treatment in patients with PDAC and co-occurrence of EGFR and KRAS mutations.

Keywords: Case report; EGFR; Erlotinib hydrochloride; KRAS; Pancreatic duct cell carcinoma.