Grant Application

Ahmed Al-Khafaji, MD

Proposed Innovation

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death among both men and women in the United States. Diagnosis and extent of CRC is determined by colonoscopy, CT imaging, and invasive biopsies. KRAS mutations are one of most dominant mutations in CRC, occurring in nearly a third of all cases and impacting prognosis and survival rates. Because tumors with a KRAS mutation are unlikely to respond to targeted therapy, genotyping of tumor tissue is recommended for all CRC patients.

But a biopsy — in most cases taken from the primary tumor rather than a liver metastasis — doesn’t guarantee the randomly sampled tissue will detect a KRAS gene mutation. This project will use radiogenomics — an exciting new technology — to extract information from imaging to assist with clinical decision making in the treatment of patients with metastases to the liver from colorectal cancer.

Improvements in Action

Existing CT scans from 125 patients will be examined to determine the presence or absence of the KRAS mutation at diagnosis and before and after treatment with Y90 internal radiation therapy. Segmented CT images will be evaluated to identify features identified with the KRAS wild-type, or mutant, gene.

Intended Outcomes

This project is expected to show that CT scans can be used to noninvasively diagnose the KRAS status of CRC liver metastases. Findings from this translational research will have immediate clinical implications for decision-making, including validity of single-site biopsy for KRAS status, treatment selection, monitoring of disease progression by CT, and prognostication.