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Case report
Rare case of triple mutant (KRAS + NRAS + BRAF) metastatic colon adenocarcinoma
  1. Anusha Vittal1,
  2. Disha Sharma2,
  3. Ipsita Samanta1 and
  4. Anup Kasi1
  1. 1 Medical Oncology, University of Kansas, Kansas City, Kansas, USA
  2. 2 Liver Diseases Branch, NIDDK, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Anup Kasi, akasi{at}


KRAS is detected in 30%–50% of colorectal cancer (CRC) and BRAF mutations are found in 10% of CRC. A 62-year-old man with the long-standing smoking history presented to the emergency department with abdominal pain, weight loss and constipation. CT scan of abdomen/pelvis showed obstructive mass which was found to be colon adenocarcinoma which on further molecular analysis tested positive for KRAS, NRAS and BRAF mutations. His tumour progressed despite chemotherapy and surgery and he died within a year of diagnosis. Concomitant KRAS, NRAS and BRAF mutations are rare enough to be considered mutually exclusive but coexistent mutations appear to be a distinct molecular and clinical subset which needs new and effective treatment strategies in a setting of dismal prognosis.

  • Carcinogenesis
  • Colon Cancer
  • Chemotherapy
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  • Contributors AV: involved in reviewing the patient medical records, acquisition of data, reviewing previously published literature and drafting the manuscript; created the figures. DS: coordinated with other authors to streamline the content to make it clinically and scientifically meaningful. IS: helped with interpretation of data and edited the content. AK: involved in the conception and design of the case report; revised it critically for important intellectual content before providing the final approval; obtained patient consent; agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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