Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) Mutation Testing Trends, Prevalence, and Outcomes in Metastatic, Non-Squamous Non-Small Cell Lung Cancer Patients in Queensland, Australia - From 2014–2023

Sep 23, 2026

Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most frequently mutated oncogene in solid tumors and is detected in up to 30% of lung adenocarcinomas. This retrospective study quantified KRAS mutation testing and outcomes in metastatic, non-squamous non-small cell lung cancer patients across Queensland, Australia, from January 2014 to December 2023, using public-hospital records. Testing rose markedly, KRAS mutations were characterized by key codon substitutions, and KRAS-mutant patients showed distinct clinical and PD-L1 expression patterns.

LanguageEnglish

CategoryHealthcare

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Abstract

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Introduction

Thoracic Cancer ORIGINAL ARTICLE OPEN ACCESS Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) Mutation Testing Trends, Prevalence, and Outcomes in Metastatic, Non-Squamous Non-Small Cell Lung Cancer (Non-SQ NSCLC) Patients in Queensland, Australia From 2014–2023 Navin Niranjan1,2 | Tracey Guan3 | Nitin Niranjan1,2 | Atefeh Taherian Fard3 | Danny R. Youlden3 | Robert Mason1,2 | Bryan A. Chan4,5,6,7 | Jasotha Sanmugarajah1,2 1Gold Coast University Hospital, Southport, Queensland, Australia | 2School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia | 3Department of Health, Metro South Hospital and Health Service, Cancer Alliance Queensland, Woolloongabba, Queensland, Australia | 4Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia | 5School of Medicine and Dentistry, Griffith University, Birtinya, Queensland, Australia | 6Centre for Bioinnovation, University of the Sunshine Coast, Sippy Downs, Queensland, Australia | 7Department of Health, Metro South Hospital and Health Service, Queensland Cancer Control Safety and Quality Partnership, Lung Cancer Subcommittee, Woolloongabba, Queensland, Australia Correspondence: Navin Niranjan ([navin.niranjan@health.qld.gov.au](navin.niranjan@health.qld.gov.au)) Received: 4 February 2026 | Revised: 16 March 2026 | Accepted: 19 March 2026 Keywords: KRAS protein (human) | molecular targeted therapy | nonsmall cell lung cancer ABSTRACT Background: Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most commonly mutated oncogene in solid tumors, detected in up to 30% of lung adenocarcinomas. This study aimed to address gaps in the literature by analyzing KRAS mutations (KRASM) in a large Australian population. Methods: A total of 3982 patients with metastatic nonsquamous nonsmall cell lung cancer diagnosed via public hospitals were retrospectively analyzed from January 1, 2014 to December 31, 2023. Records were reviewed for evidence of KRASM testing, KRAS results, biopsy type, and programmed death-ligand 1 (PD-L1) status. KRASM testing rates were also compared to that of other commonly tested oncogenic mutations. Results: KRASM testing was performed in 52.9% of eligible patients, improving from 1.9% in 2014 to 86.3% in 2023. KRASM was identified in 830 patients (39.4% ofKRASM tested patients, 20.8% overall) . The most common KRASM seen was 12th codon substitution of KRAS glycine to cysteine (G12C) followed by substitutions of glycine to valine (G12V) and glycine to aspartate (G12D). Patients harboring KRASM were significantly more likely to have smoked, be female, and have higher PD-L1 expression than their KRAS wild type (wt) counterparts. All-cause survival was higher at the 1-year (43.9% vs. 35.3%) and 5-year (12.4% vs. 8.9%) marks in KRAS wt patients compared to KRAS mt. Conclusion: This study is the largest longitudinal analysis ofKRASM testing conducted in Australia, with significant improvement in testing rates seen over the time period. Rates ofKRASM and characteristics of Australian KRAS mt patients correspond with published literature. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2026 The Author(s) . Thoracic Cancer published by John Wiley & Sons Australia, Ltd. Thoracic Cancer, 2026; 17:e70274 1 of 8 [https://doi.org/10.1111/1759-7714.70274](https://doi.org/10.1111/1759-7714.70274) 1 | Introduction Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most commonly mutated oncogene in solid tumors, including lung adenocarcinoma [1] . KRAS mutations (KRASM) can be detected in up to 30% of lung adenocarcinoma, with KRAS-driven lung cancers generally being associated with smoking history, high tumor mutational burden and higher programmed deathligand 1

FAQs

What time range and patient population were analyzed?

The study retrospectively analyzed 3,982 patients diagnosed in public hospitals in Queensland, Australia, from January 1, 2014 to December 31, 2023.

How did KRAS mutation testing rates change over time?

KRAS mutation testing increased from 1.9% in 2014 to 86.3% in 2023, with 52.9% of eligible patients receiving testing.

Which KRAS mutations were most common and how were patients with KRAS mutations different?

The most common mutation was KRAS G12C, followed by G12V and G12D. KRAS-mutant patients were more likely to have smoked, be female, and show higher PD-L1 expression than KRAS wild type patients.

Sep 23, 2026

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