Pan-tumor survey of RET fusions as detected by next-generation RNA sequencing identified RET fusion positive colorectal carcinoma as a unique molecular subset


Misako Nagasaka a b c, Danielle Brazel a, Yasmine Baca d, Joanne Xiu d, Mohammed Najeeb Al-Hallak e, Chul Kim f, Jorge Nieva g, Jeffrey J. Swensen d, David Spetzler d, Wolfgang Michael Korn h, Mark A. Socinski i, Luis E. Raez j, Balazs Halmos k, Sai-Hong Ignatius Ou a b


  • RET fusions are identified in 15 tumor types and carcinoma of unknown primary.
  • Different dominant RET fusion variant within each tumor type: KIF5B-RET (NSCLC), NCOA4-RET (colorectal, breast), and CCDC6-RET (well-differentiated thyroid).
  • RET fusion positive CRC had a higher median TMB and were commonly MSI-H.



RET fusions are driver alterations in cancer and are most commonly found in non-small cell lung cancer and well-differentiated thyroid cancer. However, RET fusion have been reported in other solid tumors.

Material and methods

A retrospective analysis of RET+ solid malignancies identified by targeted RNA sequencing and whole transcriptome sequencing of clinical tumor samples performed at Caris Life Science (Phoenix, AZ).


As of March 22, 2022, a total of 378 RET+ solid malignancies were identified in 15 different tumor types and carcinoma of unknown primary (CUP) that underwent next-generation RNA sequencing. RET+ NSCLC and RET+ thyroid cancer constituted 66.9% and 11.1% of the RET+ solid malignancies, respectively. RET+ colorectal adenocarcinoma and RET+ breast adenocarcinoma constituted 10.1% and 2.6%, respectively. The estimated frequency of RET fusions within specific tumor types were NSCLC 0.7%, thyroid cancer 3.1%, colorectal cancer 0.2% and breast cancer 0.1%. KIF5B (46.8%) was the most common fusion partner followed by CCDC6 (28.3%) and NCOA4 (13.8%) in RET+ solid tumors. KIF5B-RET was the dominant fusion variant in RET+ NSCLC, NCOA4-RET was the dominant variant in RET+ colorectal carcinoma, and CCDC6-RET was the dominant variant in thyroid cancer. The most common single gene alterations in RET+ tumors were TP53 (34.8%), RASA1 (14.3%) and ARIAD1A (11.6%). RET+ CRC had a high median TMB of 20.0 and were commonly MSI-H.


RET fusions were identified in multiple tumor types. With a higher median TMB and commonly MSI-H, RET fusion positive CRC may be a unique molecular subset of CRC.

External Link