First, although the relatively low frequency of KRAS and PIK3CA mutations in this cohort (12.5%) precluded assessment of an association with outcome, we noted that one patient with ampullary carcinoma with intestinal differentiation who had a concurrent PIK3CA and KRAS mutation had a prolonged PFS of 16.7 months. This evidence concerns the gene KRAS and carcinoma of the ampulla of vater.