Genetic variants of DNA repair-related genes predict efficacy of TAS-102 in patients with refractory metastatic colorectal cancer
ANNALS OF ONCOLOGY
Authors: Suenaga, M.; Schirripa, M.; Cao, S.; Zhang, W.; Yang, D.; Murgioni, S.; Rossini, D.; Marmorino, F.; Mennitto, A.; Ning, Y.; Okazaki, S.; Berger, M. D.; Miyamoto, Y.; Gopez, R., Jr.; Barzi, A.; Yamaguchi, T.; Loupakis, F.; Lenz, H. -J.
Abstract
Background: Tri-phosphorylated trifluridine (FTD) incorporation into DNA is TAS-102's main anti-tumor action. We tested whether genetic polymorphisms in homologous recombination (HR) and cell cycle checkpoint pathway for DNA repair is associated with outcomes in refractory metastatic colorectal cancer (mCRC) patients treated with TAS-102. Patients and methods: We analyzed genomic DNA extracted from 233 samples of three cohorts: an evaluation cohort of 52 patients receiving TAS-102, a validation cohort of 129 patients receiving TAS-102 and a control cohort of 52 patients receiving regorafenib. Single nucleotide polymorphisms of genes involved in HR (ATM, BRCA1, BRCA2, XRCC3, FANCD2, H2AX, RAD51) and cell cycle checkpoint (ATR, CHEK1, CHEK2, CDKN1A, TP53, CHE1, PIN1, PCNA) were analyzed by PCR-based direct sequencing. Results: In univariate analysis for the evaluation cohort, patients with any G allele in ATM rs609429 had longer overall survival (OS) than those with the C/C variant (8.7 vs. 4.4 months, HR 0.37, 95% CI: 0.14-0.99, P = 0.022). Patients carrying any A allele in XRCC3 rs861539 had significantly longer progression-free survival (PFS) (3.8 vs. 2.3 months, HR 0.44, 95% CI: 0.21-0.92, P = 0.024) and OS (15.6 vs. 6.3 months, HR 0.25, 95% CI: 0.08-0.79, P = 0.012) than those with the G/G variant. In multivariable analysis, ATM rs609429 remained significant for OS (P = 0.020). In the validation cohort, patients having ATM rs609429 with any G allele showed longer OS and PFS; the G/A variant in XRCC3 rs861539 showed longer OS, though without statistical significance. Conclusion: Genetic variants in the HR pathway may predict clinical outcome in mCRC patients receiving TAS-102.
Actionable co-alterations in breast tumors with pathogenic mutations in the homologous recombination DNA damage repair pathway
BREAST CANCER RESEARCH AND TREATMENT
Authors: Heeke, Arielle L.; Xiu, Joanne; Elliott, Andrew; Korn, W. Michael; Lynce, Filipa; Pohlmann, Paula R.; Isaacs, Claudine; Swain, Sandra M.; Vidal, Gregory; Schwartzberg, Lee S.; Tan, Antoinette R.
Abstract
Purpose Homologous recombination (HR)-deficient breast tumors may have genomic alterations that predict response to treatment with PARP inhibitors and other targeted therapies. Methods Comprehensive molecular profiles of 4647 breast tumors performed at Caris Life Sciences using 592-gene NGS were reviewed to identify somatic pathogenic mutations in HR genesARID1A, ATM, ATRX, BAP1, BARD1, BLM, BRCA1/2, BRIP1, CHEK1/2, FANCA/C/D2/E/F/G/L, KMT2D, MRE11, NBN, PALB2, RAD50/51/51B,andWRN,as well as 41 markers that may be associated with treatment response to targeted anticancer therapies. Results 17.9% of breast tumors had HR mutations (HR-MT, 831/4647) [ER/PR+ , HER2- 18.3%,n = 2183; TNBC 18.2%,n = 1568; ER/PR+ , HER2+ 15.6%,n = 237; ER/PR-, HER2+ 12.9%,n = 217; unknownn = 442]. Mean TMB was higher for HR-MT tumors across subtypes (9.2 mut/Mb vs 7.6 h-wild type (HR-WT),p <= 0.0001) and independent of microsatellite status. MSI-H/dMMR was more frequent among HR-MT tumors (2.1% HR-MT vs 0.2% HR-WT,p <= 0.0001), as was tumor PD-L1 overexpression (13.2% HR-MT vs 11.0% HR-WT,p = 0.08). Additional co-alterations were similar between HR-MT and HR-WT, with the exception ofPIK3CA(30.3% HR-WT vs 26.4% HR-MT,p = 0.024) andAKT1(3.7% HR-WT vs 2.1% HR-MT,p = 0.021). AR overexpression andPIK3CAmutations were more common among ER/PR+ tumors. ERBB2 mutations were seen in both HER2+ and HER2- tumors. Conclusions HR-MT was common across breast cancer subtypes and co-occurred more frequently with markers of response to immunotherapy (MSI-H/dMMR, TMB) compared to HR-WT tumors. Mutations were identified in both HR-MT and HR-WT tumors that suggest other targets for treatment. Clinical trials combining HRD-targeted agents and immunotherapy are underway and could be enriched through comprehensive molecular profiling.