Comprehensive genomic and epigenomic analysis in cancer of unknown primary guides molecularly-informed therapies despite heterogeneity.
Lino MöhrmannMaximilian WernerMałgorzata OleśAndreas MockSebastian UhrigArne JahnSimon KreutzfeldtMartina FröhlichBarbara HutterNagarajan ParamasivamDaniela RichterKatja BeckUlrike WinterKatrin PfützeChristoph E HeiligVeronica TeleanuDaniel B LipkaMarc ZapatkaDorothea HanfCatrin ListMichael AllgäuerRoland PenzelGina RüterIvan JelasRainer HamacherJohanna FalkenhorstSebastian WagnerChristian H BrandtsMelanie BörriesAnna L IllertKlaus H MetzelerC Benedikt WestphalenAlexander DesukiThomas KindlerGunnar FolprechtWilko WeichertBenedikt BrorsAlbrecht StenzingerEvelin SchröckDaniel HübschmannPeter HorakChristoph HeiningStefan FröhlingHanno GlimmPublished in: Nature communications (2022)
The benefit of molecularly-informed therapies in cancer of unknown primary (CUP) is unclear. Here, we use comprehensive molecular characterization by whole genome/exome, transcriptome and methylome analysis in 70 CUP patients to reveal substantial mutational heterogeneity with TP53, MUC16, KRAS, LRP1B and CSMD3 being the most frequently mutated known cancer-related genes. The most common fusion partner is FGFR2, the most common focal homozygous deletion affects CDKN2A. 56/70 (80%) patients receive genomics-based treatment recommendations which are applied in 20/56 (36%) cases. Transcriptome and methylome data provide evidence for the underlying entity in 62/70 (89%) cases. Germline analysis reveals five (likely) pathogenic mutations in five patients. Recommended off-label therapies translate into a mean PFS ratio of 3.6 with a median PFS1 of 2.9 months (17 patients) and a median PFS2 of 7.8 months (20 patients). Our data emphasize the clinical value of molecular analysis and underline the need for innovative, mechanism-based clinical trials.
Keyphrases
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