Comprehensive genomic profiling (CGP) in KRAS wild-type (WT) pancreatic ductal adenocarcinoma (PDAC).

Authors

null

Ben George

Froedtert & the Medical College of Wisconsin, Milwaukee, WI

Ben George , Joel R. Greenbowe , Andrew Eugene Hendifar , Talia Golan , Milind M. Javle , Anirban Maitra , Nathan Bahary , Alexa Betzig Schrock , Philip J. Stephens , Vincent A. Miller , Jeffrey S. Ross , Evgeny Yakirevich , Paul S. Ritch , James P. Thomas , Siraj Mahamed Ali , Aatur D. Singhi

Organizations

Froedtert & the Medical College of Wisconsin, Milwaukee, WI, Foundation Medicine, Inc., Cambridge, MA, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, Sheba Medical Center Oncology Institute, Tel-Hashomer, Israel, University of Texas MD Anderson Cancer Center, Houston, TX, University of Pittsburgh Medical Center Cancer Center Pavilion, Pittsburgh, PA, Brown University Warren Alpert Medical School, Providence, RI, Medical College of Wisconsin, Milwaukee, WI, University of Pittsburgh Medical Center, Pittsburgh, PA

Research Funding

Other

Background: Mutations in oncogenic KRAS have been widely accepted as the signature genomic alteration (GA) in sporadic PDAC, but therapeutic efforts aimed at targeting constitutively activated KRAS have been disappointing. We examined somatic GAs in KRAS WT PDAC utilizing a CGP platform to identify actionable targets. Methods: DNA was extracted from formalin fixed paraffin embedded (FFPE) PDAC clinical specimens and CGP was performed on hybrid-capture, adaptor ligation based libraries to a mean coverage depth of > 600 unique reads. Alterations in the RAS/RAF/MEK pathway genes (KRAS, NRAS, HRAS, ARF, BRAF, EGFR, MAP2K2, MAP2K1, MAPK1) and DNA Damage Repair (DDR) pathway genes (BRCA1/2, ATM, ATR, BRIP1, RAD50, RAD51, RAD52, PALB2, CHEK1, CHEK2) were examined. Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and microsatellite instability (MSI) was determined on 114 loci. TMB was categorized based on mutations(m)/Mbp of DNA - high (H; > 20), Intermediate (I; 8-20) and low (L; < 8). Results: CGP was performed on 3426 PDAC specimens; 1815 (53%) were male, 390 (11.3%) were KRAS WT. GAs in the RAS/RAF/MEK pathway were identified in 90.6% of all cases, while 68 (17.4%) KRAS WT cases had one or more GAs in RAS/RAF/MEK pathway genes. DDR pathway GAs were identified in 1405 (41%) cases for a total of 2050 GAs, and 180 (46%) KRAS WT cases for a total of 285 GAs. DDR pathway alterations were common in KRAS WT PDAC compared to KRAS mutated PDAC (p = 0.028). Among the 842 (24.6%) cases with available TMB data, 5 (0.6%), 104 (12.3%) and 733 (87.1%) pts had H, I and L, TMB respectively. Among 88 (22.6%) KRAS WT cases with available TMB data, 2 (2.3%), 12 (13.6%) and 74 (84.1%) pts had H, I and L, TMB, respectively. MSI status was available in 2314 (67.5%) cases, 13 (0.6%) were MSI-high (MSI-H); among the KRAS WT cases, 222 (57%) had MSI status available, 3 (1.3%) were MSI-H. Conclusions: MSI-H status and high TMB are rare in PDAC, regardless of KRAS mutation status. GAs in the DDR pathway are relatively common in PDAC and may serve as predictive biomarkers for platinum chemotherapeutic agents and/or PARP inhibitors. Prospective validation of such predictive gene signatures will improve therapeutic efficacy and minimize toxicities.

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Abstract Details

Meeting

2018 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Sub Track

Translational Research

Citation

J Clin Oncol 36, 2018 (suppl 4S; abstr 271)

DOI

10.1200/JCO.2018.36.4_suppl.271

Abstract #

271

Poster Bd #

D4

Abstract Disclosures

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