Variations in DNA repair genomic alterations and tumor mutation burden in biliary tract cancer (BTC) subtypes.

Authors

Reham Abdel-Wahab

Reham Abdel-Wahab

University of Texas MD Anderson Cancer Center, Houston, TX

Reham Abdel-Wahab , Siraj Mahamed Ali , Mitesh J. Borad , Rachna T. Shroff , Lawrence Kwong , Jean-Nicolas Vauthey , Eugene Jon Koay , Mingxin Zuo , Asif Rashid , Alexa Betzig Schrock , Jeffrey S. Ross , Tanios S. Bekaii-Saab , Milind M. Javle

Organizations

University of Texas MD Anderson Cancer Center, Houston, TX, Foundation Medicine, Inc., Cambridge, MA, Mayo Clinic, Scottsdale, AZ, Mayo Clinic, Phoenix, AZ

Research Funding

Other Foundation

Background: DNA repair genomic alterations (GAs) have been identified in 12% of Intrahepatic cholangiocarcinoma (IHCCA), 26% of extrahepatic CCA (EHCCA) and 8% of gallbladder cancer (GBC) patients (pts) (Cancer 2016;122:3838–3847). Recently, the Cancer Genome Atlas (TCGA) has described more than 20 mutated DNA repair genes, many of which were not previously represented in prior reports. DNA repair GAs including MSI are associated with higher tumor mutational burden (TMB). Our study aim is to identify variations in the frequency of DNA repair GAs in IHCCA, EHCCA, and GBC. Methods: Hybrid capture-based next-generation sequencing of 422 fixed formalin paraffin embedded (FFPE) tissue blocks of BTC including; 270 IHCCA, 60 EHCCA, and 92 GBC was performed. We included 20 DNA repair genes and classified them as "direct" DNA repair genes (ATM, ATR, BRCA1, BRCA2, FANCA, FANCD2, MLH1, MSH2, MSH6, PALB2, POLD1, POLE, PRKDC, RAD50, SLX4) and "caretaker" genes that induce genomic instability (BAP1, CDK12, MLL3, TP53, BLM). We calculated TMB on 1.1 Mb of sequenced DNA in 205 tissue specimens [138 IHCCA, 23 EHCCA, and 44 GBC] and classified into three groups; high (TMB-H; ≥ 20 mut/Mb), intermediate (TMB-I; 6-19mut/Mb) and low (TMB-L; < 6mut/Mb). Results: A distinct pattern of DNA repair GAs in each tumor type was detected. (Table 1). DNA repair GAs were more commonly noted in both EHCCA and GB (63%) as compared with IHCAA (45.2%) (p= .002). Direct DNA repair GAs were highest within EHCCA (25%), while indirect DNA GAs were predominant in GBC (59.8%) (p= 0.04 and 0.001, respectively). The frequency of TMB-H and TMB-I differed significantly between BTC subtypes. Pts with EHCCA and GBC had significantly higher TMB-H and TMB-I versus IHCCA. Conclusions: The frequency of DNA repair GA’s is higher in EHCCA and GBC as compared with IHCCA. These results may have implications for clinical trials with DNA repair inhibitors and immune checkpoint blockers.

IHCCA
N= 270 (%)
EHCCA
N=60 (%)
GBC
N=92 (%)
P
DNA repair GAs122 (45.2%)38 (63.3%)58 (63%).002
Direct DNA repair GAs35 (13%)15 (25%)11 (12%).04
Caretaker DNA repair GAs99 (36.7%)27 (45%)55 (59.8%).001
TMB-H and TMB-I36 (13.3%)11 (18.3)20 (21.7%).04

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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 263)

DOI

10.1200/JCO.2018.36.4_suppl.263

Abstract #

263

Poster Bd #

C16

Abstract Disclosures

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