Whole-exome sequencing in unresectable pancreatic cancer patients with long-term survival.

Authors

null

Kentaro Sudo

Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan

Kentaro Sudo , Sana Yokoi , Osamu Ohara , Kazuyoshi Nakamura , Akiko Tsujimoto , Emiri Kita , Yoshinori Hasegawa , Manabu Nakayama , Hiroshi Ishii , Tadamichi Denda , Taketo Yamaguchi

Organizations

Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan, Cancer Genome Center, Chiba Cancer Center, Chiba, Japan, Department of Technology Development, Kazusa DNA Research Institute, Kisarazu, Japan, Clinical Research Center, Chiba Cancer Center, Chiba, Japan, Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan

Research Funding

Other

Background: Advances in technology of genomic sequencing have revealed the mutational landscape of pancreatic cancer. However, little is known with regard to molecular mechanisms underlying clinical diversity in “unresectable” advanced pancreatic cancer. Methods: We performed whole-exome sequencing using frozen cancer tissues prospectively obtained by EUS-FNA from primary tumors before chemotherapy in patients with metastatic or locally advanced pancreatic cancer (n = 35). All patients had pathological confirmation (adenocarcinoma, n = 34; carcinoma, n = 1). Somatic alterations in the cancer genome were compared with clinical outcomes. Results: Seventeen patients had metastatic disease and 18 had locally advanced disease. Thirty-four patients received chemotherapy with or without radiotherapy and one patient was treated with supportive care alone because of rapidly progressive disease. With a median follow-up time of 60.6 months (range 41.9–94.0) for censored cases, the median survival for all patients was 10.8 months. Nine patients survived more than 2 years ( > 6 years, n = 2; > 3 years, n = 3; > 2 years, n = 4), while 11 patients died within 4 months. We show mutational landscape of unresectable advanced pancreatic cancer and identified somatic mutations in known cancer related genes including KRAS (89%), TP53 (71%), SMAD4 (20%), CDKN2A (17%) and ARID1A (14%). We found that ARID1A mutation was mutually exclusive with TP53 mutation except for one tumor and had a significant correlation with survival outcomes. Among 9 patients who survived more than 2 years, 5 patients (56%) had ARID1A somatic mutation, whereas none (0%) had mutations in the remaining 26 patients who died within 2 years (P = 0.0004). The median overall survival was 47.7 months for 5 patients with ARID1A-mutated tumors and 8.9 months for 30 patients with ARID1A wild-type tumors (P = 0.0101). Conclusions: This is the first study to perform whole-exome sequencing in unresectable pancreatic cancer patients including very long-term survivors. We found that ARID1A mutations were associated with longer survival.

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Abstract Details

Meeting

2019 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 37, 2019 (suppl 4; abstr 260)

DOI

10.1200/JCO.2019.37.4_suppl.260

Abstract #

260

Poster Bd #

D18

Abstract Disclosures