Association of DNA damage response and repair genes (DDR) mutations and microsatellite instability (MSI), PD-L1 expression, tumor mutational burden (TMB) in gastroesophageal cancers.

Authors

null

Michael Cerniglia

Georgetown University Medical Center, Washington, DC

Michael Cerniglia , Joanne Xiu , Axel Grothey , Michael J. Pishvaian , Jimmy J. Hwang , John Marshall , Ari M. Vanderwalde , Anthony Frank Shields , Heinz-Josef Lenz , Mohamed E. Salem , Philip Agop Philip , Richard M. Goldberg , W. Michael Korn , Sunnie S. Kim

Organizations

Georgetown University Medical Center, Washington, DC, Caris Life Sciences, Phoenix, AZ, Mayo Clinic, Rochester, MN, Levine Cancer Institute, Carolinas Health Care System, Charlotte, NC, Division of Hematology/Oncology, The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN, Karmanos Cancer Institute, Wayne State University, Detroit, MI, University of Southern California, Los Angeles, CA, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, Ohio State University Comprehensive Cancer Center, Columbus, OH

Research Funding

Other

Background: DDR mutations are associated with higher neoantigen load and tumor infiltrating lymphocytes, and are a potential biomarker for immunotherapy. We investigated the association of DDR mutations in gastric (GC), esophageal (EC), and gastroesophageal junction (GEJ) cancers with MSI, PD-L1, and TMB, known predictors for immune checkpoint inhibitors. Methods: 20 DDR mutations were tested by Next-Generation Sequencing (NGS) with a 592-gene panel on a total of 1935 (709 EC; 831 GC; 355 GEJ) cancers. TMB was assessed by NGS, MSI by NGS or fragment analysis, and PD-L1 by IHC (22c3 for CPS or SP142). Results: GC had the highest DDR mutation rate compared to EC and GEJ (27% vs. 20%, p = 0.0005 and 17%, p = 0.0002, respectively). MSI-High (MSI-H) was significantly more common in the DDR mutated cohort (DDR-M) compared to non-mutated cancers (18% vs. 1%; p < 0.0001). TMB-High (≥ 10 mutations/megabase [mt/MB]) was higher in DDR-M (35% vs. 21%; p < 0.0001); in DDR-M cohort, GC had the highest TMB compared to DDR-M EC and GEJ (mean: 13.8 vs. 9.4 vs. 10 mt/MB, respectively; p < 0.0001). DDR mutations were more frequent in the PD-L1 combined positive score (CPS) ≥ 50 group than CPS 0 (42.9% vs. 24%; p = 0.037) and CPS 1-9 (42.9% vs. 20.6%; p = 0.005). ARID1A, ATRX, BRCA2, and PTEN were the most prevalent DDR mutations in MSI-H (87%, 31%, 25%, 24%, respectively); ARID1A, ATRX, BRCA2, and PTEN in TMB-High (47%, 7.7%, 6.7%, 6.8%) and ARID1A, BRCA2, RAD50, and WRN in PD-L1 high (CPS ≥ 10) (48.5% vs. 5.2% vs. 2.5% vs. 3.4%). Conclusions: MSI-H, TMB-high and high PD-L1 expression were significantly more prevalent in the DDR-M cohort compared to non-DDR-mutated cancers, most pronounced in GC. Alterations in ARID1A, ATRX, BRCA2, and PTEN were correlated with MSI-H and TMB-high while ARID1A, BRCA2, RAD50, and WRN were correlated with increased PD-L1 expression. Our findings may help identify patients for tailored immunotherapy approaches in future clinical trials.

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Abstract Details

Meeting

2019 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cancers of the Esophagus and Stomach

Track

Cancers of the Esophagus and Stomach

Sub Track

Translational Research

Citation

J Clin Oncol 37, 2019 (suppl 4; abstr 60)

DOI

10.1200/JCO.2019.37.4_suppl.60

Abstract #

60

Poster Bd #

G10

Abstract Disclosures

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