Gene-specific features (MLH1, MSH2, MSH6, PMS2) of mismatch repair (MMR) protein expression and somatic mutations (muts), microsatellite instability (MSI) and tumor mutational burden (TMB) in MSI-H and MMR-mutated tumor genomic profiles (TGPs).

Authors

Michael Hall

Michael J. Hall

Fox Chase Cancer Center, Philadelphia, PA

Michael J. Hall , Joseph Nicholas Bodor , Joanne Xiu , Rebecca Feldman , Axel Grothey , Richard M. Goldberg , William Mills Worrilow , Jimmy J. Hwang , Edward S. Kim , Heinz-Josef Lenz , Derek Raghavan , Anthony Frank Shields , John Marshall , W. Michael Korn , Mohamed E. Salem

Organizations

Fox Chase Cancer Center, Philadelphia, PA, Caris Life Sciences, Phoenix, AZ, Mayo Clinic, Rochester, MN, Ohio State University Comprehensive Cancer Center, Columbus, OH, Levine Cancer Institute, Atrium Health, Charlotte, NC, Levine Cancer Institute, Carolinas Health Care System, Charlotte, NC, University of Southern California, Los Angeles, CA, Karmanos Cancer Institute, Wayne State University, Detroit, MI, Georgetown University Medical Center, Washington, DC, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC

Research Funding

Other

Background: MSI is a tumor biomarker for immunotherapy efficacy that is closely associated w/deficient MMR, and is also variably associated w/somatic muts of the MMR genes, loss of MMR protein expression by immunohistochemistry (IHC), and high TMB. Germ-line muts (Lynch syndrome/LS) in the 4 MMR genes are recognized to have distinct cancer spectrums/penetrance in LS, yet across all tumors, gene-specific variability in MMR IHC, MMR muts, and TMB is understudied. Methods: Results of TGPs performed by Caris Lifesciences (2015-17) were analyzed in colorectal (CRC), endometrial (EC) and all other cancers/tumors (OT) as: 1) all MSI-H tumors (n = 1057) and 2) all tumors w/ ≥1 mut in an MMR gene (n = 470). A subset of cases had IHC for MMR protein and PD-L1 expression. MSI and TMB were determined by NGS. Results: Characteristics of MSI-H tumors and tumors w/ ≥1 MMR mut are seen in the Table. A single MSH6 mut [F1088fs] in a coding microsatellite represented 31% of all MMR muts detected. F1088fs was found in 58% tumors w/MLH1/PMS2 loss (IHC) but only 25% w/MSH2/MSH6 loss (p < 0.001), was more commonly seen in EC vs CRC/OT (p < 0.001), and was negatively associated w/somatic POLE mut (p = 0.002). Distinct mut signatures in the MMR genes (e.g. GLUàSTOP) were seen in tumors w/POLE muts and DNA repair genes. Conclusions: MSI-H and MMR mutated tumors demonstrate marked gene-specific heterogeneity in IHC patterns, TMBs, and somatic muts that may be relevant to treatment selection, resistance, and response.

CharacteristicMSI-H tumors (n = 1057)
Tumors w/MMR mutations (n = 470)
MLH1/PMS2 loss IHCMSH2/MSH6 loss IHCMLH1MSH2
mut
MSH6
mut
PMS2
mut
N = 544N = 81N = 135N = 91N = 255N = 50
All tumors %771229195411
CRC %701685142
EC %90343172
Other %61251711237
Column p< 0.0001< 0.00010.0080.0030.0040.03
MeanTMB (mut/mb)
All24.847.036.849.937.123.1
CRC32.856.142.261.549.437.5
EC20.245.419.074.642.154.8
Other25.436.529.836.531.411.9
Column p< 0.00010.360.21130.75070.00120.4841
PD-L1+ %181526292019
POLE mut %0.63.771484
MSI-H %--69666640
IHC loss
MLH1/PMS2 %--451594
MSH2/MSH6 %--550303

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Abstract Details

Meeting

2019 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Cancers of the Colon, Rectum, and Anus

Sub Track

Prevention, Diagnosis, and Screening

Citation

J Clin Oncol 37, 2019 (suppl 4; abstr 505)

DOI

10.1200/JCO.2019.37.4_suppl.505

Abstract #

505

Poster Bd #

D8

Abstract Disclosures