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
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.
Characteristic | MSI-H tumors (n = 1057) | Tumors w/MMR mutations (n = 470) | ||||
---|---|---|---|---|---|---|
MLH1/PMS2 loss IHC | MSH2/MSH6 loss IHC | MLH1 | MSH2 mut | MSH6 mut | PMS2 mut | |
N = 544 | N = 81 | N = 135 | N = 91 | N = 255 | N = 50 | |
All tumors % | 77 | 12 | 29 | 19 | 54 | 11 |
CRC % | 70 | 16 | 8 | 5 | 14 | 2 |
EC % | 90 | 3 | 4 | 3 | 17 | 2 |
Other % | 61 | 25 | 17 | 11 | 23 | 7 |
Column p | < 0.0001 | < 0.0001 | 0.008 | 0.003 | 0.004 | 0.03 |
MeanTMB (mut/mb) | ||||||
All | 24.8 | 47.0 | 36.8 | 49.9 | 37.1 | 23.1 |
CRC | 32.8 | 56.1 | 42.2 | 61.5 | 49.4 | 37.5 |
EC | 20.2 | 45.4 | 19.0 | 74.6 | 42.1 | 54.8 |
Other | 25.4 | 36.5 | 29.8 | 36.5 | 31.4 | 11.9 |
Column p | < 0.0001 | 0.36 | 0.2113 | 0.7507 | 0.0012 | 0.4841 |
PD-L1+ % | 18 | 15 | 26 | 29 | 20 | 19 |
POLE mut % | 0.6 | 3.7 | 7 | 14 | 8 | 4 |
MSI-H % | - | - | 69 | 66 | 66 | 40 |
IHC loss | ||||||
MLH1/PMS2 % | - | - | 45 | 1 | 59 | 4 |
MSH2/MSH6 % | - | - | 5 | 50 | 30 | 3 |
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Abstract Disclosures
2018 ASCO Annual Meeting
First Author: Mohamed E. Salem
2023 ASCO Gastrointestinal Cancers Symposium
First Author: Rouba Ali-Fehmi
2024 ASCO Annual Meeting
First Author: Catherine A O'Connor
2018 ASCO Annual Meeting
First Author: Joseph Nicholas Bodor