USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
Arnab Basu , Jeremy Chang , Karen Haiber , Tanya B. Dorff , Jacek K. Pinski , David I. Quinn , Sarmad Sadeghi
Background: Muscle invasive bladder cancer (MIBC) is an aggressive disease. Several molecular subtypes have been identified. Commercial next generation sequencing (NGS) panels now provide significant genetic information on tumors. We conducted an exploratory analysis on MIBC tumor samples at our institution with commercial NGS data to evaluate if these assays provide novel prognostic information. Methods: NGS data (FoundationOne) from all locally advanced and metastatic bladder specimens were collected and combined with information on demographics, tumor characteristics (stage, grade, histology). Overall Survival (OS), post-cystectomy disease free survival (DFS), and Progression Free Survival (PFS) data were also compiled. Mutations in 353 genes were examined for alterations in TP53, Rb, FGF3-RAS-RAF and PI3K-mTOR-AKT pathways. Results: 48 samples were analyzed. Most samples were pure TCC (68.8%) followed by Squamous (16.8%) , Adenocarcinoma (6.3%), Small Cell (6.3%) and Plasmacytoid variants (2.1%). Most patients (91.5%) were locally advanced at diagnosis. Pathologic alterations were found in TP53 (54.2%) , Rb (60.4%), FGF3-RAS-RAF(89.6%) and PI3K-mTOR-AKT(70.8%) pathways. Squamous variants were more likely to have TP53 pathway alterations compared with others (100% vs 45% , p < 0.001) and predicted for poor overall survival. TP53 exons did not predict outcomes. In multivariable adjusted cox-regression models Rb alterations appeared to predict for improved post cystectomy DFS (p = 0.01). TP53 mutations predicted for worse PFS (p=0.01) while PI3K-mTOR-AKT pathway alterations were associated with poorer OS (p=0.02) after adjusting for all other predictors. Conclusions: In this limited single institution sample analyzed by commercial available NGS panels, some prognostic information was available. Analysis of a larger population could result in the validation of other predictive or prognostic markers.
Hazard Ratio (HR) | ||||||
---|---|---|---|---|---|---|
DFS | p | mPFS | p | OS | p | |
TP53 | 0.71 | 0.35 | 3.34 | 0.01* | 1.26 | 0.43 |
RB | 0.37 | 0.01* | 1.16 | 0.72 | 1.56 | 0.42 |
FGFR3-RAS-RAF | 3.61 | 0.09 | 0.31 | 0.08 | 0.46 | 0.36 |
PI3K-MTOR-AKT | 0.79 | 0.56 | 0.70 | 0.40 | 4.86 | 0.02* |
Squamous features | 0.24 | 0.14 | 1.05 | 0.94 | 26.83 | 0.03* |
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