Molecular stratification of high-grade unclassified renal cell carcinoma to improve prognostication and management strategy.

Authors

null

Yingbei Chen

Memorial Sloan Kettering Cancer Center, New York, NY

Yingbei Chen , Renzo G Di Natale , Gowtham Jayakumaran , Mazyar Ghanaat , Julian Marcon , A. Rose Brannon , Hikmat Al-Ahmadie , Samson Fine , Anuradha Gopalan , Sahussapont Joseph Sirintrapun , Satish Tickoo , Maria E. Arcila , Robert J. Motzer , A. Ari Hakimi , Victor E. Reuter

Organizations

Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

Other

Background: Unclassified renal cell carcinoma (uRCC) constitutes a large portion of aggressive non-clear cell RCC with limited response to standard therapy. Clinicopathologic parameters or biomarkers to stratify this heterogeneous group of tumors are currently lacking. In a recently reported analysis of 62 high-grade primary uRCC [“discovery cohort (DC)”], we identified distinct molecular subsets. We aimed to validate this molecular schema in an independent clinical cohort and further delineate the clinicopathologic and molecular features that may refine prognostication and management. Methods: All cases was reviewed by experienced GU pathologists based on the current WHO criteria. Primary (n = 54) or metastatic (n = 21) tumor samples from 75 uRCC patients [“validation cohort (VC)”] were analyzed by a CLIA-approved targeted NGS platform for somatic alterations. 37 had germline testing results available. We performed integrative analysis of both VC and DC. Results: Somatic mutations found in VC were NF2 (24%), SETD2 (13%), SMARCB1 (9%), TP53 (9%), TSC1 (9%), FH (8%), TSC2 (5%), MTOR (5%), EP300 (5%), BAP1 (5%), PBRM1 (5%) and PIK3CA (5%), highly consistent with findings in DC. Germline alterations [FH (11), SDHB (4), and SMARCB1 (1)] were detected in previously unsuspected patients. Integrative analysis supported the presence of NF2-loss (NF2), hyperactive mTOR-driven (MTOR), FH/SDH-deficient (FH/SDH), and chromatin/DNA damage response (Chrom/DDR) molecular subsets. Univariate analysis of combined DC and VC (n = 137, median f/u 26 mos, death 74%) showed a significantly higher risk associated with NF2 subset than the MTOR group (Table). Clonality analysis confirmed NF2 inactivating mutation as a main driver in the NF2 subset. Rare cases with alterations indicating sensitivity or resistance to immunotherapy were also identified. Conclusions: Molecular features of high-grade uRCC improve risk stratification and provide rationale for distinct management strategies.

Molecular subsetVC (n)Combined DC + VC (n)HR (95% CI)p value
MTOR8211
NF214292.56 (1.30 - 5.06)0.01
Chrom/DDR18312.07 (1.04 - 4.15)0.04
FH/SDH18222.37 (1.12 - 5.01)0.02
Other17341.69 (0.87 - 3.28)0.12

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Abstract Details

Meeting

2019 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer

Track

Renal Cell Cancer

Sub Track

Renal Cell Cancer

Citation

J Clin Oncol 37, 2019 (suppl 7S; abstr 640)

DOI

10.1200/JCO.2019.37.7_suppl.640

Abstract #

640

Poster Bd #

H13

Abstract Disclosures

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