Genomic characterization of ATM alterations in advanced pancreatic ductal adenocarcinoma (PDAC).

Authors

null

Sheron Perera

Princess Margaret Cancer Centre/University Health Network/University of Toronto, Toronto, ON, Canada

Sheron Perera , Robert Edward Denroche , Spring Holter , Deirdre Kelly , Amy Zhang , Yifan Wang , Anna Dodd , Stephanie Ramotar , Shawn Hutchinson , Mustapha Tehfe , Ravi Ramjeesingh , James Joseph Biagi , Julie Wilson , Faiyaz Notta , Sandra Fischer , George Zogopoulos , Robert C Grant , Steven Gallinger , Jennifer J. Knox , Grainne M. O'Kane

Organizations

Princess Margaret Cancer Centre/University Health Network/University of Toronto, Toronto, ON, Canada, Ontario Institute for Cancer Research, Toronto, ON, Canada, Mount Sinai Hospital, Toronto, ON, Canada, Princess Margaret Cancer Center, Toronto, ON, Canada, Ontario institute for Cancer Research, Toronto, ON, Canada, McGill University, Montréal, QC, Canada, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada, Nova Scotia Cancer Center, Dalhousie University, Nova Scotia, NS, Canada, Queen's University, Cancer Center of Southeastern Ontario, Kingston, ON, Canada, Toronto General Hospital, University Health Network, Toronto, ON, Canada, McGill University Health Center, Montréal, QC, Canada, Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada, University of Toronto, Toronto, ON, Canada

Research Funding

Other
Wallace McCain Centre for Pancreatic Cancer/Princess Margaret Cancer Foundation, Terry Fox Research Institute, Canadian Cancer Society Research Institute, and Pancreatic Cancer Canada Foundation. , Other Government Agency.

Background: BRCA1/2 and PALB2 are genes critical to the faithful repair of double strand breaks through the homologous recombination repair (HRR) pathway. Alterations in these genes serve as predictive biomarkers to both platinum and PARP inhibitors. Ataxia-telangiectasia mutated (ATM) is also indirectly involved in HRR; however, its role as a predictive biomarker to DNA damage response agents is debated. Herein we evaluated the genomic characteristics and clinical outcomes of patients with ATM alterations on the Comprehensive Molecular Characterization of Advanced Ductal Pancreas Adenocarcinoma for Better Treatment Selection (COMPASS) trial. Methods: Patients on this study undergo a biopsy for whole genome sequencing (WGS) and RNA sequencing prior to chemotherapy; those with germline variants in ATM were reviewed by a genetics counsellor and defined as pathogenic, likely pathogenic, variant of unknown significance (VUS) or benign/likely benign. Genomic characteristics were reviewed and published classifiers of homologous recombination deficiency (HRD) were applied to all cases and included the percentage of substitution base signature (SBS) 3, the HRDetect score, the computed algorithm of large scale transitions, telomeric allelic imbalances and loss of heterozygosity (LOH), otherwise known as the genomic instability score (GIS). Results: As of January 2020, 304 patients were enrolled and 245 patients had both WGS and clinical data available. 86 germline variants in ATM were present in 70 patients. The majority of these (80%) were classified as benign or likely benign. 10 VUS were detected and 4 patients (2%) had pathogenic/likely pathogenic variants (PV). Of these 4 patients, LOH or a second somatic hit was evident in 1 case. Upon review of the PVs and VUS, SBS were consistent with typical PDAC and tumour mutational burden was low. HRDetect scores were low ( < 0.1) for 13/14 cases with either a VUS or PV; one VUS without biallelic loss, had a high HRDetect score, with presence of SBS 3 and a high GIS. This particular case was also found to have a tandem duplicator phenotype. None of the 4 cases with PV had evidence of HRD. Furthermore all four were treated with platinum based regimens without evidence of response. Conclusions: In a large series of sequenced pancreatic cancers, the presence of pathogenic germline variants in ATM was rare, with none of the cases demonstrating evidence of HRD. This suggests that this population is unlikely to benefit from PARP inhibition.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2021 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session: Pancreatic Cancer

Track

Pancreatic Cancer

Sub Track

Prevention, Screening, and Hereditary Cancers

Citation

J Clin Oncol 39, 2021 (suppl 3; abstr 396)

DOI

10.1200/JCO.2021.39.3_suppl.396

Abstract #

396

Poster Bd #

Online Only

Abstract Disclosures

Similar Abstracts

First Author: Vittorio Fasulo

First Author: Elaine Tan

First Author: Wungki Park

First Author: Helen Mackay