A comprehensive landscape of BRCA1 versus BRCA2 associated molecular alterations and survival outcome across 35 cancer types.

Authors

Alberto Puccini

Alberto Puccini

Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

Alberto Puccini , Joanne Xiu , Arielle Lutterman Heeke , Andreas Seeber , Richard M. Goldberg , Wafik S. El-Deiry , Stephen V Liu , Sarah Sammons , Emil Lou , Philip Agop Philip , John Marshall , Anthony Frank Shields , Heinz-Josef Lenz , Thomas J. Herzog , W. Michael Korn , Mohamed E. Salem

Organizations

Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, Caris Life Sciences, Phoenix, AZ, Emory University, Atlanta, GA, Department of Internal Medicine V (Hematology and Oncology), Innsbruck, Austria, West Virginia University Cancer Institute, Morgantown, WV, Cancer Center at Brown University, Providence, RI, Lombardi Comprehensive Cancer Center of Georgetown University, Washington, DC, WA, Duke University Medical Center/ Duke Cancer Institute, Durham, NC, University of Minnesota School of Medicine, Minneapolis, MN, Karmanos Cancer Institute, Detroit, MI, Georgetown University, Washington, DC, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USC Norris Comprehensive Cancer Center, Los Angeles, CA, University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati, OH, Levine Cancer Institute, Atrium Health, Charlotte, NC

Research Funding

No funding received
None

Background: Poly (ADP-ribose) polymerase inhibitors (PARPi) are effective therapies for some patients with both germline and somatic BRCA1/2 mutations (MTs) or with homologous recombination repair deficiency (HRD). We aimed to characterize molecular differences between BRCA1 and BRCA2 MTs and their prognostic and/or predictive impact on PARPi outcomes in various cancer subtypes using real world data (RWD). Methods: Tumor samples obtained from patients with 35 types of cancer were analyzed by whole exome sequencing (WES, Novaseq) at Caris Life Sciences (Phoenix, AZ). High genomic loss of heterozygosity (gLOH-H) was defined as LOH-H in ≥16% of tested loci. MSI/MMR was tested by fragment analysis, IHC, and WES. Overall survival (OS) extracted from insurance claims was calculated from start of treatment or tissue collection until last contact or death using Kaplan-Meier curves. P-values adjusted for multiple comparisons (q-value of < 0.05 was considered to be significant). Results: In total, 17,640 tumors were included, of which 776 (4.3%) had tumor-based BRCA1/2 MTs. BRCA1/2 MTs were most commonly seen in ovarian (N = 221/2187, 10.1%), breast (138/2506, 5.5%), prostate (61/1131, 5.4%), pancreatic (48/1430, 3.4%), and non-small cell lung (100/4046, 2.5%) cancers. BRCA2 MTs were more frequent than BRCA1 except in ovarian cancers. BRCA1 MTs were more common in younger pts (median age, 61 vs 65 years, p <.001). When compared to BRCA2 MTs, BRCA1 MTs were more often associated with gLOH-H (64% vs 51%, p <.001) and TP53 MT (80% vs 53%, p <.001) in all tumor types. In NSCLC, EGFR mutations were exclusively seen in BRCA2 compared to BRCA1 (10.3 vs. 0%, P = 0.038). The EGFR mutations that co-occurred with BRCA2 mutations were L858R (N = 1), Exon19del (N = 4), and L861Q (N = 1). KRAS was more frequently mutated in BRCA1-mutated NSCLC (BRCA1: 32% vs. BRCA2: 16%, p =.056). In univariate analyses, overall BRCA1/2 MTs were associated with improved OS compared to wild type (HR 1.38, 95% CI [1.31-1.45], P <.0001). This effect was seen in ovarian (1.42 [1.29-1.57], p < 0.0001) and triple-negative breast cancers (TNBC) (1.18, [1.09-1.28], p <.001); but was not observed in prostate, pancreatic, or non-TNBC breast cancer subtypes. In all breast cancers, BRCA2 MTs had a superior OS (0.68, [0.51-0.89], p =.005) compared to BRCA1, while no differences were seen in other cancers. Using RWD, PARPi treated-patients with BRCA2 MTs had worse OS than BRCA1 MTs (HR 1.4, [1.09-1.80], p = 0.009); but this was not significant when individual cancers were considered. Conclusions:BRCA1 and BRCA2 MTs had variable power to be prognostic and predictive for PARPi efficacy among different cancer types using RWD. About 2.5% of NSCLCs harbor BRCA1/2 MT. Additional genomic exploration may refine biomarkers predictive of response to PARPi and may highlight features within the tumor microenvironment of importance in the setting of HRD.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Track

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Sub Track

Tissue-Based Biomarkers

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 3120)

DOI

10.1200/JCO.2021.39.15_suppl.3120

Abstract #

3120

Poster Bd #

Online Only

Abstract Disclosures