IDH1 and IDH2 Driven Intrahepatic Cholangiocarcinoma (IHCC): A comprehensive genomic and immune profiling study.

Authors

null

Shalini Makawita

MD Anderson Cancer Center, Houston, TX

Shalini Makawita , Mitesh J. Borad , Fernando Carapeto , Lawrence Kwong , Tanios S. Bekaii-Saab , Karthikeyan Murugesan , Jeffrey S. Ross , Natalie Danziger , Mason A. Israel , Kimberly McGregor , Filip Janku , Milind M. Javle

Organizations

MD Anderson Cancer Center, Houston, TX, Mayo Clinic, Scottsdale, AZ, University of Texas MD Anderson Cancer Center, Houston, TX, Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, Foundation Medicine, Inc, Cambridge, MA, Foundation Medicine, Cambridge, MA, Foundation Medicine Inc., Cambridge, MA, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Research Funding

No funding received
None

Background: IDH1/2 genetic aberrations (GA) occur in 20% of IHCC cases and may be specifically targeted by IDH inhibitors. The genomic and immunologic profile of IHCC with IDH1/2 GA remains undefined. IDH1 mutations impair DNA damage repair (DDR), loss of heterozygosity (LOH) and may represent a biomarker for DDR in these patients. Methods: Comprehensive genomic profiling (CGP) was performed in 3,067 cases of advanced stage IHCC using a hybrid capture-based FDA-approved assay. Tumor mutational burden (TMB) was determined on 0.8 Mbp of sequenced DNA and microsatellite instability (MSI) was determined on 95 loci. PD-L1 expression in tumor cells (Dako 22C3) was measured by immunohistochemistry (IHC). Genomic LOH (gLOH) was assessed for samples meeting quality criteria. Densities of tumor associated immune cells and immune-checkpoint markers expressed in epithelial malignant cells and in the tumor microenvironment of 100 surgical samples from 96 patients were evaluated by IHC using digital image analysis of 14 markers (CD3, CD4, CD8, CD68, PD1,PD-L1, B7-H4, B7-H3, IDO1, ICOS, VISTA, OX40, TIM3, LAG3). Tissue microarrays were generated for multiplex immune panel analysis. A p value < 0.05 was considered statistically significant. Results: 426 (14%) of IHCC were IDH1+ and 125 (4%) were IDH2+ (Table) and were mutually exclusive. All IDH1 GA occurred at the R132 locus and included R132C (69%) and R132L/G/S/H/F (16%/7%/4%/3%/ < 1%) and 119Q ( < 1%) and IDH2 GA at R172 (94.4%) and R140 (6.6%). IDH1+ and IDH2+ IHCC had fewer co-occurring targetable GA than IDH1/2 wildtype (WT, IDHwt) cases including FGFR2 rearrangements (RE) (P <.0001), ERBB2 (P =.0009) and BRAF (P =.04). Median gLOH were not significantly different between IDH1+IDH2+ IHCC vs. IDHwt IHCC (p = 0.37). Potential biomarkers of immune checkpoint inhibition (ICI) response including MSI High, TMB > 10 mut/Mb, and PD-L1 positivity were more frequent in IDHwt IHCC than IDH1+ IHCC. 29/96 (30%) surgical patients were positive for IDH1/2 mutation though mutational status did not confer a statistically significant difference in the 14 immune biomarker panel expression. Conclusions: CGP reveals significant differences in GA between IDH1+, IDH2+ and IDHwt IHCC consistent with IDH1 and IDH2 being driver oncogenes for IHCC. Immune biomarker expression and gLOH did not differ significantly between IDH mutated and WT cases.


IDH1+ IHCC (N = 426)
IDH2+ IHCC

(N = 125)
IDHwt IHCC

(N = 2516)
P Value
TP53
12%
9%
39%
<.0001
CDKN2A/CDKN2B
20%/16%
12%/9%
33%/23%
<.0001
MTAP
8%
6%
17%
<.0001
FGFR2 RE
1%
1%
10%
<.0001
ERBB2 short variants/amplifications
< 1%/2%
2%/1%
1%/4%
0.0009
BRAF
4%
2%
5%
0.04
MSI-High
< 1%
0%
1%
0.009
TMB > 10 mut/Mb
< 1%
0%
5%
<.0001
gLOH
10.37
10.55
10.21
0.37

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Clinical Science Symposium

Session Title

Biomarker-Driven Approaches for the Treatment of Gastrointestinal Cancers

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Hepatobiliary Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 4009)

DOI

10.1200/JCO.2021.39.15_suppl.4009

Abstract #

4009

Abstract Disclosures

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