Multimodal profiling of biliary tract cancers to detect potentially actionable biomarkers and differences in immune signatures between subtypes.

Authors

Kabir Mody

Kabir Mody

Mayo Clinic, Jacksonville, FL

Kabir Mody , Nilofer Saba Azad , Prerna Jain , Sherif El-Refai , Rachna T. Shroff , Robin Kate Kelley , Anthony B. El-Khoueiry , Denise Lau , Gregory B. Lesinski , Mark Yarchoan

Organizations

Mayo Clinic, Jacksonville, FL, Department of Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD, Tempus Labs, Inc, Chicago, IL, Tempus Labs, Chicago, IL, University of Arizona Cancer Center, Tucson, AZ, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, University of Southern California, Los Angeles, CA, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD

Research Funding

No funding received
None

Background: Biliary tract cancers (BTC) are increasingly subtyped by molecular alterations, but little is known about the relationship between gain-of-function mutations and the RNA transcript expression of immune-related pathways. Methods: A sample of retrospective, clinicogenomic and transcriptomic data from de-identified records of patients with BTC in the Tempus database was selected. We then investigated the relationship between the mutational landscape and immune-related RNA signatures of different anatomic and genomic BTC subtypes. Results: The cohort included 455 samples of intrahepatic bile duct (IH) (n=267), gallbladder (GB) (n=153), and extrahepatic bile duct (EH) (n=35) cancer subtypes. Across all subtypes, we detected alterations in TP53 (43.8%), ARID1A (19.8%), KMT2C (18.2%), BAP1 (14.6%), KRAS (12.7%), TERT (12.0%), IDH1 (11.4%), KMT2D (11.0%), LRP1B (11.0%), and PBRM1 (10.7%), along with FGFR2 fusions (2.6%). Potentially actionable biomarkers (FGFR2 and NTRK1-3 fusions, IDH1 and BRAFV600E mutations, tumor mutational burden [TMB]>10, HER2 expression, and/or microsatellite instability) were identified in 21.1% of all BTC and 28.6% of IH samples. Mutually exclusive alterations observed between subtypes were TP53&BAP1, KRAS&BAP1, TP53&IDH1, KRAS&IDH1, and SMAD4&BAP1 (P< 0.001 for all). GB was more inflamed based on RNA signatures and classical immune biomarkers, including PD-L1 and TMB. RNA signature analyses revealed a higher expression of immune-related pathways in GB than IH (P = 0.001) with no differences in comparison with EH. PD-L1 expression and continuous TMB were elevated in GB versus the other anatomical subtypes. Significant associations were noted between particular genetic mutations and immune profiling features (table). Conclusions: BTC subtypes are diverse in DNA alterations, RNA inflammatory signatures, and immune markers. Notably, potentially actionable biomarkers were identified in a sizable portion of the cohort and varied significantly between subtypes. These results provide guidance for targeted therapy development and support the use of multimodal immune profiling for BTC. For example, GB-specific clinical trials may be considered due to the relative increase in immune-related biomarkers observed in GB and the historically limited success of BTC trials.

Biomarker associations.

Gene
Biomarker
Mean Biomarker Value in Mutated Samples
Mean Biomarker Value in Wild-Type Samples
Log2 fold-change
Adjusted P
ARID1A
TMB
4.82
2.28
0.82
0.0026
BRCA1
TMB
3.81
2.73
0.94
0.049
BAP1
PD-L1 expression
0.73
0.96
-0.59
4.43E-05
BAP1
GEP score
-0.66
-0.47
0.49
0.0026
BAP1
BMS score
1.71
1.83
-0.10
0.0129
BAP1
NRS score
1.87
2.01
-0.11
0.0193
NRAS
PD-L1 expression
0.69
0.94
-0.57
0.027
NRAS
CD8
0.011
0.063
-2.833
0.027
TP53
TMB
3.37
2.32
0.75
0.00044
TP53
NRS score
2.03
1.96
0.0496
0.021

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Hepatobiliary Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 4023)

DOI

10.1200/JCO.2021.39.15_suppl.4023

Abstract #

4023

Abstract Disclosures

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