HIF-pathway genes prognostic for progression-free and overall survival in metastatic clear cell renal cell carcinoma (mccRCC).

Authors

Patrick Tamukong

Patrick Tamukong

Cedars-Sinai Medical Center, Los Angeles, CA

Patrick Tamukong , Paige Kuhlmann , Sungyong You , Shengchen Su , Yanping Wang , Eric Jay Small , Brian I. Rini , Susan Halabi , Jessica Janes , Stephen J. Freedland , Hyung Lae Kim

Organizations

Cedars-Sinai Medical Center, Los Angeles, CA, Cedars Sinai Medical Center, Los Angeles, CA, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, Vanderbilt-Ingram Cancer Center, Nashville, TN, Duke University Medical Center, Durham, NC, Durham VA Health Care System, Durham, NC, Cedars-Sinai Medical Center, Los Angeles, CA and Durham VA Medical Center, Durham, NC

Research Funding

Other

Background: Clear cell renal cell carcinoma (ccRCC) is characterized by defects in the Von Hippel-Lindau/hypoxia-inducible factor (VHL/HIF) pathway. Several FDA-approved RCC therapies target the products of HIF-response genes. HIF2A is a promising new target and drugs targeting HIF2A are undergoing clinical testing. A better understanding of HIF-related genes may reveal useful biomarkers and drug targets. Methods: Gene expression was determined from 324 archival pretreatment nephrectomy specimens available from the Cancer and Leukemia Group B (CALGB) 90206, a phase III trial of patients treated with INF-α vs. INF-α plus bevacizumab. TaqMan RT-qPCR was performed on the OpenArray platform using RNA extracted from tumor tissue macrodissected based on review of H&E staining by a genitourinary pathologist. HIF pathway genes were assessed across both treatment arms, utilizing the proportional hazards model as predictors of OS and PFS, with time from randomization to death or disease progression as endpoints. Results: A total of 28 HIF-related genes (involved either in canonical or non-canonical HIF regulation) were assessed in univariate PH. Nine of these genes were associated with OS (i.e., HIF2A, VEGFC, VEGFD, TGFA, VHL, CCND1, EGFR, EGLN3 and HSP90AA1); and 6 of them were also associated with PFS (i.e., HIF2A, TGFA, VHL, CCND1 and EGLN3, and HSP90AA1). The HIF isotypes HIF1A and HIF3A were not prognostic, likewise VEGFA and VEGFB. Prolyl hydroxylase domain (PHD) proteins efficiently hydroxylate HIFα in normoxic conditions. PHD isotypes EGLN (1-3) were evaluated and only EGLN3 was associated with OS and PFS. HIF is also regulated by non-canonical pathways that function independent of oxygen concentration. HSP90AA1 was the only non-canonical pathway gene that was prognostic, and it predicted both OS and PFS. When the 9 genes that were prognostic in univariate analysis were used in a backward stepwise multivariate cox regression, VEGFD, TGFA and EGLN3 predicted OS while HIF2A, VHL and TGFA predicted PFS. Conclusions:VHL, HIF2A (but not HIF1A and HIF3A), EGLN3 (but not EGLN1 and EGLN2) and some of the HIF-response genes were prognostic of both OS and PFS. HSP90AA1 was prognostic for OS and PFS, suggesting that the non-canonical HIF pathway also plays a role in disease progression. Future studies should consider these HIF pathway genes as potential drug targets, and as predictors of response to treatments targeting the hypoxia pathway and angiogenesis.

Gene
OS
PFS
HR
95% CI
P
HR
95% CI
P
HIF2A
1.05
1.01-1.10
0.02
1.05
1.01-1.10
0.02
VEGFD
1.08
1.01-1.15
0.03
1.05
0.99-1.13
0.13
TGFA
1.15
1.07-1.24
0.00
1.13
1.05-1.22
0.00
VHL
0.78
0.66-0.93
0.01
0.78
0.65-0.94
0.01
CCND1
1.08
1.01-1.15
0.02
1.08
1.02-1.15
0.02
EGFR
1.17
1.03-1.33
0.02
1.13
0.99-1.29
0.07
EGLN3
1.10
1.03-1.18
0.00
1.09
1.01-1.16
0.02
VEGFC
0.91
0.82-1.00
0.04
0.95
0.86-1.05
0.33
HSP90AA1
0.85
0.76-0.94
0.00
0.86
0.77-0.97
0.01

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Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer; Adrenal, Penile, Urethral, and Testicular Cancers

Track

Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Translational Research, Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr 370)

DOI

10.1200/JCO.2022.40.6_suppl.370

Abstract #

370

Poster Bd #

H4

Abstract Disclosures