Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
Veda N. Giri , Laura Gross , Jessica Russo , Ayako Shimada , Christopher McNair , William Kevin Kelly , Leonard G. Gomella
Background: Germline testing for prostate cancer (PCA) is now central to treatment, screening, and hereditary cancer management. The Fanconi anemia (FA) pathway is a key DNA repair pathway involved in PCA biology and treatment. Prevalence of FA genes BRCA2, PALB2, and BRIP1 is well-described; however, multiple other FA genes are not routinely tested, with limited prevalence data. Here we report mutation prevalence of a spectrum of FA genes among men undergoing PCA multigene testing on the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWeR) study. Methods: Eligibility includes any male with PCA or at-risk for PCA. Multigene testing includes 51 genes; FA pathway genes include BRCA2, PALB2, BRIP1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, and FANCM. Multiple additional cancer risk genes were tested. Fisher’s exact tests were conducted to compare the prevalence of FA gene mutations between participants in the EMPOWeR study vs population prevalence reported in the literature. Statistical significance level of all tests was set a priori to 0.05. Results: The current cohort includes 235 participants. Characteristics are White (83.3%), Black (13.7%), PCA diagnosis (83.4%), mean age of PCA diagnosis 61.7 + 7.69 years, Gleason score >=7 (66.2%), and T3 or higher (29.4%). Genetic results were available for 179 participants. Overall, 11.1% of participants (n=20) had a pathogenic/likely pathogenic mutation identified. Among mutation carriers, 45% (n=9) had mutations in FA genes, including FANCA (n=3), BRCA2 (n=2), FANCM (n=1), FANCD2 (n=1), PALB2 (n=1), and BRIP1 (n=1). Table shows clinical characteristics of participants with mutations in FANCA, FANCM, and FANCD2. Further mutation spectrum included: CHEK2 (n=3), NBN (n=2), MUTYH (n=2), BRCA (n=1), ATM (n=1), HOXB13 (n=1), APC (n=1). Compared to population prevalence, FA mutation prevalence was significantly higher overall (5.0% vs. 0.6%, p = 0.010) and among mutation carriers (45% vs. 0.6%, p<0.001). Conclusions: While prevalence of FA genes BRCA2, PALB2, and BRIP1 is well-described, our study supports testing a broader range of FA genes given the prevalence rates, potential implications for clinical trials, targeted therapy, inherited syndromes, and reproductive implications.
Clinical characteristics of participants with FA gene mutations. | ||||||||
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Participant | Gene | Alteration | Interpretation | Age Dx | PSA Dx | Gleason | Stage | Tx |
1 | FANCA | c.3066+1G>A (Splice donor) | Likely pathogenic | 56 | 3.9 | 9 (4+5) | pT3bN0MX | Surgery + RT + ADT |
2 | FANCA | c.3788_3790del (p.Phe1263del) | pathogenic | 55 | 15.1 | 9 (4+5) | pT3bN0MX | Surgery + RT + ADT |
3 | FANCM | c.5791C>T (p.Arg1931*) | pathogenic | 63 | 8.3 | 7 (3+4) | pT3aN0Mx | Surgery + RT |
4 | FANCA | c.4198C>T (p.Arg1400Cys) | pathogenic | 53 | N/A | 9 (4+5) | pT3bN0MX | Surgery + RT + ADT |
5 | FANCD2 | c.2715+1G>A (Splice donor) | pathogenic | 73 | 5.4 | 6 (3+3) | Active surveillance |
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