Prevalence of Fanconi anemia gene mutations among men undergoing multigene germline testing for prostate cancer: Interim results from the EMPOWeR study.

Authors

null

Veda N. Giri

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

Organizations

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, Thomas Jefferson University, Philadelphia, PA, Sidney Kimmel Cancer Center, Philadelphia, PA, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, Sidney Kimmel Cancer Center at Jefferson University, Philadelphia, PA, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

Research Funding

Other

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.


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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Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Prostate Cancer

Track

Prostate Cancer - Advanced,Prostate Cancer - Localized

Sub Track

Other

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr 188)

DOI

10.1200/JCO.2022.40.6_suppl.188

Abstract #

188

Poster Bd #

Online Only

Abstract Disclosures

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