Survival of patients with colorectal cancer (CRC) with low expression of homologous recombination proficient (HRP) genes.

Authors

null

Daniel Walden

Mayo Clinic Arizona, Phoenix, AZ;

Daniel Walden , Sachin Deshmukh , Felipe Batalini , Binbin Zheng-Lin , Sharon Wu , Joanne Xiu , Emil Lou , Daniel H. Ahn , Christina Wu , Sanjay Goel , Anthony Frank Shields , David Spetzler , Matthew James Oberley , Wolfgang Michael Korn , Tanios S. Bekaii-Saab

Organizations

Mayo Clinic Arizona, Phoenix, AZ; , Caris Life Sciences, Phoenix, AZ; , Mayo Clinic, Phoenix, AZ; , Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN; , Mayo Clinic in Arizona (Phoenix, AZ), Phoenix, AZ; , Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; , Barbara Ann Karmanos Cancer Institute, Detroit, MI; , Caris Life Sciences, Tempe, AZ; , Mayo Clinic Cancer Center Scottsdale, Phoenix, AZ;

Research Funding

No funding received
None.

Background: HR deficient (HRD) CRC has improved outcomes following exposure to DNA damaging agent (DDA) (irinotecan, IR; oxaliplatin, OX) compared to HRP CRC. Low expression of wild type (WT) BRCA1 mRNA is associated with prolonged OS in ovarian cancer; however, this finding has not been investigated in CRC or outside of BRCA. Here, we examine the effect of low expression of HR genes in HRP CRC on post-DDA survival. Methods: 12,860 CRC samples were analyzed by NGS (592, NextSeq; WES, NovaSeq) and WTS (NovaSeq) at Caris Life Sciences (Phoenix, AZ). Samples were classified by RNA expression percentiles. Real world OS was extracted from insurance claims and calculated using Kaplan-Meier estimates for molecularly defined cohorts from first of OX or IR to last contact. Results: Post-IR survival was prolonged with low expression of ATM, CHEK2 and PALB2 in WT ATM, PALB2, and CHEK2 WT CRC, respectively (bottom vs. top 10%, bottom vs. top 25%; p<0.05). Notably, low PALB2 expression (bottom 10%) showed a 14.5-month post-IR benefit compared to high PALB2 expression (top 10%) in WT PALB2 CRC (p=0.003). Post-OX survival was not significantly prolonged with low expression of CHEK2 in WT CHEK2 CRC (bottom 10% vs top 10%, bottom 25% vs top 25%) but was with low expression of ATM (+9.7 months, p=0.02) and PALB2 (+5.6 months, p=0.03) in WT ATM and PALB2 CRC, respectively (all bottom 25% vs top 25%). Conclusions: Here we report the first findings to suggest a novel subclass of CRC defined as the low expression of mRNA of non-mutated HRD genes that exhibit sensitivity to DDA. Low expression of WT ATM, CHEK2, and PALB2 correlates with prolonged OS following IR, post-OX survival was prolonged with low expression of ATM and PALB2. Further characterization defining sensitivity of low expressing HRP genes to DDA may help guide treatment considerations in HRP CRC.

Post-OX/IR survival by mRNA expression in PALB2, CHEK2 and ATM WT CRC.

DDAGeneHR
(95% CI)
Bottom 25%Top 25%∆ (mo)P-valHR
(95% CI)
Bottom 10%Top 10%∆ (mo)P-val
OXATM0.80
(0.66-0.96)
61.2mo
N=906
51.5mo
N=998
+9.70.020.76
(0.56-1.04)
57.2mo
N=344
48.9mo
N=393
+8.30.08
CHEK20.87
(0.73-1.03)
61.2mo
N=1025
55.6mo
N=1041
+5.60.110.82
(0.62-1.08)
61.5mo
N=383
55.6mo
N=406
+5.90.16
PALB20.82
(0.69-0.98)
61.2mo
N=1050
56.5mo
N=1101
+4.70.030.79
(0.59-1.05)
57.2mo
N=376
49.4mo
N=419
+7.80.10
IRATM0.79
(0.62-0.99)
35.4mo
N=463
31.1mo
N=637
+4.30.040.64
(0.42-0.96)
35.4mo
N=178
31.1mo
N=271
+4.30.03
CHEK20.75
(0.60-0.94)
43.5mo
N=541
33.5mo
N=646
+100.010.62
(0.44-0.89)
35.3mo
N=207
31.1mo
N=270
+40.01
PALB20.79
(0.64-0.97)
35.4mo
N=570
31.1mo
N=658
+4.30.030.57
(0.39-0.83)
41.1mo
N=205
26.6mo
N=271
+14.50.003

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 225)

DOI

10.1200/JCO.2023.41.4_suppl.225

Abstract #

225

Poster Bd #

M7

Abstract Disclosures

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