Distributional range of tumor mutational burden (TMB) across multiple cancer types emphasizing the importance of different cutoff values in different tumor types for clinical interpretation: A consensus statement from the SEQUOIA consortium.

Authors

null

Wojciech Swat

Cancer Genomics and Molecular Pathology, Bioreference Laboratory, Elmwood Park, NJ

Wojciech Swat , Dibyendu Kumar , Theresa A. Boyle , Emily Dalton , Stewart Comer , James Solomon , Shivani Golem , Kenneth R Eyring , Brett Baskovich , Ashutosh Vashisht , Harmanpreet Singh , Pankaj Kumar Ahluwalia , Ahmet Alptekin , Nikhil Sahajpal , Ashis Mondal , Vamsi Kota , Ravindra Kolhe

Organizations

Cancer Genomics and Molecular Pathology, Bioreference Laboratory, Elmwood Park, NJ, Moffitt Cancer Center, Tampa, FL, Illumina, Inc., San Diego, CA, NewYork-Presbyterian Hospital/Weill Cornell Medical Center Department of Pathology and Laboratory Medicine, New York, NY, KUMC, Lenexa, KS, Intermountain Precision Genomics, Intermoutain Health,, Salt Lake City, UT, Mount Sinai Health System, New York, NY, Augusta University, Augusta, GA, Medical College of Georgia at Augusta University, Augusta, GA, Greenwood Genetics Center, Greenwood, SC, Georgia Cancer Center at Augusta University, Augusta, GA, Medical College of Georgia, Augusta, GA

Research Funding

No funding received
None.

Background: The measurement of tumor mutational burden (TMB) is critical to select patients who are expected to respond to immune checkpoint inhibitors or immune-oncology (IO). The majority of the clinical guidelines on the interpretation & utility of TMB values are based on studies performed on lung cancer, setting a cutoff of 10. Laboratories that are using comprehensive genomic profiling (CGP) for tumor testing are reporting TMB values &/or interpretations (high/low) beyond lung cancer. Multiple studies have shown that the TMB signature is not universal, but rather tumor &/or even patient-specific. However, the pan-cancer trial for IO (KEYNOTE-158) failed to consider setting different cutoffs per tumor type. Currently, no major guidelines or consensus statements address the issue of reporting TMB as a biomarker beyond lung cancer. In the current study, the membership of the SEQUOIA (Sequencing & Oncology Informatics Academic Team) Consortium investigates the landscape of TMB values across multiple cancer types. Methods: We investigated TMB values in 11,670 patient samples (M = 6225; F= 5445) across 13 different tumor types & histological subtypes, including cancers with lung, colorectal, gastrointestinal, brain, prostate, pancreatic, biliary, endometrioid, ovarian, skin, hematological (CLL myeloma) & lymphoid origin. All samples were processed by a CGP panel of 523 genes. Multiple specimen types were included in the study consisting of tissue, blood, marrow, & lymph node. Results: The range of TMB values varied significantly across different cancer types & histological subtypes. The colorectal, melanoma & endometrial cancers have a wider range of TMB values (2-400 mutations/MB) relative to prostate, breast, myeloma, & serous cancers (0-30 mutations/MB). Along with the range, the mean, & median TMB values are also significantly varied across these tumor types. We also identified that a subset of patients exhibits high TMB (>30 mutations/MB) values across almost all types of cancer. Conclusions: TMB values & their association with response to immune checkpoint inhibitors are not very well studied in all cancer types, although a TMB cut-off of 10 mutations/MB was defined as TMB-high for FDA-approved IO in patients with unresectable or metastatic solid tumors. The range, mean, median, cut-offs & clinical interpretations of TMB-high & low for IO based therapies for different tumor types has not been well established. Our data confirm the wide range, mean, & median across different tumor types, & thus laboratories & oncologists need to be cautious in the clinical interpretation of TMB values for patient management. Future studies should assess responsiveness to IO in specific tumor types based on TMB value to determine tumor-specific TMB cutoff values.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Developmental Therapeutics—Immunotherapy

Track

Developmental Therapeutics—Immunotherapy

Sub Track

Tissue-Based Biomarkers

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 2615)

DOI

10.1200/JCO.2023.41.16_suppl.2615

Abstract #

2615

Poster Bd #

457

Abstract Disclosures

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