Amplification of wild-type RET and clinical response to selpercatinib for non–small-cell lung cancer (NSCLC).

Authors

null

Malini Marion Gandhi

Dana-Farber Cancer Institute, Lowe Center for Thoracic Oncology, Boston, MA

Malini Marion Gandhi , Biagio Ricciuti , Melissa Gildenberg , Ankit Singh , Yvonne Y. Li , Andréanne Gagné , Xinan Wang , Kelly Fitzgerald , Ayal Aizer , Mizuki Nishino , Joao Victor Machado Alessi , Federica Pecci , Alessandro Di Federico , Adam Fisch , Valentina Nardi , Lynette M. Sholl , Mark M. Awad , Julia K. Rotow

Organizations

Dana-Farber Cancer Institute, Lowe Center for Thoracic Oncology, Boston, MA, Department of Pathology, Brigham and Women’s Hospital, Boston, MA, Massachusetts General Hospital, Center for Integrated Diagnostics, Boston, MA, Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA, Harvard School of Public Health, Boston, MA, Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, Brigham and Women's Hospital, Boston, MA, Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, Massachusetts General Hospital, Boston, MA, Department of Pathology, Brigham and Women's Hospital, Boston, MA, Dana-Farber Cancer Institute, Boston, MA

Research Funding

No funding received
None.

Background: RET rearrangements and RET kinase domain mutations represent targetable genomic alterations in various cancer types. However, the frequency and characteristics of RET amplification in cancer and its potential role as a targetable oncogenic driver are not well-characterized. Methods: In a pan-cancer cohort of patients at the Dana-Farber Cancer Institute (DFCI) whose tumors underwent next-generation sequencing (NGS), we evaluated the frequency of wild-type (wt) RET amplification (defined as ≥6 copies) in the absence of RET rearrangements or activating mutations. We validated our findings using merged data from the TCGA, GENIE, and China Pan-Cancer datasets. Results: The frequency of wt RET amplification across all cancers was 0.08% (28/34,463) in the DFCI cohort and 0.16% (145/91,466) in the validation cohort. In NSCLC, the frequency of RET amplification was 0.10% (5/4773) in the DFCI cohort and 0.13% (15/11,622) in the validation cohort. Other cancer types with RET amplification included hepatobiliary cancer, prostate cancer, and breast cancer, among others. For 22 RET-amplified cases with available copy number data, the median RET gene copy number was 7 (range 6-36). Among 20 RET-amplified NSCLCs, 10 had no other known driver mutations, and 10 had concurrent driver mutations (including MET exon 14 skipping, MET amplification, KRAS G12C/S/D, EGFR L858R, EGFR exon 20 insertion, and EGFR exon 19 deletion). In cases with available smoking status, 5 out of 6 patients with RET-amplified NSCLC had a history of tobacco use. A 69-year-old man with unresectable stage III NSCLC had disease recurrence after chemoradiation and durvalumab. Both the initial and recurrent biopsy samples showed focal high-level RET amplification (22 and 28 copies, respectively); genomic and RNA sequencing showed no other driver mutations or RET rearrangements. He experienced partial response to the selective RET inhibitor selpercatinib with decrease of both intracranial and systemic tumor burden. Conclusions: Amplification of wt RET represents a novel, targetable, rare molecular subset of NSCLC and other cancers.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 9123)

DOI

10.1200/JCO.2023.41.16_suppl.9123

Abstract #

9123

Poster Bd #

111

Abstract Disclosures