Genomic and tumor microenvironment dynamics of brain metastases in breast cancer.

Authors

null

DHARMINI MANOGNA

Tulane Medical University, New Orleans, LA

DHARMINI MANOGNA , Sharon Wu , Sachin Kumar Deshmukh , Joanne Xiu , Sima Ehsani , Ragisha Gopalakrishnan , Ana Cristina Sandoval-Leon , Sarah L Sammons , George W. Sledge Jr., Stephanie L. Graff

Organizations

Tulane Medical University, New Orleans, LA, Caris Life Sciences, Phoenix, AZ, Cancer Center, University of Arizona, Tucson, AZ, Mount Sinai Comprehensive Cancer Center, Miami Beach, FL, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, Dana-Farber Cancer Institute, Boston, MA, Lifespan and The Warren Alpert Medical School of Brown University, Providence, RI

Research Funding

No funding sources reported

Background: Brain metastases (BM) in breast cancer (BC) have a poor prognosis, with median survival at 7.2-13 months. Interplay between genomic evolution of cancer cells and development of BM is obscure. We sought to identify genomic aberrations associated with BM. Methods: We included 14095 BC samples: 429 BM, 7858 extra-cerebral metastases (ECM) and 5808 primary tumors (PT) were analyzed by next generation sequencing of DNA (NextSeq, 592 genes and NovaSeq, WES) and RNA (NovaSeq, WTS) (Caris Life Sciences, AZ). Tumor mutational burden-high (TMB-H) was defined as ≥10 mt/MB. Cut-off for PD-L1 immunohistochemistry positivity was ≥2 intensity and >5% staining (SP142). Global loss of heterozygosity (gLOH) used a cut-off of ≥ 16%. PAM50 was evaluable for a subset (n=9724, 69%) with WTS data. Statistical significance determined using chi-square and Mann-Whitney U test and adjusted for multiple comparisons (q<0.05). Results: Median age was lower in BM than ECM and PT (55 vs 62 vs 59 years, q<0.05). BM subtype was triple negative (TNBC, 40.1%), HR+/HER2- (30.5%), or HER2+ (29.4%) vs. ECM primarily HR+/HER2- (65.4%) and PT HER2+ (52.5%). BM were Basal-like (35.3%) or HER2-enriched (35.3%), whereas ECM were Luminal B (47.2%) and PT were Basal-like (34.4%) or Luminal B (34.6%). The Table summarizes molecular findings. In HR+/HER2- BC, BM were associated with TMB-H vs. ECM and PT (q<0.05). BM had higher GATA3-mt and ESR1-mt compared to PT (q<0.05). In HER2+ BC, BM had lower PD-L1+ (11.8% vs 39.3%) and higher ESR1-mt than PT. BM had higher ERBB2-amp (93.5% vs 75.2%) and RARA-amp (27.3% vs 6.7%) than PT (q<0.05). TNBC BM had higher proportion of TMB-H tumors but lower PD-L1+ (20.8% vs 50.7%) than PT. BM had increased gLOH than ECM (59.2% vs 36.2%). PIK3CA was lower in BM vs. ECM. In all subtypes, BM, when compared to ECM and PT respectively, were associated with decreased AR+ (HR+/HER2-: 57.7% vs 80.8% vs 85.7%; HER2+: 54.4% vs 77.1% vs 81%; TNBC: 15.1% vs 27.7% vs 23.1%), increased dendritic cell infiltration (HR+/HER2-: 3.2% vs 2.6% vs 2.5%; HER2+: 3.85% vs 2.41% vs 2.36%; TNBC: 3.96% vs 2.89% vs 3.05%) but lower IFN score (HR+/HER2-: -0.56 vs -0.41 vs-0.35; HER2+: -0.53 vs -0.39 vs -0.30; TNBC: -0.55 vs -0.30 vs -0.28). Conclusions: BM in BC are more frequently associated with TNBC and Basal-like BC phenotypes than ECM or PTs. BM have a higher proportion of ESR1-mut than PTs, highlighting a possible association between endocrine resistance and development of BM. BM had lower IFN score and PDL-1 expression highlighting an immunosuppressed tumor microenvironment.

Frequency of mutations by BC sub-type.

Cancer TypeLocationPIK3CA mut (%)GATA3 mut (%)ESR1 mut (%)AKT1 mut (%)TMB-H (%)gLOH (%)
HR+/HER2-BM38.525.413.23.8812.712.7
ECM41.213.920.34.591010
PT42.413.54.194.815.365.36
HER2+BM26.46.42.4014.848.1
ECM38.96.885.30.1812.736.6
PT32.68.320.206.0739
TNBCBM14.61.7604.0910.759.2
ECM23.21.580.053.2810.636.2
PT15.50.590.052.95.2539.5

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Abstract Details

Meeting

2024 ASCO Annual Meeting

Session Type

Rapid Oral Abstract Session

Session Title

Breast Cancer—Metastatic

Track

Breast Cancer

Sub Track

Biologic Correlates

Citation

J Clin Oncol 42, 2024 (suppl 16; abstr 1018)

DOI

10.1200/JCO.2024.42.16_suppl.1018

Abstract #

1018

Abstract Disclosures

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