TP53 mutation as predictive factor of platinum response in BRCA-mutated ovarian cancer: A prospective case-series analysis.

Authors

Eleonora Lai

Eleonora Lai

Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy

Eleonora Lai , Manuela Neri , Elisabetta Sanna , Sonia Nemolato , Fabio Bardanzellu , Mario Scartozzi , Sabrina Giglio , Antonio Macciò , Clelia Madeddu

Organizations

Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy, Gynecologic Oncology Unit, ARNAS G. Brotzu, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy, Department of Pathology, ARNAS G. Brotzu, Cagliari, Italy, Medical Genetics Unit, University of Cagliari, Department of Medical Sciences and Public Health, R. Binaghi Hospital, ASL 8 Cagliari, Cagliari, Italy, Medical Oncolgy Unit, University Hospital and University of Cagliari, Cagliari, Italy

Research Funding

No funding sources reported

Background: Platinum sensitivity (PS) is a prerequisite for first-line PARP inhibitors (PARPi) in locally advanced and relapsed high grade serous ovarian cancer (HGS-OC). BRCA mutations are predictive of PS and of response to PARPi. Notably, platinum and PARPi cytotoxic action is mainly related to p53-mediated inducted apoptosis. Therefore, the integrity of p53 machinery is crucial for platinum-related activity whereas the presence of p53 mutation is a fairly frequent event in ovarian cancer, especially in HGS-OC and in BRCA mutated. Methods: We prospectively analyzed 208 women with primary ovarian cancer undergoing surgery at the Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy, between 2019 and 2023. Somatic NGS analysis was performed to detect BRCA and HRD mutations. TP53 mutations were classified according to according to hotspot, structural (missense/nonsense) and functional classification as “gain of function” (GOF) or “loss of function” (LOF), based on IARC TP53 database. Comparative testing with Fisher's exact test was used to examine TP53 mutation distribution and associations with clinicopathologic factors and PS. BRCA mutation status was further used to stratify the analysis. Results: Globally, we included 127 adult HGS-OC patients (pts). 84.2% had stage III-IV disease. TP53 mutation was found in 83.4% of pts. Somatic BRCA mutations were found in 28.3%. HGS-OC with somatic BRCA mutations had higher TP53 mutation frequency (88.8%) than BRCA WT (81.3%, p=0.1510). Employing the structural classification scheme, most harbored a missense TP53 mutation (76.5%). LOF TP53 mutations were found in 59.4% while GOF in 31.2%. No significant disparity was observed in the distribution of specific TP53 mutations within each classification scheme between cases with BRCA mutations and those without. As for BRCA mutated pts, TP53 WT were all PS. Among those p53 mutated, GOF mutations were associated with PS in 7 pts and platinum resistance in 3 pts; LOF mutations were associated with PS in 7 pts and platinum resistance in 12 pts. The difference in distribution of PS between functional categories of p53 mutations was significant (p=0.0291). As for BRCA WT pts, TP53 WT were all PS. Among TP53 mutated, GOF mutations were associated with PS in 14 pts and platinum resistance in 10 pts, whereas LOF mutations were associated with PS in 19 pts and platinum resistance in 25 pts, even if these findings were not statistically significant (p=0.2357). Of relevance, in 5 cases where LOF mutations of p53 was associated with null HIC p53 expression, pts were refractory to platinum-based chemotherapy. Conclusions: Even if preliminary, our data show that HGS-OC harboring TP53 null mutations are the poorest prognostic subgroup, especially in terms of PS. Further studies are needed to confirm our findings and the role of TP53 mutation as a biomarker of inherent or acquired platinum resistance.

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Abstract Details

Meeting

2024 ASCO Breakthrough

Session Type

Poster Session

Session Title

Poster Session B

Track

Thoracic Cancers,Breast Cancer,Gynecologic Cancer,Head and Neck Cancer,Hematologic Malignancies,Genetics/Genomics/Multiomics,Healthtech Innovations,Models of Care and Care Delivery,Viral-Mediated Malignancies,Other Malignancies or Topics

Sub Track

Other Therapeutic Interventions

Citation

J Clin Oncol 42, 2024 (suppl 23; abstr 128)

DOI

10.1200/JCO.2024.42.23_suppl.128

Abstract #

128

Poster Bd #

D4

Abstract Disclosures