1
|
Pantaleo A, Forte G, Fasano C, Lepore Signorile M, Sanese P, De Marco K, Di Nicola E, Latrofa M, Grossi V, Disciglio V, Simone C. Understanding the Genetic Landscape of Pancreatic Ductal Adenocarcinoma to Support Personalized Medicine: A Systematic Review. Cancers (Basel) 2023; 16:56. [PMID: 38201484 PMCID: PMC10778202 DOI: 10.3390/cancers16010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal malignancies worldwide. While population-wide screening recommendations for PDAC in asymptomatic individuals are not achievable due to its relatively low incidence, pancreatic cancer surveillance programs are recommended for patients with germline causative variants in PDAC susceptibility genes or a strong family history. In this study, we sought to determine the prevalence and significance of germline alterations in major genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, TP53) involved in PDAC susceptibility. We performed a systematic review of PubMed publications reporting germline variants identified in these genes in PDAC patients. Overall, the retrieved articles included 1493 PDAC patients. A high proportion of these patients (n = 1225/1493, 82%) were found to harbor alterations in genes (ATM, BRCA1, BRCA2, PALB2) involved in the homologous recombination repair (HRR) pathway. Specifically, the remaining PDAC patients were reported to carry alterations in genes playing a role in other cancer pathways (CDKN2A, STK11, TP53; n = 181/1493, 12.1%) or in the mismatch repair (MMR) pathway (MLH1, MSH2, MSH6, PMS2; n = 87/1493, 5.8%). Our findings highlight the importance of germline genetic characterization in PDAC patients for better personalized targeted therapies, clinical management, and surveillance.
Collapse
Affiliation(s)
- Antonino Pantaleo
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Giovanna Forte
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Candida Fasano
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Martina Lepore Signorile
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Paola Sanese
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Katia De Marco
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Elisabetta Di Nicola
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Marialaura Latrofa
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Valentina Grossi
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Vittoria Disciglio
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Cristiano Simone
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
- Medical Genetics, Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| |
Collapse
|
2
|
Muhammad N, Sadaqat R, Naeemi H, Masood I, Hassan U, Ijaz B, Hanif F, Syed AA, Yusuf MA, Rashid MU. Contribution of germline PALB2 variants to an unselected and prospectively registered pancreatic cancer patient cohort in Pakistan. HPB (Oxford) 2022; 24:2134-2144. [PMID: 36175305 DOI: 10.1016/j.hpb.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partner and localizer of BRCA2 (PALB2) is a pancreatic cancer (PC) susceptibility gene reported in Caucasians. However, limited data are available among Asians. We investigated the contribution of PALB2 germline variants to Pakistani PC patients. METHODS 150 unselected and prospectively enrolled PC patients were comprehensively screened for PALB2 variants, using denaturing high-performance liquid chromatography and DNA sequencing. Novel variants were investigated for their pathogenic effect using in-silico tools. Potentially functional variants were screened in 200 controls. RESULTS Twenty-two different PALB2 variants were identified. A missense variant (p.Arg37His) was identified in a 48-years-old male patient with a family history of breast cancer. Another missense variant (p.Trp898Arg) was identified in a 48-years-old male patient with a family history of esophageal cancer. A novel 3' downstream variant (c.∗480A>G) was detected in a 34-years-old female patient with family history of lung cancer. Another novel 3' downstream variant (c.∗417A>C) was identified in a 41-years-old male patient. All these variants were absent in 200 controls. p.Arg37His and p.Trp898Arg were predicted as likely pathogenic. c.∗417A>C and c.∗480A>G were classified as variants of uncertain significance. CONCLUSION This is the first study that suggests a minimal contribution of PALB2 variants to PC risk in Pakistani population.
Collapse
Affiliation(s)
- Noor Muhammad
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan
| | - Rida Sadaqat
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan
| | - Humaira Naeemi
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan
| | - Iqra Masood
- Clinical Research Office, SKMCH&RC, Lahore, Pakistan
| | - Usman Hassan
- Department of Pathology, SKMCH&RC, Lahore, Pakistan
| | - Bushra Ijaz
- Laboratory of Applied and Functional Genomics, National Center of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Faisal Hanif
- Department of Surgical Oncology, SKMCH&RC, Lahore, Pakistan; Centre for Liver and Biliary Sciences, Bahria International Hospital, Lahore, Pakistan
| | - Aamir A Syed
- Department of Surgical Oncology, SKMCH&RC, Lahore, Pakistan
| | | | - Muhammad U Rashid
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan.
| |
Collapse
|
3
|
Mohindroo C, De Jesus-Acosta A, Yurgelun MB, Maitra A, Mork M, McAllister F. The Evolving Paradigm of Germline Testing in Pancreatic Ductal Adenocarcinoma and Implications for Clinical Practice. Surg Pathol Clin 2022; 15:491-502. [PMID: 36049831 DOI: 10.1016/j.path.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Identification of deleterious germline mutations in pancreatic ductal adenocarcinoma (PDAC) patients can have therapeutic implications for the patients and result in cascade testing and prevention in their relatives. Universal testing for germline mutations is now considered standard of care in patients with PDAC, regardless of family history, personal history, or age. Here, we highlight the commonly identified germline mutations in PDAC patients as well as the impact of multigene panel testing. We further discuss therapeutic implications of germline testing on the index cases, and the impact of cascade testing on cancer early detection and prevention in relatives.
Collapse
Affiliation(s)
- Chirayu Mohindroo
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1360, Houston, TX 77030, USA; Department of Internal Medicine, Sinai Hospital of Baltimore, 2435 W. Belvedere Ave, Ste 56, Baltimore, MD 21215, USA
| | - Ana De Jesus-Acosta
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, 401 North Broadway, Baltimore, MD 21231, USA
| | - Matthew B Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Anirban Maitra
- Department of Translational Molecular Pathology, Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, 2130 West Holcombe Boulevard, Houston, TX 77030, USA
| | - Maureen Mork
- Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA
| | - Florencia McAllister
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1360, Houston, TX 77030, USA; Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
4
|
Bennett C, Suguitan M, Abad J, Chawla A. Identification of high-risk germline variants for the development of pancreatic cancer: Common characteristics and potential guidance to screening guidelines. Pancreatology 2022; 22:719-729. [PMID: 35798629 DOI: 10.1016/j.pan.2022.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/05/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
Pancreatic cancer (PC) is a product of a variety of environmental and genetic factors. Recent work has highlighted the influence of hereditary syndromes on pancreatic cancer incidence. The purpose of this review is to identify the high-risk syndromes, common variants, and risks associated with PC. The study also elucidates common characteristics of patients with these mutations, which is used to recommend potential changes to current screening protocols for greater screening efficacy. We analyzed 8 syndromes and their respective variants: Hereditary Breast and Ovarian Cancer (BRCA1/2), Familial Atypical Multiple Mole Melanoma Syndrome (CDKN2A), Peutz-Jeghers Syndrome (STK11), Lynch Syndrome (PMS2, MLH1, MSH2, MSH6, EPCAM), Ataxia Telangiectasia (ATM), Li-Fraumeni Syndrome (TP53), Fanconi Anemia (PALB2), and Hereditary Pancreatitis (PRSS1, SPINK1, CFTR). Of 587 studies evaluated, 79 studies fit into our inclusion criteria. Information from each study was analyzed to draw conclusions on these variants as well as their association with pancreatic cancer. Information from this review is intended to improve precision medicine and improve criteria for screening.
Collapse
Affiliation(s)
- Cade Bennett
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mike Suguitan
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Abad
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Akhil Chawla
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
| |
Collapse
|
5
|
A Genome-First Approach to Estimate Prevalence of Germline Pathogenic Variants and Risk of Pancreatic Cancer in Select Cancer Susceptibility Genes. Cancers (Basel) 2022; 14:cancers14133257. [PMID: 35805029 PMCID: PMC9265005 DOI: 10.3390/cancers14133257] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 12/20/2022] Open
Abstract
Patients with germline pathogenic variants (GPV) in cancer predisposition genes are at increased risk of pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer. The genes most frequently found to harbor GPV in unselected PDAC cases are ATM, BRCA1, BRCA2, CDKN2A, CHEK2, and PALB2. However, GPV prevalence and gene-specific associations have not been extensively studied in the general population. To further explore these associations, we analyzed genomic and phenotypic data obtained from the UK Biobank (UKB) and Geisinger MyCode Community Health Initiative (GHS) cohorts comprising 200,600 and 175,449 participants, respectively. We estimated the frequency and calculated relative risks (RRs) of heterozygotes in both cohorts and a subset of individuals with PDAC. The combined frequency of heterozygous carriers of GPV in the general population ranged from 1.22% for CHEK2 to 0.05% for CDKN2A. The frequency of GPV in PDAC cases varied from 2.38% (ATM) to 0.19% (BRCA1 and CDKN2A). The RRs of PDAC were elevated for all genes except for BRCA1 and varied widely by gene from high (ATM) to low (CHEK2, BRCA2). This work expands our understanding of the frequencies of GPV heterozygous carriers and associations between PDAC and GPV in several important PDAC susceptibility genes.
Collapse
|
6
|
Astiazaran-Symonds E, Goldstein AM. A systematic review of the prevalence of germline pathogenic variants in patients with pancreatic cancer. J Gastroenterol 2021; 56:713-721. [PMID: 34255164 PMCID: PMC8475496 DOI: 10.1007/s00535-021-01806-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/22/2021] [Indexed: 02/04/2023]
Abstract
The genetics of pancreatic ductal adenocarcinoma (PDAC) is complex with patients reported to harbor germline pathogenic variants (PVs) in many different genes. PDAC patients with familial pancreatic cancer (FPC) are more likely to carry germline PVs but there is no consensus main gene involved in FPC. We performed a systematic review of publications from PubMed and Scopus reporting PVs in patients with FPC, sporadic pancreatic cancer (SPC) and unselected cohorts of PDAC patients undergoing genetic testing and calculated a cumulative prevalence of PVs for each gene evaluated across these three groups of patients. When available, variants in the selected publications were reclassified according to the American College of Medical Genetics and Genomics classification system and used for prevalence calculations if classified as pathogenic or likely pathogenic. We observed an increased prevalence of PVs in FPC compared to SPC or unselected PDAC patients for most of the 41 genes reported. The genes with the highest prevalence of carriers of PVs in FPC were ATM, BRCA2, and CDKN2A. BRCA2 and ATM showed the highest prevalence of PVs in both SPC and unselected PDAC cohorts. Several genes with the highest prevalence of PVs are involved in breast and ovarian cancer suggesting strong overlap with underlying genetics in these disorders but no single gene was predominant. More research is needed to further understand the risk of PDAC associated with these many diverse genes.
Collapse
Affiliation(s)
- Esteban Astiazaran-Symonds
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Rockville, MD, USA,National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - Alisa M Goldstein
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Rockville, MD, USA
| |
Collapse
|
7
|
Screening for pancreatic cancer: a review for general clinicians. ACTA ACUST UNITED AC 2021; 58:119-128. [PMID: 32364522 DOI: 10.2478/rjim-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 02/06/2023]
Abstract
Pancreatic cancer (PC) is an exceptionally lethal malignancy with increasing incidence and mortality worldwide. One of the principal challenges in the treatment of PC is that the diagnosis is usually made at a late stage when potentially curative surgical resection is no longer an option. General clinicians including internists and family physicians are well positioned to identify high-risk individuals and refer them to centers with expertise in PC screening and treatment where screening modalities can be employed. Here, we provide an up-to-date review of PC precursor lesions, epidemiology, and risk factors to empower the general clinician to recognize high-risk patients and employ risk reduction strategies. We also review current screening guidelines and modalities and preview progress that is being made to improve screening tests and biomarkers. It is our hope that this review article will empower the general clinician to understand which patients need to be screened for PC, strategies that may be used to reduce PC risk, and which screening modalities are available in order to diminish the lethality of PC.
Collapse
|
8
|
Ge O, Huang A, Wang X, Chen Y, Ye Y, Schomburg L. PALB2 upregulation is associated with a poor prognosis in pancreatic ductal adenocarcinoma. Oncol Lett 2021; 21:224. [PMID: 33613713 PMCID: PMC7856690 DOI: 10.3892/ol.2021.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
During DNA repair, BRCA1 and BRCA2 interact with the tumor suppressor partner and localizer of BRCA2 (PALB2). PALB2 mutations are associated with an increased risk of breast and ovarian carcinoma, and upregulated PALB2 expression is associated with poor clinical outcomes. The present study investigated the role and prognostic value of PALB2 in pancreatic ductal adenocarcinoma (PDAC). PALB2 expression was inhibited using a small interfering RNA in PDAC cell lines, and the subsequent effects on cell proliferation and migration were investigated. Tissue microarrays from 157 patients undergoing a pancreaticoduodenectomy for PDAC were analyzed via immunohistochemistry, and PALB2 expression was compared with patient outcomes using Kaplan-Meier curves and the multivariate Cox regression model. PALB2-knockdown in PDAC cells had little effect on cell proliferation, but significantly decreased cell migration. Relatively high PALB2 expression was observed in PDAC tissues compared with in peritumoral tissues. Overall survival (OS) was negatively associated with PALB2 expression. TNM stage and PALB2 expression were identified as independent prognostic factors associated with OS via multivariate analysis. Overall, the present study demonstrated that PDAC cell migration was dependent on PALB2, which was further supported by the finding that elevated PALB2 expression in PDAC tissues was associated with poor survival in patients with PDAC. Therefore, PALB2 may serve as a novel prognostic marker in PDAC, which may aid with the development of therapeutic strategies for the disease.
Collapse
Affiliation(s)
- Ouyang Ge
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Anle Huang
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Xin Wang
- Medical Department for Hematology and Oncology, Klinikum rechts der Isar, Technische University Munich, D-81675 Munich, Germany
| | - Yuling Chen
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10117 Berlin, Germany.,German Rheumatism Research Centre Berlin, Leibniz Institute, D-10117 Berlin, Germany
| | - Yuanchun Ye
- Department of Gastroenterology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P.R. China.,Department of Hematology and Oncology, Benjamin Franklin Campus, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, D-12203 Berlin, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, D-13353 Berlin, Germany
| |
Collapse
|
9
|
Thompson ED, Roberts NJ, Wood LD, Eshleman JR, Goggins MG, Kern SE, Klein AP, Hruban RH. The genetics of ductal adenocarcinoma of the pancreas in the year 2020: dramatic progress, but far to go. Mod Pathol 2020; 33:2544-2563. [PMID: 32704031 PMCID: PMC8375585 DOI: 10.1038/s41379-020-0629-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
The publication of the "Pan-Cancer Atlas" by the Pan-Cancer Analysis of Whole Genomes Consortium, a partnership formed by The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC), provides a wonderful opportunity to reflect on where we stand in our understanding of the genetics of pancreatic cancer, as well as on the opportunities to translate this understanding to patient care. From germline variants that predispose to the development of pancreatic cancer, to somatic mutations that are therapeutically targetable, genetics is now providing hope, where there once was no hope, for those diagnosed with pancreatic cancer.
Collapse
Affiliation(s)
- Elizabeth D Thompson
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas J Roberts
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura D Wood
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R Eshleman
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael G Goggins
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott E Kern
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison P Klein
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
10
|
Zhong Y, Schubert J, Wu J, Xu F, Lin F, Cao K, Zelley K, Luo M, Foster JB, Cole KA, MacFarland SP, Resnick AC, Storm PB, Li MM. A germline PALB2 pathogenic variant identified in a pediatric high-grade glioma. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a005397. [PMID: 32554798 PMCID: PMC7476410 DOI: 10.1101/mcs.a005397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
PALB2 (partner and localizer of BRCA2) gene encodes a protein that colocalizes with BRCA2 in nuclear foci and likely permits the stable intranuclear localization and accumulation of BRCA2. PALB2 plays a critical role in maintaining genome integrity through its role in the Fanconi anemia and homologous recombination DNA repair pathways. It has a known loss-of-function disease mechanism. Biallelic PALB2 pathogenic variants have been described in autosomal recessive Fanconi anemia. Heterozygous pathogenic variants in PALB2 are associated with increased risk for female and male breast cancer and pancreatic cancer (Science 324: 217; Cancer Res 71: 2222–2229; N Engl J Med 371: 497–506). Heterozygous germline PALB2 mutations have also been observed in patients with medulloblastoma (Lancet Oncol 19: 785–798). However, PALB2-related cancer predisposition to high-grade gliomas has not been reported. Here we report a germline PALB2 pathogenic variant (c.509_510delGA, p.Arg170Ilefs*14, NM_024675.3) found in a pediatric patient with high-grade glioma. This variant was first identified by tumor sequencing using the Children's Hospital of Philadelphia (CHOP) Comprehensive Solid Tumor Panel and then confirmed to be a germline change using the CHOP Comprehensive Hereditary Cancer Panel on DNA from a blood sample of this patient. Parental studies showed that this variant was paternally inherited. Further studies are needed to illustrate if pathogenic variants in PALB2 convey increased risk to developing brain tumor. This case also highlights the potential of identifying germline mutation through tumor sequencing.
Collapse
Affiliation(s)
- Yiming Zhong
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jeffrey Schubert
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Jinhua Wu
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Feng Xu
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Fumin Lin
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Kajia Cao
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Kristin Zelley
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Minjie Luo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jessica B Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Kristina A Cole
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Suzanne P MacFarland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Adam C Resnick
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Neurosurgery, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Phillip B Storm
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Neurosurgery, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Marilyn M Li
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| |
Collapse
|
11
|
Macklin-Mantia SK, Hines SL, Kasi PM. Retrospective review of outcomes in patients with DNA-damage repair related pancreatic cancer. Hered Cancer Clin Pract 2020; 18:17. [PMID: 32793315 PMCID: PMC7419180 DOI: 10.1186/s13053-020-00148-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with DNA-damage response genes (DDR)-related pancreas cancer (BRCA1/2 or other DNA-damage related genes) may have improved outcomes secondary to increased sensitivity to DNA-damaging drugs (platinum chemotherapy/ poly ADP ribose polymerase (PARP)-inhibitors). However, data is scarce pertaining to outcomes in this subset of patients. Our objective was to retrospectively identify DDR-related pancreas cancer patients and report on clinical outcomes. METHODS Pancreas cancer patients with a germline pathogenic variant in BRCA1/2 or other DDR gene were identified retrospectively through review of medical records (medical genetics/oncology) and genetic testing results at our institution. Data regarding clinical outcomes, therapy received, and survival was subsequently extracted. RESULTS A total of 11 patients with pancreas cancer were identified to carry a pathogenic DDR-variant: BRCA1 (3), ATM (4), BRCA2 (2), PALB2 (1) and FANCC (1). Five of these individuals had prior history of other cancers. Clinically these tumors were localized (4), locally advanced (3), and metastatic (4) at diagnosis. Four out of 11 patients were still alive at time of data review. Survival in the 7 patients who had died was 13.7, 140.0, 20.5, 22.3, 23.5, 25.8, and 111.5 months. All patients with advanced disease had exposure to platinum chemotherapy. CONCLUSIONS Historical survival in patients with advanced and metastatic pancreas cancer is poor. Results of this DDR-subset of patients do show significantly superior outcomes, likely secondary to exposure to platinum drugs. This data, alongside other similar cohorts, would favor the DDR-genes being a predictive marker with improved survival if exposed to these drugs and the new class of drugs, PARP-inhibitors.
Collapse
Affiliation(s)
| | - Stephanie L. Hines
- Department of Diagnostic and Consultative Medicine, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Pashtoon M. Kasi
- Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| |
Collapse
|
12
|
Wong W, Raufi AG, Safyan RA, Bates SE, Manji GA. BRCA Mutations in Pancreas Cancer: Spectrum, Current Management, Challenges and Future Prospects. Cancer Manag Res 2020; 12:2731-2742. [PMID: 32368150 PMCID: PMC7185320 DOI: 10.2147/cmar.s211151] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/04/2020] [Indexed: 12/13/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a challenging disease to treat. Despite advances in surgical techniques, radiation, and medical therapies, the 5-year survival rate remains below 9%. Over the past decade, the genomic landscape of PDAC has been well studied and BRCA mutations have emerged as a target for the development of more effective therapies. Alterations in germline BRCA and PALB2 are detected in approximately 5-9% of patients with PDAC and can lead to homologous repair deficiency (HRD). PDAC with HRD is more susceptible to cytotoxic agents, such as platinum salts and topoisomerase inhibitors, that cause DNA damage. Furthermore, PARP inhibitors have emerged as an effective non-cytotoxic approach to treating HRD-PDAC. In addition to BRCA and PALB2, germline mutations in other genes involved in the homologous DNA repair pathway - such as ATM and RAD51 - are potential targets, as are patients with the "BRCAness" phenotype and somatic mutations in the DNA repair pathway. Given the clinical implications of germline mutation related HRD in PDAC, universal germline testing is now recommended. In this review, we will discuss current and emerging biomarkers for HRD in PDAC, treatments, and the challenges associated with them.
Collapse
Affiliation(s)
- Winston Wong
- Division of Hematology and Oncology, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
| | - Alexander G Raufi
- Division of Hematology and Oncology, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
- Division of Hematology-Oncology, Lifespan Cancer Institute, Warren-Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachael A Safyan
- Division of Hematology and Oncology, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
| | - Susan E Bates
- Division of Hematology and Oncology, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
- Division of Hematology and Oncology, James J. Peters Veterans Affairs Medical Center, The Bronx, NY10468, USA
| | - Gulam A Manji
- Division of Hematology and Oncology, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center and New York Presbyterian Hospital Herbert Irving Pavilion, New York, NY10032, USA
| |
Collapse
|
13
|
Park D, Shakya R, Koivisto C, Pitarresi JR, Szabolcs M, Kladney R, Hadjis A, Mace TA, Ludwig T. Murine models for familial pancreatic cancer: Histopathology, latency and drug sensitivity among cancers of Palb2, Brca1 and Brca2 mutant mouse strains. PLoS One 2019; 14:e0226714. [PMID: 31877165 PMCID: PMC6932818 DOI: 10.1371/journal.pone.0226714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
Alterations of the PALB2 tumor suppressor gene have been identified in familial breast, ovarian and pancreatic cancer cases. PALB2 cooperates with BRCA1/2 proteins through physical interaction in initiation of homologous recombination, in maintenance of genome integrity following DNA double-strand breaks. To determine if the role of PALB2 as a linker between BRCA1 and BRCA2 is critical for BRCA1/2-mediated tumor suppression, we generated Palb2 mouse pancreatic cancer models and compared tumor latencies, phenotypes and drug responses with previously generated Brca1/2 pancreatic cancer models. For development of Palb2 pancreatic cancer, we crossed conditional Palb2 null mouse with mice carrying the KrasG12D; p53R270H; Pdx1-Cre (KPC) constructs, and these animals were observed for pancreatic tumor development. Individual deletion of Palb2, Brca1 or Brca2 genes in pancreas per se using Pdx1-Cre was insufficient to cause tumors, but it reduced pancreata size. Concurrent expression of mutant KrasG12D and p53R270H, with tumor suppressor inactivated strains in Palb2-KPC, Brca1-KPC or Brca2-KPC, accelerated pancreatic ductal adenocarcinoma (PDAC) development. Moreover, most Brca1-KPC and some Palb2-KPC animals developed mucinous cystic neoplasms with PDAC, while Brca2-KPC and KPC animals did not. 26% of Palb2-KPC mice developed MCNs in pancreata, which resemble closely the Brca1 deficient tumors. However, the remaining 74% of Palb2-KPC animals developed PDACs without any cysts like Brca2 deficient tumors. In addition, the number of ADM lesions and immune cells infiltrations (CD3+ and F/480+) were significantly increased in Brca1-KPC tumors, but not in Brca2-KPC tumors. Interestingly, the level of ADM lesions and infiltration of CD3+ or F/480+ cells in Palb2-KPC tumors were intermediate between Brca1-KPC and Brca2-KPC tumors. As expected, disruption of Palb2 and Brca1/2 sensitized tumor cells to DNA damaging agents in vitro and in vivo. Altogether, Palb2-KPC PDAC exhibited features observed in both Brca1-KPC and Brca2-KPC tumors, which could be due to its role, as a linker between Brca1 and Brca2.
Collapse
Affiliation(s)
- Dongju Park
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Reena Shakya
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Christopher Koivisto
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Jason R Pitarresi
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Matthias Szabolcs
- Institute for Cancer Genetics, Department of Pathology and Cell Biology, and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, United States of America
| | - Raleigh Kladney
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Ashley Hadjis
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Thomas A Mace
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Thomas Ludwig
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| |
Collapse
|
14
|
Bernstein Molho R, Zalmanoviz S, Laitman Y, Friedman E. De novo pathogenic germline variant in PALB2 in a patient with pancreatic cancer. Fam Cancer 2019; 19:193-196. [PMID: 31858328 DOI: 10.1007/s10689-019-00157-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
De novo mutations in the major breast/ovarian cancer susceptibility genes BRCA1 and BRCA2 are rare. De novo mutations in the PALB2 gene have never been reported. Here we report a de novo PALB2 germ line mutation (c.3455delC (p.Pro1152Hisfs*11) in a patient with pancreatic cancer, where non-paternity and somatic parental mosaicism have to the extent possible been excluded as a mechanism for detecting the de novo mutation. The lack of previous reports on de novo PALB2 mutations maybe the limited number of PALB2germline mutations reported overall.
Collapse
Affiliation(s)
- Rinat Bernstein Molho
- Breast cancer unit, Institute of Oncology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shelly Zalmanoviz
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, 52621, Tel- Hashomer, Israel.
| |
Collapse
|
15
|
Vagena A, Papamentzelopoulou M, Kalfakakou D, Kollia P, Papadimitriou C, Psyrri A, Apostolou P, Fountzilas G, Konstantopoulou I, Yannoukakos D, Fostira F. PALB2 c.2257C>T truncating variant is a Greek founder and is associated with high breast cancer risk. J Hum Genet 2019; 64:767-773. [DOI: 10.1038/s10038-019-0612-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/15/2019] [Accepted: 04/19/2019] [Indexed: 12/20/2022]
|
16
|
Qiao F, Pan P, Yan J, Sun J, Zong Y, Wu Z, Lu X, Chen N, Mi R, Ma Y, Ji Y. Role of tumor‑derived extracellular vesicles in cancer progression and their clinical applications (Review). Int J Oncol 2019; 54:1525-1533. [PMID: 30864674 DOI: 10.3892/ijo.2019.4745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/15/2019] [Indexed: 11/06/2022] Open
Abstract
Extracellular vesicles (EVs), including micro‑vesicles and exosomes, are heterogeneous small membranous vesicles shed from the surface of myriad cells and are crucial in mediating intercellular communication. The vertical trafficking of cargo to the plasma membrane and subsequent redistribution of surface lipids may contribute to EV formation. Tumor‑derived extracellular vesicles (TD‑EVs) can carry complex, bioactive cargo, such as nucleic acids and proteins, during tumor metastasis. Paracrine information gets relayed by TD‑EVs to adjacent tumor cells and this allows a crosstalk between malignant cells. These structures may even move to a distant metastatic lesion and modulate the tumor microenvironment to form a premetastatic niche. Thus, TD‑EVs might be potential biomarkers for tumor development and metastasis. Additionally, EVs are promising candidates for use as cell‑free vaccines or as vehicles for the delivery of specific tumor therapeutic molecules. Genetically modified microvesicles and engineered exosomes have shed light on a novel strategy for tumor‑targeted gene therapy. This review focuses on the role of EVs in tumor development and metastasis and their possible applications in the advanced diagnosis and therapy of cancer and personalized medicine.
Collapse
Affiliation(s)
- Fuhao Qiao
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Peng Pan
- School of Medicine, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Jiaping Yan
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Jing Sun
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Yan Zong
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Zhiyong Wu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Xiaoqin Lu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Na Chen
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Xintai, Xintai, Shandong 271200, P.R. China
| | - Rui Mi
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Yongbin Ma
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Yuan Ji
- School of Medicine, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| |
Collapse
|
17
|
Smith AL, Wong C, Cuggia A, Borgida A, Holter S, Hall A, Connor AA, Bascuñana C, Asselah J, Bouganim N, Poulin V, Jolivet J, Vafiadis P, Le P, Martel G, Lemay F, Beaudoin A, Rafatzand K, Chaudhury P, Barkun J, Metrakos P, Marcus V, Omeroglu A, Chong G, Akbari MR, Foulkes WD, Gallinger S, Zogopoulos G. Reflex Testing for Germline BRCA1, BRCA2, PALB2, and ATM Mutations in Pancreatic Cancer: Mutation Prevalence and Clinical Outcomes From Two Canadian Research Registries. JCO Precis Oncol 2018; 2:1-16. [DOI: 10.1200/po.17.00098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose We investigated the translational value of reflex testing for germline mutations in four homology-directed DNA repair predisposition genes ( BRCA1, BRCA2, PALB2, and ATM) in consecutive patients with pancreatic adenocarcinoma. Methods One hundred fifty patients with French-Canadian (FC) ancestry were evaluated for founder mutations, and 114 patients were subsequently assessed by full gene sequencing and multiplex ligation-dependent probe amplification for nonfounder mutations. Two hundred thirty-six patients unselected for ancestry were also assessed for mutations by full gene sequencing. Results The FC founder mutation prevalence among the 150 patients was 5.3% (95% CI, 2.6% to 10.3%), and the nonfounder mutation prevalence across the four genes among the 114 patients tested was 2.6% (95% CI, 0.6% to 7.8%). In the case series unselected for ancestry, 10.0% (95% CI, 2.7% to 26.4%) of patients reporting Ashkenazi Jewish (AJ) ancestry carried an AJ founder mutation, with no nonfounder mutations identified. The mutation prevalence among patients without FC/AJ ancestry was 4.9% (95% CI, 2.6% to 8.8%). Mutations were more frequent in patients diagnosed at ≤ 50 years of age ( P = .03) and in patients with either two or more first- or second-degree relatives with pancreas, breast, ovarian or prostate cancer, or one such relative and a second primary of one of these cancer types ( P < .001). BRCA1, BRCA2, and PALB2 carriers with late-stage (III or IV) disease had an overall survival advantage ( P = .049), particularly if treated with platinum-based chemotherapies ( P = .030). Conclusion Considering these results, we recommend reflex founder mutation testing of patients with FC/AJ ancestry and full gene sequencing of patients who are ≤ 50 years or meet the identified family history criteria. Reflex testing of all incident patients for these four genes may become justified as full gene sequencing costs decline.
Collapse
Affiliation(s)
- Alyssa L. Smith
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Cavin Wong
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Adeline Cuggia
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Ayelet Borgida
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Spring Holter
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Anita Hall
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Ashton A. Connor
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Claire Bascuñana
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jamil Asselah
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Nathaniel Bouganim
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Véronique Poulin
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jacques Jolivet
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Petro Vafiadis
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Philippe Le
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Guillaume Martel
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Frédéric Lemay
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Annie Beaudoin
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Khashayar Rafatzand
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Prosanto Chaudhury
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Jeffrey Barkun
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Peter Metrakos
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Victoria Marcus
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Atilla Omeroglu
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - George Chong
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Mohammad R. Akbari
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - William D. Foulkes
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - Steven Gallinger
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| | - George Zogopoulos
- Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, and George Zogopoulos, Goodman Cancer Research Centre, McGill University; Alyssa L. Smith, Cavin Wong, Adeline Cuggia, Anita Hall, Claire Bascuñana, Peter Metrakos, William D. Foulkes, and George Zogopoulos, Research Institute of the McGill University Health Centre; Jamil Asselah, Nathaniel Bouganim, Khashayar Rafatzand, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Victoria Marcus, Atilla Omeroglu, William D. Foulkes, and
| |
Collapse
|
18
|
Zhan W, Shelton CA, Greer PJ, Brand RE, Whitcomb DC. Germline Variants and Risk for Pancreatic Cancer: A Systematic Review and Emerging Concepts. Pancreas 2018; 47:924-936. [PMID: 30113427 PMCID: PMC6097243 DOI: 10.1097/mpa.0000000000001136] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pancreatic cancer requires many genetic mutations. Combinations of underlying germline variants and environmental factors may increase the risk of cancer and accelerate the oncogenic process. We systematically reviewed, annotated, and classified previously reported pancreatic cancer-associated germline variants in established risk genes. Variants were scored using multiple criteria and binned by evidence for pathogenicity, then annotated with published functional studies and associated biological systems/pathways. Twenty-two previously identified pancreatic cancer risk genes and 337 germline variants were identified from 97 informative studies that met our inclusion criteria. Fifteen of these genes contained 66 variants predicted to be pathogenic (APC, ATM, BRCA1, BRCA2, CDKN2A, CFTR, CHEK2, MLH1, MSH2, NBN, PALB2, PALLD, PRSS1, SPINK1, TP53). Pancreatic cancer risk genes were organized into key biological mechanisms that promote pancreatic oncogenesis within an oncogenic model. Development of precision medicine approaches requires updated variant information within the framework of an oncogenic progression model. Complex risk modeling may improve interpretation of early biomarkers and guide pathway-specific treatment for pancreatic cancer in the future. Precision medicine is within reach.
Collapse
Affiliation(s)
- Wei Zhan
- School of Medicine, Tsinghua University, Beijing, China
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Celeste A. Shelton
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Phil J. Greer
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Randall E. Brand
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - David C. Whitcomb
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
19
|
Soukupova J, Zemankova P, Lhotova K, Janatova M, Borecka M, Stolarova L, Lhota F, Foretova L, Machackova E, Stranecky V, Tavandzis S, Kleiblova P, Vocka M, Hartmannova H, Hodanova K, Kmoch S, Kleibl Z. Validation of CZECANCA (CZEch CAncer paNel for Clinical Application) for targeted NGS-based analysis of hereditary cancer syndromes. PLoS One 2018; 13:e0195761. [PMID: 29649263 PMCID: PMC5896995 DOI: 10.1371/journal.pone.0195761] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background Carriers of mutations in hereditary cancer predisposition genes represent a small but clinically important subgroup of oncology patients. The identification of causal germline mutations determines follow-up management, treatment options and genetic counselling in patients’ families. Targeted next-generation sequencing-based analyses using cancer-specific panels in high-risk individuals have been rapidly adopted by diagnostic laboratories. While the use of diagnosis-specific panels is straightforward in typical cases, individuals with unusual phenotypes from families with overlapping criteria require multiple panel testing. Moreover, narrow gene panels are limited by our currently incomplete knowledge about possible genetic dispositions. Methods We have designed a multi-gene panel called CZECANCA (CZEch CAncer paNel for Clinical Application) for a sequencing analysis of 219 cancer-susceptibility and candidate predisposition genes associated with frequent hereditary cancers. Results The bioanalytical and bioinformatics pipeline was validated on a set of internal and commercially available DNA controls showing high coverage uniformity, sensitivity, specificity and accuracy. The panel demonstrates a reliable detection of both single nucleotide and copy number variants. Inter-laboratory, intra- and inter-run replicates confirmed the robustness of our approach. Conclusion The objective of CZECANCA is a nationwide consolidation of cancer-predisposition genetic testing across various clinical indications with savings in costs, human labor and turnaround time. Moreover, the unified diagnostics will enable the integration and analysis of genotypes with associated phenotypes in a national database improving the clinical interpretation of variants.
Collapse
Affiliation(s)
- Jana Soukupova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- * E-mail: (ZK); (JS)
| | - Petra Zemankova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Klara Lhotova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Janatova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marianna Borecka
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Stolarova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Lhota
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Centre for Medical Genetics and Reproductive Medicine, Gennet, Prague, Czech Republic
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Eva Machackova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Viktor Stranecky
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Spiros Tavandzis
- Department of Medical Genetics, AGEL Laboratories, AGEL Research and Training Institute, Novy Jicin, Czech Republic
| | - Petra Kleiblova
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michal Vocka
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Hana Hartmannova
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Katerina Hodanova
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Stanislav Kmoch
- Research Unit for Rare Diseases, Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdenek Kleibl
- Institute of Biochemistry and Experimental Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- * E-mail: (ZK); (JS)
| |
Collapse
|
20
|
Manji GA, Olive KP, Saenger YM, Oberstein P. Current and Emerging Therapies in Metastatic Pancreatic Cancer. Clin Cancer Res 2018; 23:1670-1678. [PMID: 28373365 DOI: 10.1158/1078-0432.ccr-16-2319] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 02/06/2023]
Abstract
Targeted therapies and immunotherapy have changed the face of multiple solid malignancies, including metastatic melanoma and lung cancer, but no such therapies exist for pancreatic ductal adenocarcinoma (PDAC) despite the knowledge of key mutations and an increasing understanding of the tumor microenvironment. Until now, most clinical studies have not been biomarker driven in this highly immunosuppressive and heterogeneous cancer. Ongoing basic and translational studies are better classifying the disease in hopes of identifying critical pathways that distinguish the unique PDAC subtypes, which will lead to personalized therapies. In this review, we discuss the current treatment options for metastatic pancreatic cancer and highlight current ongoing clinical trials, which aim to target the stroma and the immune microenvironment either alone or in combination with standard chemotherapy. Identifying biomarkers and key resistance pathways and targeting these pathways in a personalized manner in combination with chemotherapy are likely to yield a more immediate and durable clinical benefit. Clin Cancer Res; 23(7); 1670-8. ©2017 AACRSee all articles in this CCR Focus section, "Pancreatic Cancer: Challenge and Inspiration."
Collapse
Affiliation(s)
- Gulam Abbas Manji
- Division of Medical Oncology, Columbia University Medical Center, and New York Presbyterian Hospital, Herbert Irving Pavilion, New York, New York.
| | - Kenneth P Olive
- Department of Pathology and Cell Biology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Yvonne M Saenger
- Division of Medical Oncology, Columbia University Medical Center, and New York Presbyterian Hospital, Herbert Irving Pavilion, New York, New York
| | - Paul Oberstein
- Division of Medical Oncology, Columbia University Medical Center, and New York Presbyterian Hospital, Herbert Irving Pavilion, New York, New York
| |
Collapse
|
21
|
Abstract
Pancreatic cancers arise through a series of genetic events both inherited and acquired. Inherited genetic changes, both high penetrance and low penetrance, are an important component of pancreatic cancer risk, and may be used to characterize populations who will benefit from early detection. Furthermore, pancreatic cancer patients with inherited mutations may be particularly sensitive to certain targeted agents, providing an opportunity to personalized treatment. Family history of pancreatic cancer is one of the strongest risk factors for the disease, and is associated with an increased risk of caners at other sites, including but not limited to breast, ovarian and colorectal cancer. The goal of this chapter is to discuss the importance of family history of pancreatic cancer, and the known genes that account for a portion of the familial clustering of pancreatic cancer.
Collapse
Affiliation(s)
- Fei Chen
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas J Roberts
- Department of Pathology, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Alison P Klein
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pathology, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institution, Baltimore, MD, USA.
| |
Collapse
|