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Evans DG, Green K, Burghel GJ, Forde C, Lalloo F, Schlecht H, Woodward ER. Cascade screening in HBOC and Lynch syndrome: guidelines and procedures in a UK centre. Fam Cancer 2024; 23:187-195. [PMID: 38478259 PMCID: PMC11153258 DOI: 10.1007/s10689-024-00360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/25/2024] [Indexed: 06/06/2024]
Abstract
In the 33 years since the first diagnostic cancer predisposition gene (CPG) tests in the Manchester Centre for Genomic Medicine, there has been substantial changes in the identification of index cases and cascade testing for at-risk family members. National guidelines in England and Wales are usually determined from the National Institute of healthcare Evidence and these have impacted on the thresholds for testing BRCA1/2 in Hereditary Breast Ovarian Cancer (HBOC) and in determining that all cases of colorectal and endometrial cancer should undergo screening for Lynch syndrome. Gaps for testing other CPGs relevant to HBOC have been filled by the UK Cancer Genetics Group and CanGene-CanVar project (web ref. https://www.cangene-canvaruk.org/ ). We present time trends (1990-2020) of identification of index cases with germline CPG variants and numbers of subsequent cascade tests, for BRCA1, BRCA2, and the Lynch genes (MLH1, MSH2, MSH6 and PMS2). For BRCA1/2 there was a definite increase in the proportion of index cases with ovarian cancer only and pre-symptomatic index tests both doubling from 16 to 32% and 3.2 to > 8% respectively. A mean of 1.73-1.74 additional family tests were generated for each BRCA1/2 index case within 2 years. Overall close to one positive cascade test was generated per index case resulting in > 1000 risk reducing surgery operations. In Lynch syndrome slightly more cascade tests were performed in the first two years potentially reflecting the increased actionability in males with 42.2% of pre-symptomatic tests in males compared to 25.8% in BRCA1/2 (p < 0.0001).
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Affiliation(s)
- D Gareth Evans
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK.
- Division of Evolution Infection and Genomic Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Biological Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Kate Green
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - George J Burghel
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Claire Forde
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Helene Schlecht
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine and North-West Genomics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
- Division of Evolution Infection and Genomic Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Biological Sciences, University of Manchester, Manchester, M13 9PL, UK
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Helderman NC, Andini KD, van Leerdam ME, van Hest LP, Hoekman DR, Ahadova A, Bajwa-Ten Broeke SW, Bosse T, van der Logt EMJ, Imhann F, Kloor M, Langers AMJ, Smit VTHBM, Terlouw D, van Wezel T, Morreau H, Nielsen M. MLH1 Promotor Hypermethylation in Colorectal and Endometrial Carcinomas from Patients with Lynch Syndrome. J Mol Diagn 2024; 26:106-114. [PMID: 38061582 DOI: 10.1016/j.jmoldx.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 01/26/2024] Open
Abstract
Screening for Lynch syndrome (LS) in colorectal cancer (CRC) and endometrial cancer patients generally involves immunohistochemical staining of the mismatch repair (MMR) proteins. In case of MLH1 protein loss, MLH1 promotor hypermethylation (MLH1-PM) testing is performed to indirectly distinguish the constitutional MLH1 variants from somatic epimutations. Recently, multiple studies have reported that MLH1-PM and pathogenic constitutional MMR variants are not mutually exclusive. This study describes 6 new and 86 previously reported MLH1-PM CRCs or endometrial cancers in LS patients. Of these, methylation of the MLH1 gene promotor C region was reported in 30 MLH1, 6 MSH2, 6 MSH6, and 3 PMS2 variant carriers at a median age at diagnosis of 48.5 years [interquartile range (IQR), 39-56.75 years], 39 years (IQR, 29-51 years), 58 years (IQR, 53.5-67 years), and 68 years (IQR, 65.6-68.5 years), respectively. For 31 MLH1-PM CRCs in LS patients from the literature, only the B region of the MLH1 gene promotor was tested, whereas for 13 cases in the literature the tested region was not specified. Collectively, these data indicate that a diagnosis of LS should not be excluded when MLH1-PM is detected. Clinicians should carefully consider whether follow-up genetic MMR gene testing should be offered, with age <60 to 70 years and/or a positive family history among other factors being suggestive for a potential constitutional MMR gene defect.
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Affiliation(s)
- Noah C Helderman
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Katarina D Andini
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liselotte P van Hest
- Department of Human Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, the Netherlands
| | - Daniël R Hoekman
- Department of Human Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, the Netherlands
| | - Aysel Ahadova
- Department of Applied Tumor Biology, Heidelberg University Hospital, Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Centre, Heidelberg, Germany
| | - Sanne W Bajwa-Ten Broeke
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Floris Imhann
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthias Kloor
- Department of Applied Tumor Biology, Heidelberg University Hospital, Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Centre, Heidelberg, Germany
| | - Alexandra M J Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diantha Terlouw
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maartje Nielsen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
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Sangiorgi E, Giannuzzi F, Molinario C, Rapari G, Riccio M, Cuffaro G, Castri F, Benvenuto R, Genuardi M, Massi D, Savino G. Base-Excision Repair Mutational Signature in Two Sebaceous Carcinomas of the Eyelid. Genes (Basel) 2023; 14:2055. [PMID: 38002998 PMCID: PMC10671510 DOI: 10.3390/genes14112055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Personalized medicine aims to develop tailored treatments for individual patients based on specific mutations present in the affected organ. This approach has proven paramount in cancer treatment, as each tumor carries distinct driver mutations that respond to targeted drugs and, in some cases, may confer resistance to other therapies. Particularly for rare conditions, personalized medicine has the potential to revolutionize treatment strategies. Rare cancers often lack extensive datasets of molecular and pathological information, large-scale trials for novel therapies, and established treatment guidelines. Consequently, surgery is frequently the only viable option for many rare tumors, when feasible, as traditional multimodal approaches employed for more common cancers often play a limited role. Sebaceous carcinoma of the eyelid is an exceptionally rare cancer affecting the eye's adnexal tissues, most frequently reported in Asia, but whose prevalence is significantly increasing even in Europe and the US. The sole established curative treatment is surgical excision, which can lead to significant disfigurement. In cases of metastatic sebaceous carcinoma, validated drug options are currently lacking. In this project, we set out to characterize the mutational landscape of two sebaceous carcinomas of the eyelid following surgical excision. Utilizing available bioinformatics tools, we demonstrated our ability to identify common features promptly and accurately in both tumors. These features included a Base-Excision Repair mutational signature, a notably high tumor mutational burden, and key driver mutations in somatic tissues. These findings had not been previously reported in similar studies. This report underscores how, in the case of rare tumors, it is possible to comprehensively characterize the mutational landscape of each individual case, potentially opening doors to targeted therapeutic options.
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Affiliation(s)
- Eugenio Sangiorgi
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.R.); (M.R.); (M.G.)
| | - Federico Giannuzzi
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.G.); (G.C.); (G.S.)
| | - Clelia Molinario
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (F.C.); (R.B.)
| | - Giulia Rapari
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.R.); (M.R.); (M.G.)
| | - Melania Riccio
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.R.); (M.R.); (M.G.)
| | - Giovanni Cuffaro
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.G.); (G.C.); (G.S.)
| | - Federica Castri
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (F.C.); (R.B.)
| | - Roberta Benvenuto
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (F.C.); (R.B.)
| | - Maurizio Genuardi
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (G.R.); (M.R.); (M.G.)
- UOC Genetica Medica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Roma, Italy
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, 50121 Florence, Italy;
| | - Gustavo Savino
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.G.); (G.C.); (G.S.)
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Benusiglio PR, Elder F, Touat M, Perrier A, Sanson M, Colas C, Guerrini-Rousseau L, Tran DT, Trabelsi N, Carpentier C, Marie Y, Adam C, Bernier M, Cazals-Hatem D, Mokhtari K, Tran S, Mathon B, Capelle L, Dhooge M, Idbaih A, Alentorn A, Houillier C, Dehais C, Hoang-Xuan K, Cuzzubbo S, Carpentier A, Duval A, Coulet F, Bielle F. Mismatch Repair Deficiency and Lynch Syndrome Among Adult Patients With Glioma. JCO Precis Oncol 2023; 7:e2200525. [PMID: 37262394 DOI: 10.1200/po.22.00525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/13/2023] [Accepted: 04/04/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE The Lynch syndrome (LS)-glioma association is poorly documented. As for mismatch repair deficiency (MMRd) in glioma, a hallmark of LS-associated tumors, there are only limited data available. We determined MMRd and LS prevalence in a large series of unselected gliomas, and explored the associated characteristics. Both have major implications in terms of treatment, screening, and prevention. METHODS Somatic next-generation sequencing was performed on 1,225 treatment-naive adult gliomas referred between 2017 and June 2022. For gliomas with ≥1 MMR pathogenic variant (PV), MMR immunohistochemistry (IHC) was done. Gliomas with ≥1 PV and protein expression loss were considered MMRd. Eligible patients had germline testing. To further explore MMRd specifically in glioblastomas, isocitrate dehydrogenase (IDH)-wild type (wt), we performed IHC, and complementary sequencing when indicated, in a series of tumors diagnosed over the 2007-2021 period. RESULTS Nine gliomas were MMRd (9/1,225; 0.73%). Age at glioma diagnosis was <50 years for all but one case. Eight were glioblastomas, IDH-wt, and one was an astrocytoma, IDH-mutant. ATRX (n = 5) and TP53 (n = 8) PV were common. There was no TERT promoter PV or EGFR amplification. LS prevalence was 5/1,225 (0.41%). One 77-year-old patient was a known LS case. Four cases had a novel LS diagnosis, with germline PV in MSH2 (n = 3) and MLH1 (n = 1). One additional patient had PMS2-associated constitutional mismatch repair deficiency. Germline testing was negative in three MSH6-deficient tumors. In the second series of glioblastomas, IDH-wt, MMRd prevalence was 12.5% in the <40-year age group, 2.6% in the 40-49 year age group, and 1.6% the ≥50 year age group. CONCLUSION Screening for MMRd and LS should be systematic in glioblastomas, IDH-wt, diagnosed under age 50 years.
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Affiliation(s)
- Patrick R Benusiglio
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Fikret Elder
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Mehdi Touat
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Alexandre Perrier
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Marc Sanson
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Chrystelle Colas
- Département de Génétique, Institut Curie, Paris, France
- INSERM U830, U 830 Unité de génétique et biologie des cancers, Institut Curie et Université de Paris, Paris, France
| | - Lea Guerrini-Rousseau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Molecular Predictors and New Targets in Oncology, INSERM U981 Team "Genomics and Oncogenesis of pediatric Brain Tumors", Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Duy Thanh Tran
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Department of Pathology, VietDuc university hospital, Hoan Kiem, Hanoi, Vietnam
| | - Nesrine Trabelsi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Catherine Carpentier
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Yannick Marie
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Clovis Adam
- Service d'anatomopathologie, CHU de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Michèle Bernier
- Département d'Anatomie et Cytologie Pathologiques, Hôpital Foch, Suresnes, France
| | - Dominique Cazals-Hatem
- Département d'Anatomie Pathologique, Hôpital Beaujon, AP-HP, Université de Paris, Clichy, France
| | - Karima Mokhtari
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Suzanne Tran
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Laurent Capelle
- Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Marion Dhooge
- Gastroentérologie et Oncologie Digestive, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Ahmed Idbaih
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Agusti Alentorn
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Caroline Houillier
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Caroline Dehais
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Khe Hoang-Xuan
- Service de Neurologie 2 Mazarin, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
| | - Stefania Cuzzubbo
- Service de Neurologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France
| | - Antoine Carpentier
- Service de Neurologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France
| | - Alex Duval
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Florence Coulet
- Département de Génétique Médicale et Institut Universitaire de Cancérologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine (CRSA), Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Franck Bielle
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, SIRIC CURAMUS, Onconeurothèque, AP-HP, Paris, France
- Service de Neuropathologie Raymond Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
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Han Q, Liu S, Cui Z, Wang Q, Ma T, Jiang L, Li X, Dai G. Case Report and Literature Review: Diagnosis, Tailored Genetic Counseling and Cancer Prevention for a Locally Advanced dMMR/MSI-H/TMB-H Lung Cancer Patient With Concurrent Lynch Syndrome Mediated by a Rare PMS2 Splicing Variant (c.1144+1G>A). Front Genet 2022; 12:799807. [PMID: 35116055 PMCID: PMC8804326 DOI: 10.3389/fgene.2021.799807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Lynch syndrome (LS) is a cancer-predisposing genetic disease mediated by pathogenic mutations in DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, and PMS2. Accumulating evidence demonstrates that there is significant biological heterogeneity across MMR genes. Compared to MLH1 and MSH2, PMS2 variant carriers have a much lower risk for LS-related cancers. Tumors in MLH1 and MSH2 variant carriers often display MMR deficiency (dMMR) and/or high microsatellite instability (MSI-H), two predictive biomarkers for immunotherapy efficacy. However, tumors in PMS2 variant carriers are largely microsatellite stable (MSS) instead of MSI. Therefore, the optimal management of cancer patients with LS requires the integration of disease stage, MMR gene penetrance, dMMR/MSI status, and tumor mutational burden (TMB). In this work, we presented a locally advanced lung cancer patient with dMMR/MSI-H/TMB-H tumor and selective loss of PMS2 by immunohistochemistry. Germline testing revealed a rare PMS2 splicing variant (c.1144+1G>A) in the proband and his healthy daughter. The diagnosis of LS was made based on genetic analysis of this variant and literature review. Given the incomplete penetrance of PMS2, the proband and the carrier received tailored genetic counseling. To reduce cancer risk, the proband received four cycles of nivolumab plus chemotherapy and achieved a disease-free survival of sixteen months.
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Affiliation(s)
- Quanli Han
- Department of Medical Oncology, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Si Liu
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Zhi Cui
- Department of Medical Oncology, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qi Wang
- Department of Medical Oncology, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Tonghui Ma
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Liwen Jiang
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
| | - Xiaomo Li
- Genetron Health (Beijing) Technology, Co. Ltd., Beijing, China
- *Correspondence: Guanghai Dai, ; Xiaomo Li,
| | - Guanghai Dai
- Department of Medical Oncology, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Guanghai Dai, ; Xiaomo Li,
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