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Rubinson DA, Tanaka N, Fece de la Cruz F, Kapner KS, Rosenthal MH, Norden BL, Barnes H, Ehnstrom S, Morales-Giron AA, Brais LK, Lemke CT, Aguirre AJ, Corcoran RB. Sotorasib Is a Pan-RASG12C Inhibitor Capable of Driving Clinical Response in NRASG12C Cancers. Cancer Discov 2024; 14:727-736. [PMID: 38236605 PMCID: PMC11061598 DOI: 10.1158/2159-8290.cd-23-1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/09/2023] [Accepted: 01/16/2024] [Indexed: 01/19/2024]
Abstract
KRASG12C inhibitors, like sotorasib and adagrasib, potently and selectively inhibit KRASG12C through a covalent interaction with the mutant cysteine, driving clinical efficacy in KRASG12C tumors. Because amino acid sequences of the three main RAS isoforms-KRAS, NRAS, and HRAS-are highly similar, we hypothesized that some KRASG12C inhibitors might also target NRASG12C and/or HRASG12C, which are less common but critical oncogenic driver mutations in some tumors. Although some inhibitors, like adagrasib, were highly selective for KRASG12C, others also potently inhibited NRASG12C and/or HRASG12C. Notably, sotorasib was five-fold more potent against NRASG12C compared with KRASG12C or HRASG12C. Structural and reciprocal mutagenesis studies suggested that differences in isoform-specific binding are mediated by a single amino acid: Histidine-95 in KRAS (Leucine-95 in NRAS). A patient with NRASG12C colorectal cancer treated with sotorasib and the anti-EGFR antibody panitumumab achieved a marked tumor response, demonstrating that sotorasib can be clinically effective in NRASG12C-mutated tumors. SIGNIFICANCE These studies demonstrate that certain KRASG12C inhibitors effectively target all RASG12C mutations and that sotorasib specifically is a potent NRASG12C inhibitor capable of driving clinical responses. These findings have important implications for the treatment of patients with NRASG12C or HRASG12C cancers and could guide design of NRAS or HRAS inhibitors. See related commentary by Seale and Misale, p. 698. This article is featured in Selected Articles from This Issue, p. 695.
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Affiliation(s)
- Douglas A. Rubinson
- Dana Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Noritaka Tanaka
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ferran Fece de la Cruz
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kevin S. Kapner
- Dana Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Michael H. Rosenthal
- Dana Farber Cancer Institute and Brigham and Women's Hospital, Department of Radiology, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Bryanna L. Norden
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Haley Barnes
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sara Ehnstrom
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alvin A. Morales-Giron
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren K. Brais
- Dana Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew J. Aguirre
- Dana Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Ryan B. Corcoran
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Gurban P, Mambet C, Botezatu A, Necula LG, Neagu AI, Matei L, Pitica IM, Nedeianu S, Chivu-Economescu M, Bleotu C, Ataman M, Mocanu G, Saguna C, Pavel AG, Stambouli D, Sepulchre E, Anton G, Diaconu CC, Constantinescu SN. Leukemic conversion involving RAS mutations of type 1 CALR-mutated primary myelofibrosis in a patient treated for HCV cirrhosis: a case report. Front Oncol 2023; 13:1266996. [PMID: 37841434 PMCID: PMC10570518 DOI: 10.3389/fonc.2023.1266996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 10/17/2023] Open
Abstract
Somatic frameshift mutations in exon 9 of calreticulin (CALR) gene are recognized as disease drivers in primary myelofibrosis (PMF), one of the three classical Philadelphia-negative myeloproliferative neoplasms (MPNs). Type 1/type 1-like CALR mutations particularly confer a favorable prognostic and survival advantage in PMF patients. We report an unusual case of PMF incidentally diagnosed in a 68-year-old woman known with hepatitis C virus (HCV) cirrhosis who developed a progressive painful splenomegaly, without anomalies in blood cell counts. While harboring a type 1 CALR mutation, the patient underwent a leukemic transformation in less than 1 year from diagnosis, with a lethal outcome. Analysis of paired DNA samples from chronic and leukemic phases by a targeted next-generation sequencing (NGS) panel and single-nucleotide polymorphism (SNP) microarray revealed that the leukemic clone developed from the CALR-mutated clone through the acquisition of genetic events in the RAS signaling pathway: an increased variant allele frequency of the germline NRAS Y64D mutation present in the chronic phase (via an acquired uniparental disomy of chromosome 1) and gaining NRAS G12D in the blast phase. SNP microarray analysis showed five clinically significant copy number losses at regions 7q22.1, 8q11.1-q11.21, 10p12.1-p11.22, 11p14.1-p11.2, and Xp11.4, revealing a complex karyotype already in the chronic phase. We discuss how additional mutations, detected by NGS, as well as HCV infection and antiviral therapy, might have negatively impacted this type 1 CALR-mutated PMF. We suggest that larger studies are required to determine if more careful monitoring would be needed in MPN patients also carrying HCV and receiving anti-HCV treatment.
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Affiliation(s)
- Petruta Gurban
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
- Cytogenomic Medical Laboratory Ltd., Bucharest, Romania
| | - Cristina Mambet
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
- Department of Radiology, Oncology, and Hematology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Hematology Department, Emergency University Clinical Hospital, Bucharest, Romania
| | - Anca Botezatu
- Molecular Virology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Laura G. Necula
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Ana I. Neagu
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
- Department of Radiology, Oncology, and Hematology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Lilia Matei
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Ioana M. Pitica
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Saviana Nedeianu
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Mihaela Chivu-Economescu
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Coralia Bleotu
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Marius Ataman
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Gabriela Mocanu
- Department of Hematology, Coltea Clinical Hospital, Bucharest, Romania
| | - Carmen Saguna
- Department of Radiology, Oncology, and Hematology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Hematology, Coltea Clinical Hospital, Bucharest, Romania
| | - Anca G. Pavel
- Cytogenomic Medical Laboratory Ltd., Bucharest, Romania
| | | | - Elise Sepulchre
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Gabriela Anton
- Molecular Virology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Carmen C. Diaconu
- Cellular and Molecular Pathology Department, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
| | - Stefan N. Constantinescu
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- SIGN (Cell Signalling and Molecular Hematology), Ludwig Institute for Cancer Research Brussels, Brussels, Belgium
- Walloon Excellence in Life Sciences and Biotechnology (WELBIO) Department, WEL Research Institute, Wavre, Belgium
- Nuffield Department of Medicine, Ludwig Institute for Cancer Research, Oxford University, Oxford, United Kingdom
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Semchenkova A, Mikhailova E, Komkov A, Gaskova M, Abasov R, Matveev E, Kazanov M, Mamedov I, Shmitko A, Belova V, Miroshnichenkova A, Illarionova O, Olshanskaya Y, Tsaur G, Verzhbitskaya T, Ponomareva N, Bronin G, Kondratchik K, Fechina L, Diakonova Y, Vavilova L, Myakova N, Novichkova G, Maschan A, Maschan M, Zerkalenkova E, Popov A. Lineage Conversion in Pediatric B-Cell Precursor Acute Leukemia under Blinatumomab Therapy. Int J Mol Sci 2022; 23:4019. [PMID: 35409391 PMCID: PMC8999738 DOI: 10.3390/ijms23074019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 12/28/2022] Open
Abstract
We report incidence and deep molecular characteristics of lineage switch in 182 pediatric patients affected by B-cell precursor acute lymphoblastic leukemia (BCP-ALL), who were treated with blinatumomab. We documented six cases of lineage switch that occurred after or during blinatumomab exposure. Therefore, lineage conversion was found in 17.4% of all resistance cases (4/27) and 3.2% of relapses (2/63). Half of patients switched completely from BCP-ALL to CD19-negative acute myeloid leukemia, others retained CD19-positive B-blasts and acquired an additional CD19-negative blast population: myeloid or unclassifiable. Five patients had KMT2A gene rearrangements; one had TCF3::ZNF384 translocation. The presented cases showed consistency of gene rearrangements and fusion transcripts across initially diagnosed leukemia and lineage switch. In two of six patients, the clonal architecture assessed by IG/TR gene rearrangements was stable, while in others, loss of clones or gain of new clones was noted. KMT2A-r patients demonstrated very few additional mutations, while in the TCF3::ZNF384 case, lineage switch was accompanied by a large set of additional mutations. The immunophenotype of an existing leukemia sometimes changes via different mechanisms and with different additional molecular changes. Careful investigation of all BM compartments together with all molecular -minimal residual disease studies can lead to reliable identification of lineage switch.
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Affiliation(s)
- Alexandra Semchenkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Ekaterina Mikhailova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Alexander Komkov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
- Department of Genomics of Adaptive Immunity, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, 117998 Moscow, Russia
| | - Marina Gaskova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Ruslan Abasov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Evgenii Matveev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), 127051 Moscow, Russia
| | - Marat Kazanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), 127051 Moscow, Russia
- Skolkovo Institute of Science and Technology, 121205 Moscow, Russia
| | - Ilgar Mamedov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
- Department of Genomics of Adaptive Immunity, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, 117998 Moscow, Russia
| | - Anna Shmitko
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, 119334 Moscow, Russia; (A.S.); (V.B.)
| | - Vera Belova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, 119334 Moscow, Russia; (A.S.); (V.B.)
| | - Anna Miroshnichenkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Olga Illarionova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Yulia Olshanskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Grigory Tsaur
- Regional Clinical Children Hospital, 620149 Ekaterinburg, Russia; (G.T.); (T.V.); (L.F.)
- Research Institute of Medical Cell Technologies, 620026 Ekaterinburg, Russia
| | - Tatiana Verzhbitskaya
- Regional Clinical Children Hospital, 620149 Ekaterinburg, Russia; (G.T.); (T.V.); (L.F.)
- Research Institute of Medical Cell Technologies, 620026 Ekaterinburg, Russia
| | | | - Gleb Bronin
- Morozov City Children Clinical Hospital, 119049 Moscow, Russia; (G.B.); (K.K.)
| | | | - Larisa Fechina
- Regional Clinical Children Hospital, 620149 Ekaterinburg, Russia; (G.T.); (T.V.); (L.F.)
- Research Institute of Medical Cell Technologies, 620026 Ekaterinburg, Russia
| | - Yulia Diakonova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Liudmila Vavilova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Natalia Myakova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Alexey Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Michael Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Elena Zerkalenkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
| | - Alexander Popov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117998 Moscow, Russia; (A.S.); (E.M.); (A.K.); (M.G.); (R.A.); (E.M.); (M.K.); (I.M.); (A.M.); (O.I.); (Y.O.); (Y.D.); (L.V.); (N.M.); (G.N.); (A.M.); (M.M.); (E.Z.)
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