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Riedinger CJ, Esnakula A, Haight PJ, Suarez AA, Chen W, Gillespie J, Villacres A, Chassen A, Cohn DE, Goodfellow PJ, Cosgrove CM. Reply to "Mismatch repair and microsatellite instability-Recommendation for an optimal test strategy". Cancer 2024; 130:1713-1714. [PMID: 38430468 DOI: 10.1002/cncr.35257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Courtney J Riedinger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ashwini Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adrian A Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jessica Gillespie
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alyssa Villacres
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alexis Chassen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Riedinger CJ, Esnakula A, Haight PJ, Suarez AA, Chen W, Gillespie J, Villacres A, Chassen A, Cohn DE, Goodfellow PJ, Cosgrove CM. Characterization of mismatch-repair/microsatellite instability-discordant endometrial cancers. Cancer 2024; 130:385-399. [PMID: 37751191 PMCID: PMC10843110 DOI: 10.1002/cncr.35030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Mismatch-repair (MMR)/microsatellite instability (MSI) status has therapeutic implications in endometrial cancer (EC). The authors evaluated the concordance of testing and factors contributing to MMR expression heterogeneity. METHODS Six hundred sixty-six ECs were characterized using immunohistochemistry (IHC), MSI testing, and mut-L homolog 1 (MLH1) methylation. Select samples underwent whole-transcriptome analysis and next-generation sequencing. MMR expression of metastatic/recurrent sites was evaluated. RESULTS MSI testing identified 27.3% of cases as MSI-high (n = 182), MMR IHC identified 25.1% cases as MMR-deficient (n = 167), and 3.8% of cases (n = 25) demonstrated discordant results. A review of IHC staining explained discordant results in 18 cases, revealing subclonal loss of MLH1/Pms 1 homolog 2 (PMS2) (n = 10) and heterogeneous MMR IHC (mut-S homolog 6 [MSH6], n = 7; MLH1/PMS2, n = 1). MSH6-associated Lynch syndrome was diagnosed in three of six cases with heterogeneous expression. Subclonal or heterogeneous cases had a 38.9% recurrence rate (compared with 16.7% in complete MMR-deficient cases and 9% in MMR-proficient cases) and had abnormal MMR IHC results in all metastatic recurrent sites (n = 7). Tumors with subclonal MLH1/PMS2 demonstrated 74 differentially expressed genes (determined using digital spatial transcriptomics) when stratified by MLH1 expression, including many associated with epithelial-mesenchymal transition. CONCLUSIONS Subclonal/heterogeneous MMR IHC cases showed epigenetic loss in 66.7%, germline mutations in 16.7%, and somatic mutations in 16.7%. MMR IHC reported as intact/deficient missed 21% of cases of Lynch syndrome. EC with subclonal/heterogeneous MMR expression demonstrated a high recurrence rate, and metastatic/recurrent sites were MMR-deficient. Transcriptional analysis indicated an increased risk for migration/metastasis, suggesting that clonal MMR deficiency may be a driver for tumor aggressiveness. Reporting MMR IHC only as intact/deficient, without reporting subclonal and heterogeneous staining, misses opportunities for biomarker-directed therapy. PLAIN LANGUAGE SUMMARY Endometrial cancer is the most common gynecologic cancer, and 20%-40% of tumors have a defect in DNA proofreading known as mismatch-repair (MMR) deficiency. These results can be used to guide therapy. Tests for this defect can yield differing results, revealing heterogeneous (mixed) proofreading capabilities. Tumors with discordant testing results and mixed MMR findings can have germline or somatic defects in MMR genes. Cells with deficient DNA proofreading in tumors with mixed MMR findings have DNA expression profiles linked to more aggressive characteristics and cancer spread. These MMR-deficient cells may drive tumor behavior and the risk of spreading cancer.
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Affiliation(s)
- Courtney J. Riedinger
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Ashwini Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paulina J. Haight
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Adrian A. Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jessica Gillespie
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Alyssa Villacres
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Alexis Chassen
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - David E. Cohn
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Casey M. Cosgrove
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
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Riedinger CJ, Brown M, Haight PJ, Backes FJ, Cohn DE, Goodfellow PJ, Cosgrove CM. Epigenetic MMR defect identifies a risk group not accounted for through traditional risk stratification algorithms in endometrial cancer. Front Oncol 2023; 13:1147657. [PMID: 37091179 PMCID: PMC10117833 DOI: 10.3389/fonc.2023.1147657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose We sought to evaluate the contribution of mismatch repair (MMR) status to traditional risk stratification algorithms used to predict nodal involvement and recurrence in a large single-institution cohort. Methods Endometrioid endometrial cancer (EC) cases from 2014-2020 were evaluated. MMR immunohistochemistry (IHC) was performed universally. Uterine factors assessed in the Mayo criteria were used to retrospectively classify patients as low or high risk for lymphatic spread. Patients were classified according to risk for recurrence using GOG 99 and PORTEC criteria. Associations were evaluated using chi-square and t-tests and contributing factors assessed using logistic regression models. Results 1,514 endometrioid EC were evaluated; 392 (25.9%) were MMR (MMR) deficient of which 80.4% of MMR defects were associated with epigenetic silencing of MLH1. Epigenetic MMR defects were significantly more likely to be high risk for lymph node (LN) metastasis based on Mayo criteria (74.9% vs 60.6%, p=<0.001) and with the presence of LN metastasis (20.3 vs 10.5%, p=0.003) compared to MMR proficient tumors. Tumors with epigenetic MMR defects were significantly more likely to be classified as high or high intermediate risk using GOG99 and PORTEC criteria. Furthermore, cases with epigenetic MMR defects classified as low or low intermediate risk were significantly more likely to recur (GOG99 p=0.013; PORTEC p=0.008) and independently associated with worse disease-free survival (DFS). MMR status was found to be independently associated with worse DFS (HR 1.90; 95% CI 1.34-2.70; p=0.003) but not overall survival. Conclusion While MMR deficient EC has been associated with poor prognostic features in prior reports; we demonstrate that only epigenetic MMR defects have poorer outcomes. Epigenetic MMR defect were independently associated with lymph node metastasis after controlling for risk criteria. Epigenetic MMR deficiency was found to be an independent predictor of recurrence beyond the factors considered in traditional risk stratification algorithms. Traditional uterine-based risk stratification algorithms may not fully reflect the risk for recurrence in MMR deficient tumors. Consideration should be given to implementing MMR status and MLH1 hypermethylation alongside traditional risk stratification algorithms. Performing MMR IHC on preoperative pathologic specimens may aid in risk stratification and patient counseling.
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Affiliation(s)
- Courtney J. Riedinger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- *Correspondence: Courtney J. Riedinger,
| | - Morgan Brown
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Paulina J. Haight
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Floor J. Backes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - David E. Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Casey M. Cosgrove
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Riedinger CJ, Patterson JM, Backes FJ, O'Malley D, Bixel KL, Copeland LJ, Cohn DE, Goodfellow PJ, Cosgrove CM. The contemporary presentation and diagnosis of endometrial cancer recurrence: When, where, and how? Gynecol Oncol 2022; 167:174-180. [PMID: 36154763 DOI: 10.1016/j.ygyno.2022.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine patients with confirmed endometrial cancer recurrence; evaluate patterns, presentation, and mode of diagnosis. STUDY DESIGN A retrospective review of women with endometrial cancer diagnosis between 2014 and 2020. Disease recurrences were evaluated. Medical records were reviewed focusing on presentation at time of recurrence. Relationships were assessed using χ2, Fisher's exact test, t-test, and Wilcoxon test. The Kaplan-Meier product limit was used to estimate survival. Multiple logistic regression analysis was used to assess the impact of covariates. RESULTS Endometrial cancer recurrence was identified in 201 (11.7%) patients. Sixty percent (120/201) of patients presented with symptoms. Pain was the most common presenting symptom (23.4%, 47/201) and bleeding was reported in <14% (28/201). Patients with symptomatic presentation were less likely to be able to receive treatment for their recurrent disease (76.7% vs 91.3%, p = 0.005). Asymptomatic pelvic exam diagnosed recurrence in 13.4% (27/201) and was more common in patients initially diagnosed with early-stage disease (66.7% vs 34.5% p = 0.001) of endometrioid histology (66.7% vs 36.8%, p = 0.003) without prior adjuvant therapy (48.2% vs 17.9%, p = 0.001). More than1/3 of diagnoses were made by providers outside of the oncologic care team. CONCLUSION The majority of women with recurrent endometrial cancer were symptomatic and pain is a common complaint associated with disease recurrence. Patients with symptomatic presentation of disease recurrence were less likely to receive treatment for recurrent disease but this did not result in an overall survival (OS) difference. Given the rising mortality rate of endometrial cancer further work is needed to develop multidisciplinary surveillance strategies that will enable meaningful treatment of disease recurrence.
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Affiliation(s)
- Courtney J Riedinger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| | - Jenna M Patterson
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Floor J Backes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David O'Malley
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Kristin L Bixel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Larry J Copeland
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David E Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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Levine MD, Barrington DA, Hampel H, Goodfellow PJ, Cohn DE. Implementing universal upfront multi-gene panel testing in endometrial cancer: From cost to practical considerations. Gynecol Oncol 2022; 166:538-542. [PMID: 35871048 DOI: 10.1016/j.ygyno.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The routine use of upfront universal germline genetic testing among patients with newly diagnosed endometrial cancer (EC) has been proposed to improve diagnosis of Lynch syndrome (LS) and discover pathogenic variants (PVs) in other cancer susceptibility genes. We propose an algorithm prioritizing upfront multi-gene panel testing (MGPT) for newly diagnosed EC patients. METHODS A decision analysis compared the cost of the current algorithm of universal mismatch repair (MMR) immunohistochemistry (IHC) for all EC cases to a new MGPT algorithm that employs upfront MGPT for all EC cases and reserves MMR IHC for the recurrent setting. The increase in the number of LS diagnoses using upfront MGPT, and the number of patients with PVs in BRCA1 and BRCA2 are also estimated. RESULTS The MGPT algorithm demonstrated a cost savings of $259 per patient. Assuming 66,950 new cases of EC per year, this would represent $17.1 M of cost savings per year. When applied to all new diagnoses of EC in one year, the MGPT algorithm identified 660 (1%) additional cases of LS that would have been missed with the current algorithm. An additional 660 (1%) EC patients with BRCA1 or BRCA2 PVs would be diagnosed only through implementation of universal MGPT. CONCLUSIONS The use of universal upfront MGPT is a practical consideration for patients with newly diagnosed EC for cost savings and improved diagnosis of highly penetrant cancer syndromes. Incorporation of germline genetic testing in the upfront setting represents an opportunity to improve access to genetic counseling and testing, and ultimately an avenue to achieve equity and improve the lives of our patients with EC and their families.
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Affiliation(s)
- Monica D Levine
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH, United States of America.
| | - David A Barrington
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH, United States of America
| | - Heather Hampel
- City of Hope National Medical Center, Division of Clinical Cancer Genomics, Duarte, CA, United States of America
| | - Paul J Goodfellow
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH, United States of America
| | - David E Cohn
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH, United States of America
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Cosgrove CM, Backes FJ, O'Malley D, Bixel KL, Suarez AA, Fowler JM, Copeland LJ, Goodfellow PJ, Cohn DE. Endometrial Cancer: Who Lives, Who Dies, Can We Improve Their Story? Oncologist 2021; 26:1044-1051. [PMID: 34402130 PMCID: PMC8649025 DOI: 10.1002/onco.13934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endometrial cancer (EC) is the most common gynecologic cancer in the U.S. The objective of this cohort study was to characterize the clinical and pathologic features that are associated with endometrial cancer-specific death for women cared for at a single National Cancer Institute-designated comprehensive cancer center. PATIENTS, MATERIALS, AND METHODS This is a retrospective cohort from 2014 to 2017 including all women who had a hysterectomy for EC. Charts were reviewed for clinical and pathologic data, focusing on survival outcomes. RESULTS Seven hundred seventy-one patients with EC underwent hysterectomy with 760 informative for outcomes. Seventy-six (10%) deaths were related to their EC; 62 women died from recurrent EC. Nonendometrioid histology and advanced stage were predictors of recurrence and EC death. Among patients with endometrioid ECs, mismatch repair status was significantly associated with EC-specific survival (relative risk = 4.8; 95% confidence interval, 2.3-10.3; p < .0001). Most patients with EC who recurred died of their disease 62/83 (74.7%). Nearly half of the patients that recurred (27/62) had no additional therapy at the time of recurrence. Overall survival was significantly longer for those women who had additional treatment at the time of recurrence; however, the improvement in overall survival with therapy at recurrence was largely attributable to effects in those women who were adjuvant therapy naïve. CONCLUSION Although there is benefit of treatment at the time of recurrence for treatment-naïve women; only approximately half of patients were able to receive therapy. There is an urgent need for continued efforts for more effective EC therapy in both the front-line and recurrent setting as well as early identification of cancer diagnosis and recurrence. IMPLICATIONS FOR PRACTICE Approximately 10% of patients died of their endometrial cancer. Most deaths were from recurrent disease; however, almost 20% of endometrial cancer deaths were within 120 days of surgery. Although treatment at the time of recurrence improves overall survival, only approximately half of patients will receive therapy at the time of recurrence. Traditional prognostic features like histology and stage remain important to predict risk of recurrence, and newer biomarkers, such as mismatch repair status, may improve risk stratification and targeted therapy. There remains an urgent need for improved therapy and early detection of diagnosis and recurrence.
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Affiliation(s)
- Casey M. Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - Floor J. Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - David O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - Kristin L. Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - Adrian A. Suarez
- Department of Pathology, The Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Jeffrey M. Fowler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - Larry J. Copeland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - Paul J. Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
| | - David E. Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecologic, The Ohio State University Comprehensive Cancer Center/James Cancer HospitalColumbusOhioUSA
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Levine MD, Pearlman R, Hampel H, Cosgrove C, Cohn D, Chassen A, Suarez A, Barrington DA, McElroy JP, Waggoner S, Nakayama J, Billingsley C, Resnick K, Andrews S, Singh S, Jenison E, Clements A, Neff R, Goodfellow PJ. Up-Front Multigene Panel Testing for Cancer Susceptibility in Patients With Newly Diagnosed Endometrial Cancer: A Multicenter Prospective Study. JCO Precis Oncol 2021; 5:1588-1602. [PMID: 34994648 PMCID: PMC9848552 DOI: 10.1200/po.21.00249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Clinical utility of up-front multigene panel testing (MGPT) is directly related to the frequency of pathogenic variants (PVs) in the population screened and how genetic findings can be used to guide treatment decision making and cancer prevention efforts. The benefit of MGPT for many common malignancies remains to be determined. In this study, we evaluated up-front MGPT in unselected patients with endometrial cancer (EC) to determine the frequency of PVs in cancer susceptibility genes. METHODS Patients with EC were prospectively enrolled at nine Ohio institutions from October 1, 2017, to December 31, 2020. Nine hundred and sixty-one patients with newly diagnosed EC underwent clinical germline MGPT for 47 cancer susceptibility genes. In addition to estimating the prevalence of germline PVs, the number of individuals identified with Lynch syndrome (LS) was compared between MGPT and tumor-based screening. RESULTS Likely pathogenic variants or PVs were identified in 97 of 961 women (10.1%). LS was diagnosed in 29 of 961 patients (3%; 95% CI, 2.1 to 4.3), with PVs in PMS2 most frequent. MGPT revealed nine patients with LS in addition to the 20 identified through routine tumor-based screening. BRCA1 and BRCA2 PVs were found in 1% (10 of 961; 95% CI, 0.6 to 1.9) of patients and that group was significantly enriched for type II ECs. CONCLUSION This prospective, multicenter study revealed potentially actionable germline variants in 10% of unselected women with newly diagnosed EC, supporting the use of up-front MGPT for all EC patients. The discovery that BRCA1 or BRCA2 heterozygotes frequently had type II cancers points to therapeutic opportunities for women with aggressive histologic EC subtypes.
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Affiliation(s)
- Monica D. Levine
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Rachel Pearlman
- Division of Human Genetics, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - Heather Hampel
- Division of Human Genetics, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - Casey Cosgrove
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - David Cohn
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Alexis Chassen
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Adrian Suarez
- Department of Pathology, The Ohio State
University Comprehensive Cancer Center, Columbus, OH
| | - David A. Barrington
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH
| | - Joseph P. McElroy
- Center for Biostatistics, Department of
Biomedical Informatics, The Ohio State University College of Medicine, Columbus,
OH
| | - Steven Waggoner
- Division of Gynecologic Oncology,
University Hospitals Seidman Cancer Center, Cleveland, OH
| | - John Nakayama
- Division of Gynecologic Oncology,
University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Kim Resnick
- Division of Gynecologic Oncology,
MetroHealth, Cleveland, OH
| | | | - Sareena Singh
- Division of Gynecologic Oncology, Aultman
Hospital, Canton, OH
| | - Eric Jenison
- Division of Gynecologic Oncology, Mercy
Toledo, Toledo, OH
| | - Aine Clements
- Division of Gynecologic Oncology,
OhioHealth, Columbus, OH
| | - Robert Neff
- Division of Gynecologic Oncology,
TriHealth, Cincinnati, OH
| | - Paul J. Goodfellow
- Division of Gynecologic Oncology, The Ohio
State University Comprehensive Cancer Center, Columbus, OH,Paul J. Goodfellow, PhD, The Ohio State University Comprehensive
Cancer Center, 460 West 12th Ave, Room 808 BRT, Columbus, OH 43210; e-mail:
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Levine M, Pearlman R, Hampel H, Cosgrove C, Cohn DE, Chassen A, Suarez A, Waggoner SE, Billingsley C, Resnick KE, Andrews S, Singh S, Jenison E, Clements AE, Neff R, Goodfellow PJ. High prevalence of actionable germline variants in unselected endometrial cancer (EC) patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5577 Background: The use of upfront germline genetic testing for cancer patients to identify hereditary syndromes and to aid in treatment decision making has increased dramatically. Recent evidence suggests that such testing should be considered for all solid tumors. In EC, mismatch repair deficiency (MMRd) has emerged as an important molecular marker for treatment with checkpoint inhibitors. MMRd is the hallmark of Lynch syndrome (LS), the most common hereditary cause of EC. Therefore, identifying LS not only affords opportunities for cancer prevention but also for making treatment decisions for women who already have EC. Although tumor-based screening is highly effective, some LS diagnoses will be missed. Upfront multi-gene panel testing (MGPT) for EC has been evaluated as an alternative approach to identifying LS with the potential to simultaneously find actionable germline variants in other cancer susceptibility genes (CSGs). Our objective was to determine the frequency and types of actionable germline variants in a large, unselected group of women with EC. Methods: Prospective germline MGPT for 47 CSGs was performed for 961 unselected EC cases. Patients diagnosed from 2017-2020 were enrolled at nine different institutions. Clinicopathologic data were abstracted from patients’ records. Results: 101 likely pathogenic (LP) or pathogenic variants (PV) were identified in 98 women (10.2%). LP/PVs in LS genes were most common: 29 LS cases were identified (3.02%, 95% CI 2.1 - 4.3%). MGPT found 9 cases (one-third of LS cases) that were not identified by tumor screening: 6 were from institutions that do not perform tumor screening and 3 had normal immunohistochemistry. There were 72 LP/PVs found in 17 different CSGs. 21 patients (2.1%) had LP/PVs in high penetrance CSGs other than the LS genes, 19 of which were in genes associated with breast and/or ovarian cancer (4 in BRCA1, 6 in BRCA2, 6 in BRIP1, 2 in PALB2, 1 in RAD51C). BRCA1/2 PVs (1.04% of the study population, 95% CI 0.6 - 1.9%) were significantly more frequent in women with type II cancers than the rest of the cohort (P =.005, HR 2.00, 95% CI 1.16 - 4.75). 21 additional LP/PVs were found in moderate risk CSGs ( ATM, CHEK2, NBN, NF1). Conclusions: Upfront MGPT in an unselected EC population improved LS diagnosis and identified an additional 2% of patients with LP/PVs in highly penetrant CSGs. The enrichment of germline BRCA1/2 PVs in type II cancers is consistent with prior reports that non-endometrioid tumors are frequently deficient in homologous recombination. Germline BRCA mutation is a known predictive biomarker in ovarian cancer and an attractive therapeutic target in EC. Knowing germline status at the time of diagnosis facilitates further delineation of germline/phenotype associations, and it defines a genetic syndrome allowing for cancer prevention. Upfront MGPT in EC provides clinically impactful information and should be adopted into routine clinical care. Clinical trial information: NCT03460483.
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Affiliation(s)
- Monica Levine
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | | | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Casey Cosgrove
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - David E. Cohn
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | | | - Adrian Suarez
- The Ohio State University Medical Center, Columbus, OH
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9
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Pearlman R, Frankel WL, Swanson BJ, Jones D, Zhao W, Yilmaz A, Miller K, Bacher J, Bigley C, Nelsen L, Goodfellow PJ, Goldberg RM, Paskett E, Shields PG, Freudenheim JL, Stanich PP, Lattimer I, Arnold M, Prior TW, Haut M, Kalady MF, Heald B, Paquette I, Draper DJ, Brell JM, Mahesh S, Weeman K, Bastola S, Zangmeister J, Gowda A, Kencana F, Malcolm A, Liu Y, Cole S, Bane C, Li C, Rehmus E, Pritchard CC, Shirts BH, Jacobson A, Cummings SA, de la Chapelle A, Hampel H. Prospective Statewide Study of Universal Screening for Hereditary Colorectal Cancer: The Ohio Colorectal Cancer Prevention Initiative. JCO Precis Oncol 2021; 5:PO.20.00525. [PMID: 34250417 PMCID: PMC8232834 DOI: 10.1200/po.20.00525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022] Open
Abstract
Hereditary cancer syndromes infer high cancer risks and require intensive surveillance. Identification of high-risk individuals among patients with colorectal cancer (CRC) needs improvement. METHODS Three thousand three hundred ten unselected adults who underwent surgical resection for primary invasive CRC were prospectively accrued from 51 hospitals across Ohio between January 1, 2013, and December 31, 2016. Universal Tumor screening (UTS) for mismatch repair (MMR) deficiency was performed for all, and pathogenic germline variants (PGVs) were identified using multigene panel testing (MGPT) in those who met at least one inclusion criterion: MMR deficiency, diagnosed < 50 years, multiple primary tumors (CRC or endometrial cancer), or with a first-degree relative with CRC or endometrial cancer. RESULTS Five hundred twenty-five patients (15.9%) had MMR deficiency. Two hundred thirty-four of 3,310 (7.1%; 16% of the 1,462 who received MGPT) had 248 PGVs in cancer susceptibility genes. One hundred forty-two (4.3%) had a PGV in an MMR gene, and 101 (3.1%) had a PGV in a non-MMR gene. Ten with Lynch syndrome (LS) also had a non-MMR PGV and were included in both groups. Two (0.06%) had constitutional MLH1 hypermethylation. Of unexplained MMR-deficient patients, 88.4% (76 of 86) had double somatic MMR mutations. Testing for only MMR genes in MMR-deficient patients would have missed 18 non-MMR gene PGVs (7.3% of total PGVs identified). Had UTS been the only method used to screen for hereditary cancer syndromes, 38.6% (91 of 236) would have been missed, including 6.3% (9 of 144) of those with LS. These results have treatment implications as 5.3% (175 of 3,310) had PGVs in genes with therapeutic targets. CONCLUSION UTS alone is insufficient for identifying a large proportion of CRC patients with hereditary syndromes, including some with LS. At a minimum, 7.1% of individuals with CRC have a PGV and pan-cancer MGPT should be considered for all patients with CRC.
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Affiliation(s)
- Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wendy L. Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin J. Swanson
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Pathology and Microbiology, The University of Nebraska Medical Center, Omaha, NE
| | - Dan Jones
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ahmet Yilmaz
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristin Miller
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jason Bacher
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher Bigley
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
- Vikor Scientific, Charleston, SC
| | - Lori Nelsen
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard M. Goldberg
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Medicine, West Virginia University, Morgantown, WV
| | - Electra Paskett
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter G. Shields
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jo L. Freudenheim
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | - Peter P. Stanich
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ilene Lattimer
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mark Arnold
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas W. Prior
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | | | - Matthew F. Kalady
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- Sanford R. Weiss Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH
| | - Brandie Heald
- Sanford R. Weiss Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH
| | - Ian Paquette
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David J. Draper
- TriHealth Cancer Institute, Good Samaritan Hospital, Cincinnati, OH
| | - Joanna M. Brell
- Department of Medicine, MetroHealth Cancer Center, Cleveland, OH
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sameer Mahesh
- Department of Internal Medicine, Summa Cancer Institute, Summa Akron City Hospital, Akron, OH
| | - Kisa Weeman
- Department of Hematology/Oncology, Aultman Hospital, Canton, OH
| | - Shyamal Bastola
- Department of Oncology and Hematology, Genesis HealthCare System, Zanesville, OH
| | | | - Aruna Gowda
- Department of Hematology/Oncology, Licking Memorial Hospital, Newark, OH
| | - Filix Kencana
- Division of Medical Oncology, Springfield Regional Medical Center, Springfield, OH
| | | | - Yinong Liu
- Southern Ohio Medical Center, Portsmouth, OH
| | - Sharon Cole
- Blanchard Valley Medical Center, Findlay, OH
| | | | | | | | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Brian H. Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Angela Jacobson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | - Albert de la Chapelle
- Department of Cancer Biology and Genetics, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Heather Hampel
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
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10
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Koivisto CS, Parrish M, Bonala SB, Ngoi S, Torres A, Gallagher J, Sanchez-Hodge R, Zeinner V, Nahhas GJ, Liu B, Cohn DE, Backes FJ, Goodfellow PJ, Chamberlin HM, Leone G. Evaluating the efficacy of enzalutamide and the development of resistance in a preclinical mouse model of type-I endometrial carcinoma. Neoplasia 2020; 22:484-496. [PMID: 32818842 PMCID: PMC7452078 DOI: 10.1016/j.neo.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
Androgen Receptor (AR) signaling is a critical driver of hormone-dependent prostate cancer and has also been proposed to have biological activity in female hormone-dependent cancers, including type I endometrial carcinoma (EMC). In this study, we evaluated the preclinical efficacy of a third-generation AR antagonist, enzalutamide, in a genetic mouse model of EMC, Sprr2f-Cre;Ptenfl/fl. In this model, ablation of Pten in the uterine epithelium leads to localized and distant malignant disease as observed in human EMC. We hypothesized that administering enzalutamide through the diet would temporarily decrease the incidence of invasive and metastatic carcinoma, while prolonged administration would result in development of resistance and loss of efficacy. Short-term treatment with enzalutamide reduced overall tumor burden through increased apoptosis but failed to prevent progression of invasive and metastatic disease. These results suggest that AR signaling may have biphasic, oncogenic and tumor suppressive roles in EMC that are dependent on disease stage. Enzalutamide treatment increased Progesterone Receptor (PR) expression within both stromal and tumor cell compartments. Prolonged administration of enzalutamide decreased apoptosis, increased tumor burden and resulted in the clonal expansion of tumor cells expressing high levels of p53 protein, suggestive of acquired Trp53 mutations. In conclusion, we show that enzalutamide induces apoptosis in EMC but has limited efficacy overall as a single agent. Induction of PR, a negative regulator of endometrial proliferation, suggests that adding progestin therapy to enzalutamide administration may further decrease tumor burden and result in a prolonged response.
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Affiliation(s)
- Christopher S Koivisto
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Melodie Parrish
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Santosh B Bonala
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Soo Ngoi
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Adrian Torres
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA.
| | - James Gallagher
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA.
| | - Rebekah Sanchez-Hodge
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA; Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Victor Zeinner
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Bei Liu
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - David E Cohn
- Division of Gynecologic Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Floor J Backes
- Division of Gynecologic Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Helen M Chamberlin
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA.
| | - Gustavo Leone
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
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11
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Konstantinopoulos PA, Norquist B, Lacchetti C, Armstrong D, Grisham RN, Goodfellow PJ, Kohn EC, Levine DA, Liu JF, Lu KH, Sparacio D, Annunziata CM. Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1222-1245. [PMID: 31986064 PMCID: PMC8842911 DOI: 10.1200/jco.19.02960] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To provide recommendations on genetic and tumor testing for women diagnosed with epithelial ovarian cancer based on available evidence and expert consensus. METHODS A literature search and prospectively defined study selection criteria sought systematic reviews, meta-analyses, randomized controlled trials (RCTs), and comparative observational studies published from 2007 through 2019. Guideline recommendations were based on the review of the evidence. RESULTS The systematic review identified 19 eligible studies. The evidence consisted of systematic reviews of observational data, consensus guidelines, and RCTs. RECOMMENDATIONS All women diagnosed with epithelial ovarian cancer should have germline genetic testing for BRCA1/2 and other ovarian cancer susceptibility genes. In women who do not carry a germline pathogenic or likely pathogenic BRCA1/2 variant, somatic tumor testing for BRCA1/2 pathogenic or likely pathogenic variants should be performed. Women with identified germline or somatic pathogenic or likely pathogenic variants in BRCA1/2 genes should be offered treatments that are US Food and Drug Administration (FDA) approved in the upfront and the recurrent setting. Women diagnosed with clear cell, endometrioid, or mucinous ovarian cancer should be offered somatic tumor testing for mismatch repair deficiency (dMMR). Women with identified dMMR should be offered FDA-approved treatment based on these results. Genetic evaluations should be conducted in conjunction with health care providers familiar with the diagnosis and management of hereditary cancer. First- or second-degree blood relatives of a patient with ovarian cancer with a known germline pathogenic cancer susceptibility gene variant should be offered individualized genetic risk evaluation, counseling, and genetic testing. Clinical decision making should not be made based on a variant of uncertain significance. Women with epithelial ovarian cancer should have testing at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Elise C Kohn
- Gynecologic Cancer Therapeutics, National Cancer Institute, Bethesda, MD
| | | | | | - Karen H Lu
- The University of Texas MD Anderson Cancer Center, Houston,TX
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12
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Moyer CL, Ivanovich J, Gillespie JL, Doberstein R, Radke MR, Richardson ME, Kaufmann SH, Swisher EM, Goodfellow PJ. Rare BRIP1 Missense Alleles Confer Risk for Ovarian and Breast Cancer. Cancer Res 2019; 80:857-867. [PMID: 31822495 DOI: 10.1158/0008-5472.can-19-1991] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
Germline loss-of-function mutations in BRCA1 interacting protein C-terminal helicase 1 (BRIP1) are associated with ovarian carcinoma and may also contribute to breast cancer risk, particularly among patients who develop disease at an early age. Normal BRIP1 activity is required for DNA interstrand cross-link (ICL) repair and is thus central to the maintenance of genome stability. Although pathogenic mutations have been identified in BRIP1, genetic testing more often reveals missense variants, for which the impact on molecular function and subsequent roles in cancer risk are uncertain. Next-generation sequencing of germline DNA in 2,160 early-onset breast cancer and 1,199 patients with ovarian cancer revealed nearly 2% of patients carry a very rare missense variant (minor allele frequency < 0.0001) in BRIP1. This is 3-fold higher than the frequency of all rare BRIP1 missense alleles reported in more than 60,000 individuals of the general population (P < 0.0001, χ 2 test). Using CRISPR-Cas9 gene editing technology and rescue assays, we functionally characterized 20 of these missense variants, focusing on the altered protein's ability to repair ICL damage. A total of 75% of the characterized variants rendered the protein hypomorph or null. In a clinical cohort of >117,000 patients with breast and ovarian cancer who underwent panel testing, the combined OR associated with BRIP1 hypomorph or null missense carriers compared with the general population was 2.30 (95% confidence interval, 1.60-3.30; P < 0.0001). These findings suggest that novel missense variants within the helicase domain of BRIP1 may confer risk for both breast and ovarian cancer and highlight the importance of functional testing for additional variants. SIGNIFICANCE: Functional characterization of rare variants of uncertain significance in BRIP1 revealed that 75% demonstrate loss-of-function activity, suggesting rare missense alleles in BRIP1 confer risk for both breast and ovarian cancer.
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Affiliation(s)
- Cassandra L Moyer
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Jennifer Ivanovich
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana
| | - Jessica L Gillespie
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Rachel Doberstein
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Marc R Radke
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington
| | - Marcy E Richardson
- Department of Clinical Genomics, Ambry Genetics, Aliso Viejo, California
| | - Scott H Kaufmann
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, University of Washington, Seattle, Washington
| | - Paul J Goodfellow
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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13
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Hampel H, Pearlman R, Beightol M, Zhao W, Jones D, Frankel WL, Goodfellow PJ, Yilmaz A, Miller K, Bacher J, Jacobson A, Paskett E, Shields PG, Goldberg RM, de la Chapelle A, Shirts BH, Pritchard CC. Assessment of Tumor Sequencing as a Replacement for Lynch Syndrome Screening and Current Molecular Tests for Patients With Colorectal Cancer. JAMA Oncol 2019; 4:806-813. [PMID: 29596542 DOI: 10.1001/jamaoncol.2018.0104] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Universal tumor screening for Lynch syndrome (LS) in colorectal cancer (CRC) is recommended and involves up to 6 sequential tests. Somatic gene testing is performed on stage IV CRCs for treatment determination. The diagnostic workup for patients with CRC could be simplified and improved using a single up-front tumor next-generation sequencing test if it has higher sensitivity and specificity than the current screening protocol. Objective To determine whether up-front tumor sequencing (TS) could replace the current multiple sequential test approach for universal tumor screening for LS. Design, Setting, and Participants Tumor DNA from 419 consecutive CRC cases undergoing standard universal tumor screening and germline genetic testing when indicated as part of the multicenter, population-based Ohio Colorectal Cancer Prevention Initiative from October 2015 through February 2016 (the prospective cohort) and 46 patients with CRC known to have LS due to a germline mutation in a mismatch repair gene from January 2013 through September 2015 (the validation cohort) underwent blinded TS. Main Outcomes and Measures Sensitivity of TS compared with microsatellite instability (MSI) testing and immunohistochemical (IHC) staining for the detection of LS. Results In the 465 patients, mean age at diagnosis was 59.9 years (range, 20-96 years), and 241 (51.8%) were female. Tumor sequencing identified all 46 known LS cases from the validation cohort and an additional 12 LS cases from the 419-member prospective cohort. Testing with MSI or IHC, followed by BRAF p.V600E testing missed 5 and 6 cases of LS, respectively. Tumor sequencing alone had better sensitivity (100%; 95% CI, 93.8%-100%) than IHC plus BRAF (89.7%; 95% CI, 78.8%-96.1%; P = .04) and MSI plus BRAF (91.4%; 95% CI, 81.0%-97.1%; P = .07). Tumor sequencing had equal specificity (95.3%; 95% CI, 92.6%-97.2%) to IHC plus BRAF (94.6%; 95% CI, 91.9%-96.6%; P > .99) and MSI plus BRAF (94.8%; 95% CI, 92.2%-96.8%; P = .88). Tumor sequencing identified 284 cases with KRAS, NRAS, or BRAF mutations that could affect therapy for stage IV CRC, avoiding another test. Finally, TS identified 8 patients with germline DPYD mutations that confer toxicity to fluorouracil chemotherapy, which could also be useful for treatment selection. Conclusions and Relevance Up-front TS in CRC is simpler and has superior sensitivity to current multitest approaches to LS screening, while simultaneously providing critical information for treatment selection.
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Affiliation(s)
- Heather Hampel
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus
| | - Rachel Pearlman
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus
| | - Mallory Beightol
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Weiqiang Zhao
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Daniel Jones
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Wendy L Frankel
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus
| | - Ahmet Yilmaz
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Kristin Miller
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Jason Bacher
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus
| | - Angela Jacobson
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Electra Paskett
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus
| | - Peter G Shields
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus
| | - Richard M Goldberg
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus.,Department of Internal Medicine, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Albert de la Chapelle
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus.,Department of Cancer Biology and Genetics, Ohio State University, Columbus
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle
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14
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Aryal NK, Pant V, Wasylishen AR, Rimel BJ, Baseler L, El-Naggar AK, Mutch DG, Goodfellow PJ, Arur S, Lozano G. Dicer1 Phosphomimetic Promotes Tumor Progression and Dissemination. Cancer Res 2019; 79:2662-2668. [PMID: 30914430 DOI: 10.1158/0008-5472.can-18-2460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/23/2018] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Dicer1 functions as a tumor suppressor in mouse models. In humans, somatic mutations are associated with many cancers in adults, and patients with DICER1 syndrome with DICER1 germline mutations are susceptible to childhood cancers. Dicer is phosphorylated by the ERK-MAP kinase pathway and because this pathway is activated in human cancers, we asked whether phosphorylated Dicer1 contributed to tumor development. In human endometrioid cancers, we discovered that phosphorylated DICER1 is significantly associated with invasive disease. To test a direct involvement of Dicer1 phosphorylation in tumor development, we studied mice with phosphomimetic alterations at the two conserved serines phosphorylated by ERK and discovered that a phosphomimetic Dicer1 drives tumor development and dissemination in two independent murine cancer models (KRas+/LA1 and p53+/- ). Our findings demonstrate that phosphomimetic Dicer1 promotes tumor development and invasion. SIGNIFICANCE: This work highlights the relevance of Dicer1 phosphorylation in mammalian tumor development and dissemination.
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Affiliation(s)
- Neeraj K Aryal
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Genes and Development Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Vinod Pant
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amanda R Wasylishen
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bobbie J Rimel
- Division of Gynecologic Oncology, Cedars Sinai Medical Center, Los Angeles, California
| | - Laura Baseler
- Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adel K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David G Mutch
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University and James Comprehensive Cancer Center, Columbus, Ohio
| | - Swathi Arur
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Genes and Development Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Guillermina Lozano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Genes and Development Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas
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15
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Brooks RA, Tritchler DS, Darcy KM, Lankes HA, Salani R, Sperduto P, Guntupalli S, DiSilvestro P, Kesterson J, Olawaiye AB, Moxley K, Waggoner S, Santin A, Rader JS, Kizer NT, Thaker PH, Powell MA, Mutch DG, Birrer MJ, Goodfellow PJ. GOG 8020/210: Risk stratification of lymph node metastasis, disease progression and survival using single nucleotide polymorphisms in endometrial cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2019; 153:335-342. [PMID: 30827726 DOI: 10.1016/j.ygyno.2019.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The ability to stratify a patient's risk of metastasis and survival permits more refined care. A proof of principle study was undertaken to investigate the relationship between single nucleotide polymorphisms (SNPs) in literature based candidate cancer genes and the risk of nodal metastasis and clinical outcome in endometrioid endometrial cancer (EEC) patients. METHODS Surgically-staged EEC patients from the Gynecologic Oncology Group or Washington University School of Medicine with germline DNA available were eligible. Fifty-four genes represented by 384 SNPs, were evaluated by Illumina Custom GoldenGate array. Association with lymph node metastases was the primary outcome. Progression-free survival (PFS) and overall survival (OS) was also evaluated. RESULTS 361 SNPs with high quality genotype data were evaluated in 337 patients with outcome data. Five SNPs in CXCR2 had an odds ratio (OR) between 0.68 and 0.70 (p-value ≤ 0.025). The A allele rs946486 in ABL had an OR of 1.5 (p-value = 0.01) for metastasis. The G allele in rs7795743 in EGFR had an OR for metastasis of 0.68 (p-value = 0.02) and hazard ratio (HR) for progression of 0.66 (p-value = 0.004). Importantly, no SNP met genome wide significance after adjusting for multiple test correcting and clinical covariates. The A allele in rs2159359 SNP in NME1 and the G allele in rs13222385 in EGFR were associated with worse OS. Both exhibited genome wide significance; rs13222385 remained significant after adjusting for prognostic clinical variables. CONCLUSION SNPs in cancer genes including rs2159359 SNP in NME1 and rs13222385 in EGFR may stratify risk in EEC and are prioritized for further investigation.
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Affiliation(s)
- Rebecca A Brooks
- Division of Gynecologic Oncology, University of California at Dabvis, Sacramento, CA, United States of America.
| | | | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Inova Medical Campus, Falls Church, VA, United States of America
| | - Heather A Lankes
- Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Paul Sperduto
- Division of Radiation Oncology, Ridgeview Medical Center, Waconia, MN, United States of America
| | - Saketh Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Paul DiSilvestro
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Joshua Kesterson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Penn State College of Medicine, Milton S. Hershey Medical Center, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA, United States of America
| | - Katherine Moxley
- Department of OB/GYN, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Steven Waggoner
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Alessandro Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States of America
| | - Janet S Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nora T Kizer
- Department of Obstetrics and Gynecology, Springfield Clinic, Springfield, IL, United States of America
| | - Premal H Thaker
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - Matthew A Powell
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - David G Mutch
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, United States of America
| | - Michael J Birrer
- Division of Hematology Oncology, The University of Alabama, Birmingham, AL, United States of America
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States of America
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16
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Rush CM, Goodfellow PJ. Diverse mutational signatures in endometrial cancer: implications for tumor etiology and evolution. Gynecol Oncol 2019; 152:1-2. [DOI: 10.1016/j.ygyno.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Backes FJ, Haag J, Cosgrove CM, Suarez A, Cohn DE, Goodfellow PJ. Mismatch repair deficiency identifies patients with high‐intermediate–risk (HIR) endometrioid endometrial cancer at the highest risk of recurrence: A prognostic biomarker. Cancer 2018; 125:398-405. [DOI: 10.1002/cncr.31901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/01/2018] [Accepted: 07/13/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Floor J. Backes
- Division of Gynecologic Oncology Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Jennifer Haag
- Division of Gynecologic Oncology Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Casey M. Cosgrove
- Division of Gynecologic Oncology Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Adrian Suarez
- Division of Pathology Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - David E. Cohn
- Division of Gynecologic Oncology Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Paul J. Goodfellow
- Division of Gynecologic Oncology Ohio State University Comprehensive Cancer Center Columbus Ohio
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18
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Polusani SR, Huang YW, Huang G, Chen CW, Wang CM, Lin LL, Osmulski P, Lucio ND, Liu L, Hsu YT, Zhou Y, Lin CL, Aguilera-Barrantes I, Valente PT, Kost ER, Chen CL, Shim EY, Lee SE, Ruan J, Gaczynska ME, Yan P, Goodfellow PJ, Mutch DG, Jin VX, Nicholson BJ, Huang THM, Kirma NB. Adipokines Deregulate Cellular Communication via Epigenetic Repression of Gap Junction Loci in Obese Endometrial Cancer. Cancer Res 2018; 79:196-208. [PMID: 30389702 DOI: 10.1158/0008-5472.can-18-1615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/10/2018] [Accepted: 10/26/2018] [Indexed: 11/16/2022]
Abstract
Emerging evidence indicates that adipose stromal cells (ASC) are recruited to enhance cancer development. In this study, we examined the role these adipocyte progenitors play relating to intercellular communication in obesity-associated endometrial cancer. This is particularly relevant given that gap junctions have been implicated in tumor suppression. Examining the effects of ASCs on the transcriptome of endometrial epithelial cells (EEC) in an in vitro coculture system revealed transcriptional repression of GJA1 (encoding the gap junction protein Cx43) and other genes related to intercellular communication. This repression was recapitulated in an obesity mouse model of endometrial cancer. Furthermore, inhibition of plasminogen activator inhibitor 1 (PAI-1), which was the most abundant ASC adipokine, led to reversal of cellular distribution associated with the GJA1 repression profile, suggesting that PAI-1 may mediate actions of ASC on transcriptional regulation in EEC. In an endometrial cancer cohort (n = 141), DNA hypermethylation of GJA1 and related loci TJP2 and PRKCA was observed in primary endometrial endometrioid tumors and was associated with obesity. Pharmacologic reversal of DNA methylation enhanced gap-junction intercellular communication and cell-cell interactions in vitro. Restoring Cx43 expression in endometrial cancer cells reduced cellular migration; conversely, depletion of Cx43 increased cell migration in immortalized normal EEC. Our data suggest that persistent repression by ASC adipokines leads to promoter hypermethylation of GJA1 and related genes in the endometrium, triggering long-term silencing of these loci in endometrial tumors of obese patients. SIGNIFICANCE: Studies reveal that adipose-derived stem cells in endometrial cancer pathogenesis influence epigenetic repression of gap junction loci, which suggests targeting of gap junction activity as a preventive strategy for obesity-associated endometrial cancer.
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Affiliation(s)
- Srikanth R Polusani
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Yi-Wen Huang
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukie, Wisconsin
| | - Guangcun Huang
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Chun-Wei Chen
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Chiou-Miin Wang
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Li-Ling Lin
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Pawel Osmulski
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Nicholas D Lucio
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lu Liu
- Department of Computer Science, North Dakota State University, Fargo, North Dakota
| | - Ya-Ting Hsu
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Yufan Zhou
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Chun-Lin Lin
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Philip T Valente
- Department of Pathology, University of Texas Health San Antonio, San Antonio, Texas
| | - Edward R Kost
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Chun-Liang Chen
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Eun Yong Shim
- Department of Radiation Oncology, University of Texas Health San Antonio, San Antonio, Texas
| | - Sang Eun Lee
- Department of Radiation Oncology, University of Texas Health San Antonio, San Antonio, Texas
| | - Jianhua Ruan
- Department of Computer Science, University of Texas San Antonio, San Antonio, Texas
| | - Maria E Gaczynska
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Pearlly Yan
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - David G Mutch
- Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Victor X Jin
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Bruce J Nicholson
- Department of Biochemistry and Structural Biology, University of Texas Health San Antonio, San Antonio, Texas
| | - Tim H-M Huang
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas.
| | - Nameer B Kirma
- Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas.
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19
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Neff R, Rush CM, Smith B, Backes FJ, Cohn DE, Goodfellow PJ. Functional characterization of recurrent FOXA2 mutations seen in endometrial cancers. Int J Cancer 2018; 143:2955-2961. [PMID: 30091462 DOI: 10.1002/ijc.31784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
FOXA2, a member of the forkhead family of DNA-binding proteins, is frequently mutated in uterine cancers. Most of the mutations observed in uterine cancers are frameshifts and stops. FOXA2 is considered to be a driver gene in uterine cancers, functioning as a haploinsufficient tumor suppressor. The functional consequences of FOXA2 mutations, however, have not yet been determined. We evaluated the effects that frameshift mutations and a recurrent missense mutation have on FOXA2 transcriptional activity. Recurrent N-terminal frameshifts resulted in truncated proteins that failed to translocate to the nucleus and have no transcriptional activity using an E-cadherin/luciferase reporter assay. Protein abundance was reduced for the recurrent p.S169 W mutation, as was transcriptional activity. A C-terminal frameshift mutation had increased FOXA2 levels evidenced by both Western blot and immunofluorescence. Given that FOXA2 is a recognized activator of E-cadherin (CDH1) expression and E-cadherin's potential role in epithelial-to-mesenchymal transition in a wide range of cancer types, we tested the hypothesis that FOXA2 mutations in primary uterine cancer specimens would be associated with reduced CDH1 transcript levels. qRT-PCR revealed significantly lower levels of CDH1 expression in primary tumors with FOXA2 mutations. Our findings in vitro and in vivo suggest that reduced transcriptional activity associated with FOXA2 mutations in uterine cancers is likely to contribute to protumorigenic changes in gene expression.
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Affiliation(s)
- Robert Neff
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH
| | - Craig M Rush
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH
| | - Blair Smith
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH.,University of Missouri-Kansas City School of Medicine, Kansas City, KS
| | - Floor J Backes
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH
| | - David E Cohn
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH
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20
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Rush CM, Gardner ML, Sapp CE, Freitas MA, Goodfellow PJ. Abstract 3335: Characterizing the MAXH28R secretome in endometrial cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We have previously shown that the recurrent endometrial cancer MAX p.His28Arg mutation (MAXH28R) is associated with a proangiogenesis phenotype in both in vitro and xenograft models. The purpose of this study is to characterize the MAXH28R secretome to identify the proangiogenic and other paracrine factors contributing to MAXH28R associated tumorigenesis. Bottom-up high-resolution liquid chromatography tandem mass spectrometry (LC-MS/MS) of secreted proteins coupled with microarray analysis of global gene expression was performed in AN3CA endometrial cancer cell lines that stably express the long isoform of MAX-wild type (MAXWT) or MAXH28R. Orthogonal validation of differentially expressed proteins was performed by Western blot (WB) and enzyme-linked immunosorbent assay (ELISA) using MAXWT- or MAXH28R-expressing AN3CA cell lines. Bioinformatic analysis of the proteins secreted into conditioned media (secretome) identified 114 proteins differentially expressed by MAXH28R compared to MAXWT-expressing AN3CA cells (P < 0.05). Differential expression of proteins was highly correlated with mRNA expression (Pearson r = 0.75, P < 0.001), indicating that a subset of the differentially expressed proteins are potential direct transcriptional targets of MAX. Secretome analysis revealed that Laminin-β1 expression in MAXH28R was reduced more than 100-fold compared to MAXWT (P < 0.001), while ALCAM (CD166) expression was increased 3.5-fold (P < 0.001). Decreased expression of TGFβ1 (5.9-fold decrease, P = 0.023) and TGFβ2 (3-fold decrease, P = 0.009) was seen for MAXH28R cells compared to MAXWT. Differential expression of Laminin-β1 and ALCAM was confirmed by WB analysis and TGFβ1 and TGFβ2 by ELISA. Our analyses revealed extensive changes in the MAXH28R secretome, as exemplified above. Reduced Laminin-β1 highlights alteration in the extracellular matrix with implications for cell adhesion and integrin signaling. Increased ALCAM expression indicates changes to cell-cell adhesion. Elevated levels of ALCAM in conditioned media are consistent with increased ALCAM shedding, which is a marker of more aggressive tumors in a variety of malignancies. Reduced TGFβ ligand levels suggest potential alterations in paracrine and autocrine TGFβ signaling. However, the impact on canonical and noncanonical TGFβ signaling in MAX mutant endometrial cancers remains unknown. ChIP-qPCR experiments are ongoing to assess MAXH28R binding at the promoters of differentially expressed genes. Biologic validation of MAXH28R effects on differential expression of secreted proteins is being performed in the Ishikawa and RL95-2 endometrial cancer cell lines that stably express MAXH28R and MAXWT. The effects of reduced Laminin-β1 on integrin signaling and anchorage independent growth will be reported, as will effects of altered TGFβ expression on canonical and noncanonical TGFβ signaling.
Citation Format: Craig M. Rush, Miranda L. Gardner, Caroline E. Sapp, Michael A. Freitas, Paul J. Goodfellow. Characterizing the MAXH28R secretome in endometrial cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3335.
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Affiliation(s)
- Craig M. Rush
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Caroline E. Sapp
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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21
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Walker CJ, Rush CM, Dama P, O’Hern MJ, Cosgrove CM, Gillespie JL, Zingarelli RA, Smith B, Stein ME, Mutch DG, Shakya R, Chang CW, Selvendiran K, Song JW, Cohn DE, Goodfellow PJ. MAX Mutations in Endometrial Cancer: Clinicopathologic Associations and Recurrent MAX p.His28Arg Functional Characterization. J Natl Cancer Inst 2018; 110:517-526. [PMID: 29155953 PMCID: PMC6279289 DOI: 10.1093/jnci/djx238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022] Open
Abstract
Background Genomic studies have revealed that multiple genes are mutated at varying frequency in endometrial cancer (EC); however, the relevance of many of these mutations is poorly understood. An EC-specific recurrent mutation in the MAX transcription factor p.His28Arg was recently discovered. We sought to assess the functional consequences of this hotspot mutation and determine its association with cancer-relevant phenotypes. Methods MAX was sequenced in 509 endometrioid ECs, and associations between mutation status and clinicopathologic features were assessed. EC cell lines stably expressing MAXH28R were established and used for functional experiments. DNA binding was examined using electrophoretic mobility shift assays and chromatin immunoprecipitation. Transcriptional profiling was performed with microarrays. Murine flank (six to 11 mice per group) and intraperitoneal tumor models were used for in vivo studies. Vascularity of xenografts was assessed by MECA-32 immunohistochemistry. The paracrine pro-angiogenic nature of MAXH28R-expressing EC cells was tested using microfluidic HUVEC sprouting assays and VEGFA enzyme-linked immunosorbent assays. All statistical tests were two-sided. Results Twenty-two of 509 tumors harbored mutations in MAX, including 12 tumors with the p.His28Arg mutation. Patients with a MAX mutation had statistically significantly reduced recurrence-free survival (hazard ratio = 4.00, 95% confidence interval = 1.15 to 13.91, P = .03). MAXH28R increased affinity for canonical E-box sequences, and MAXH28R-expressing EC cells dramatically altered transcriptional profiles. MAXH28R-derived xenografts statistically significantly increased vascular area compared with MAXWT and empty vector tumors (P = .003 and P = .008, respectively). MAXH28R-expressing EC cells secreted nearly double the levels of VEGFA compared with MAXWT cells (P = .03, .005, and .005 at 24, 48, and 72 hours, respectively), and conditioned media from MAXH28R cells increased sprouting when applied to HUVECs. Conclusion These data highlight the importance of MAX mutations in EC and point to increased vascularity as one mechanism contributing to clinical aggressiveness of EC.
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MESH Headings
- Aged
- Aged, 80 and over
- Amino Acid Substitution/genetics
- Animals
- Animals, Outbred Strains
- Arginine/genetics
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Endometrioid/epidemiology
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/pathology
- Cells, Cultured
- Codon, Nonsense
- Endometrial Neoplasms/epidemiology
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/pathology
- Female
- Genetic Association Studies
- Genetic Predisposition to Disease
- HEK293 Cells
- Histidine/genetics
- Humans
- Mice
- Mice, Nude
- Middle Aged
- Neoplasm Invasiveness
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/pathology
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Affiliation(s)
| | - Craig M Rush
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Paola Dama
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Matthew J O’Hern
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Casey M Cosgrove
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | | | - Roman A Zingarelli
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Blair Smith
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Maggie E Stein
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - David G Mutch
- Siteman Cancer Center and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Jonathan W Song
- James Comprehensive Cancer Center
- Department of Mechanical and Aerospace Engineering The Ohio State University, Columbus, OH
| | - David E Cohn
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
| | - Paul J Goodfellow
- James Comprehensive Cancer Center
- Department of Obstetrics and Gynecology
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22
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Saini U, Suarez AA, Naidu S, Wallbillich JJ, Bixel K, Wanner RA, Bice J, Kladney RD, Lester J, Karlan BY, Goodfellow PJ, Cohn DE, Selvendiran K. STAT3/PIAS3 Levels Serve as "Early Signature" Genes in the Development of High-Grade Serous Carcinoma from the Fallopian Tube. Cancer Res 2018; 78:1739-1750. [PMID: 29339537 DOI: 10.1158/0008-5472.can-17-1671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 01/23/2023]
Abstract
The initial molecular events that lead to malignant transformation of the fimbria of the fallopian tube (FT) through high-grade serous ovarian carcinoma (HGSC) remain poorly understood. In this study, we report that increased expression of signal transducer and activator of transcription 3 (pSTAT3 Tyr705) and suppression or loss of protein inhibitor of activated STAT3 (PIAS3) in FT likely drive HGSC. We evaluated human tissues-benign normal FT, tubal-peritoneal junction (TPJ), p53 signature FT tissue, tubal intraepithelial lesion in transition (TILT), serous tubal intraepithelial carcinoma (STIC) without ovarian cancer, and HGSC for expression of STAT3/PIAS3 (compared with their known TP53 signature) and their target proliferation genes. We observed constitutive activation of STAT3 and low levels or loss of PIAS3 in the TPJ, p53 signature, TILT, and STIC through advanced stage IV (HGSC) tissues. Elevated expression of pSTAT3 Tyr705 and decreased levels of PIAS3 appeared as early as TPJ and the trend continued until very advanced stage HGSC (compared with high PIAS3 and low pSTAT3 expression in normal benign FT). Exogenous expression of STAT3 in FT cells mediated translocation of pSTAT3 and c-Myc into the nucleus. In vivo experiments demonstrated that overexpression of STAT3 in FT secretory epithelial cells promoted tumor progression and metastasis, mimicking the clinical disease observed in patients with HGSC. Thus, we conclude that the STAT3 pathway plays a role in the development and progression of HGSC from its earliest premalignant states.Significance: Concomitant gain of pSTAT3 Tyr705 and loss of PIAS3 appear critical for initiation and development of high-grade serous carcinoma. Cancer Res; 78(7); 1739-50. ©2018 AACR.
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Affiliation(s)
- Uksha Saini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adrian A Suarez
- Department of Pathology, Gynecological Pathology and Cytopathology Unit, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shan Naidu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John J Wallbillich
- Division of Gynecologic Oncology, Department of OB/GYN, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ross A Wanner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jason Bice
- Pathology Core Lab, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raleigh D Kladney
- Pathology Core Lab, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jenny Lester
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Beth Y Karlan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Karuppaiyah Selvendiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, Ohio.
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23
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Cosgrove CM, Tritchler DL, Cohn DE, Mutch DG, Rush CM, Lankes HA, Creasman WT, Miller DS, Ramirez NC, Geller MA, Powell MA, Backes FJ, Landrum LM, Timmers C, Suarez AA, Zaino RJ, Pearl ML, DiSilvestro PA, Lele SB, Goodfellow PJ. An NRG Oncology/GOG study of molecular classification for risk prediction in endometrioid endometrial cancer. Gynecol Oncol 2018; 148:174-180. [PMID: 29132872 PMCID: PMC5756518 DOI: 10.1016/j.ygyno.2017.10.037] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the prognostic significance of a simplified, clinically accessible classification system for endometrioid endometrial cancers combining Lynch syndrome screening and molecular risk stratification. METHODS Tumors from NRG/GOG GOG210 were evaluated for mismatch repair defects (MSI, MMR IHC, and MLH1 methylation), POLE mutations, and loss of heterozygosity. TP53 was evaluated in a subset of cases. Tumors were assigned to four molecular classes. Relationships between molecular classes and clinicopathologic variables were assessed using contingency tests and Cox proportional methods. RESULTS Molecular classification was successful for 982 tumors. Based on the NCI consensus MSI panel assessing MSI and loss of heterozygosity combined with POLE testing, 49% of tumors were classified copy number stable (CNS), 39% MMR deficient, 8% copy number altered (CNA) and 4% POLE mutant. Cancer-specific mortality occurred in 5% of patients with CNS tumors; 2.6% with POLE tumors; 7.6% with MMR deficient tumors and 19% with CNA tumors. The CNA group had worse progression-free (HR 2.31, 95%CI 1.53-3.49) and cancer-specific survival (HR 3.95; 95%CI 2.10-7.44). The POLE group had improved outcomes, but the differences were not statistically significant. CNA class remained significant for cancer-specific survival (HR 2.11; 95%CI 1.04-4.26) in multivariable analysis. The CNA molecular class was associated with TP53 mutation and expression status. CONCLUSIONS A simple molecular classification for endometrioid endometrial cancers that can be easily combined with Lynch syndrome screening provides important prognostic information. These findings support prospective clinical validation and further studies on the predictive value of a simplified molecular classification system.
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Affiliation(s)
| | - David L Tritchler
- NRG Oncology Statistics and Data Management Center, Buffalo, NY, United States
| | - David E Cohn
- The Ohio State University, Columbus, OH, United States
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, United States
| | - Craig M Rush
- The Ohio State University, Columbus, OH, United States
| | - Heather A Lankes
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - William T Creasman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - David S Miller
- Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nilsa C Ramirez
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States
| | | | - Lisa M Landrum
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | | | - Richard J Zaino
- Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA, United States
| | - Michael L Pearl
- Stony Brook University Hospital, Stony Brook, NY, United States
| | - Paul A DiSilvestro
- Women and Infants Hospital of Rhode Island, Providence, RI, United States
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Cosgrove CM, Cohn DE, Goodfellow PJ. Primum non nocere: Are we ready for POLE testing in endometrial cancer? Gynecol Oncol 2017; 147:240-242. [PMID: 28947175 PMCID: PMC5705034 DOI: 10.1016/j.ygyno.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Casey M Cosgrove
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - David E Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, Columbus, United States.
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25
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MacKay HJ, Levine DA, Bae-Jump VL, Bell DW, McAlpine JN, Santin A, Fleming GF, Mutch DG, Nephew KP, Wentzensen N, Goodfellow PJ, Dorigo O, Nijman HW, Broaddus R, Kohn EC. Moving forward with actionable therapeutic targets and opportunities in endometrial cancer: NCI clinical trials planning meeting report on identifying key genes and molecular pathways for targeted endometrial cancer trials. Oncotarget 2017; 8:84579-84594. [PMID: 29137450 PMCID: PMC5663622 DOI: 10.18632/oncotarget.19961] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022] Open
Abstract
The incidence and mortality rates from endometrial cancer are increasing. There have been no new drugs approved for the treatment of endometrial cancer in decades. The National Cancer Institute, Gynecologic Cancer Steering Committee identified the integration of molecular and/or histologic stratification into endometrial cancer management as a top strategic priority. Based on this, they convened a group of experts to review the molecular data in this disease. Here we report on the actionable opportunities and therapeutic directions identified for incorporation into future clinical trials.
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Affiliation(s)
- Helen J. MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Douglas A. Levine
- Division of Gynecologic Cancer, Department of OB/GYN, NYU Langone Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Victoria L. Bae-Jump
- Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, CA, United States
| | - Daphne W. Bell
- Reproductive Cancer Genetics Section, Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute/NIH, MSC 8000, Bethesda, ML, United States
| | - Jessica N. McAlpine
- University of British Columbia & BC Cancer Agency, Division of Gynecologic Oncology, Vancouver, British Columbia, Canada
| | - Alessandro Santin
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Gini F. Fleming
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - David G. Mutch
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kenneth P. Nephew
- Medical Sciences Program, Indiana University School of Medicine, Bloomington, IN, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, ML, United States
| | - Paul J. Goodfellow
- James Comprehensive Cancer Center and The Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States
| | - Oliver Dorigo
- Division Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford, CA, United States
| | - Hans W. Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Russell Broaddus
- Department of Pathology, Unit 85, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Elise C. Kohn
- Clinical Investigations Branch of The Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, ML, United States
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26
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Le Gallo M, Rudd ML, Urick ME, Hansen NF, Merino MJ, Mutch DG, Goodfellow PJ, Mullikin JC, Bell DW. The FOXA2 transcription factor is frequently somatically mutated in uterine carcinosarcomas and carcinomas. Cancer 2017; 124:65-73. [PMID: 28940304 DOI: 10.1002/cncr.30971] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Uterine carcinosarcomas (UCSs) are a rare but clinically aggressive form of cancer. They are biphasic tumors consisting of both epithelial and sarcomatous components. The majority of uterine carcinosarcomas are clonal, with the carcinomatous cells undergoing metaplasia to give rise to the sarcomatous component. The objective of the current study was to identify novel somatically mutated genes in UCSs. METHODS We whole exome sequenced paired tumor and nontumor DNAs from 14 UCSs and orthogonally validated 464 somatic variants using Sanger sequencing. Fifteen genes that were somatically mutated in at least 2 tumor exomes were Sanger sequenced in another 39 primary UCSs. RESULTS Overall, among 53 UCSs in the current study, the most frequently mutated of these 15 genes were tumor protein p53 (TP53) (75.5%), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (34.0%), protein phosphatase 2, regulatory subunit A, alpha (PPP2R1A) (18.9%), F-box and WD repeat domain containing 7 (FBXW7) (18.9%), chromodomain helicase DNA binding protein 4 (CHD4) (17.0%), and forkhead box A2 (FOXA2) (15.1%). FOXA2 has not previously been implicated in UCSs and was predominated by frameshift and nonsense mutations. One UCS with a FOXA2 frameshift mutation expressed truncated FOXA2 protein by immunoblotting. Sequencing of FOXA2 in 160 primary endometrial carcinomas revealed somatic mutations in 5.7% of serous, 22.7% of clear cell, 9% of endometrioid, and 11.1% of mixed endometrial carcinomas, the majority of which were frameshift mutations. CONCLUSIONS Collectively, the findings of the current study provide compelling genetic evidence that FOXA2 is a pathogenic driver gene in the etiology of primary uterine cancers, including UCSs. Cancer 2018;124:65-73. © 2017 American Cancer Society.
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Affiliation(s)
- Matthieu Le Gallo
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Meghan L Rudd
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary Ellen Urick
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nancy F Hansen
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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- National Institutes of Health Intramural Sequencing Center, National Institutes of Health, Rockville, Maryland
| | - Maria J Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - James C Mullikin
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne W Bell
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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27
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Walker CJ, O'Hern MJ, Serna VA, Kurita T, Miranda MA, Sapp CE, Mutch DG, Cohn DE, Goodfellow PJ. Novel SOX17 frameshift mutations in endometrial cancer are functionally distinct from recurrent missense mutations. Oncotarget 2017; 8:68758-68768. [PMID: 28978154 PMCID: PMC5620294 DOI: 10.18632/oncotarget.20213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/31/2017] [Indexed: 12/21/2022] Open
Abstract
Extensive genomic profiling for endometrioid endometrial carcinoma (EEC) has pointed to genes and pathways important in uterine development as critical mediators of endometrial tumorigenesis. SOX17 is a developmental transcription factor necessary for proper endoderm formation that has been implicated as a tumor suppressor and shown to modulate WNT signaling. SOX17 mutation analysis in 539 primary EECs revealed frequent missense and frameshift mutations with an overall 11.5% mutation rate. More than half the mutations identified were frameshifts (32 of 62), and the hotspot missense changes, p.Ala96Gly and p.Ser403Ile, were seen in 14 tumors. None of the cases with a mutation had a second SOX17 mutation or evidence of allelic loss. Immunofluorescence microscopy performed on primary samples showed that there were no changes in SOX17 protein expression associated with mutation. Low/absent SOX17 staining was significantly associated with advanced stage, high tumor grade and reduced recurrence-free survival. Functional assessment of the two hotspot missense mutations and three representative frameshift mutations showed that SOX17-A96G and SOX17-S403I have transcriptional activities similar to SOX17 wild-type (WT), whereas none of the frameshift mutant proteins showed transcriptional activity. Forced expression of SOX17-WT, -A96G or -S403I in EC cell lines moderately increased β-catenin mediated transcription, which contrasts with previous data showing SOX17 is an inhibitor of TCF/β-catenin signaling. The proliferation of EC cell lines was expectedly reduced by transfection with SOX17-WT, and further reduced by SOX17-A96G and SOX17-S403I. These data implicate SOX17 mutation as a selected event in EEC, with clear differences between the missense and frameshift mutations.
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Affiliation(s)
- Christopher J Walker
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - Matthew J O'Hern
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - Vanida A Serna
- James Comprehensive Cancer Center and the Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Takeshi Kurita
- James Comprehensive Cancer Center and the Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Mario A Miranda
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - Caroline E Sapp
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - David G Mutch
- Siteman Cancer Center and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David E Cohn
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - Paul J Goodfellow
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
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28
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Cosgrove CM, Cohn DE, Hampel H, Frankel WL, Jones D, McElroy JP, Suarez AA, Zhao W, Chen W, Salani R, Copeland LJ, O'Malley DM, Fowler JM, Yilmaz A, Chassen AS, Pearlman R, Goodfellow PJ, Backes FJ. Epigenetic silencing of MLH1 in endometrial cancers is associated with larger tumor volume, increased rate of lymph node positivity and reduced recurrence-free survival. Gynecol Oncol 2017; 146:588-595. [PMID: 28709704 DOI: 10.1016/j.ygyno.2017.07.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the relationship between mismatch repair (MMR) classification and clinicopathologic features including tumor volume, and explore outcomes by MMR class in a contemporary cohort. METHODS Single institution cohort evaluating MMR classification for endometrial cancers (EC). MMR immunohistochemistry (IHC)±microsatellite instability (MSI) testing and reflex MLH1 methylation testing was performed. Tumors with MMR abnormalities by IHC or MSI and MLH1 methylation were classified as epigenetic MMR deficiency while those without MLH1 methylation were classified as probable MMR mutations. Clinicopathologic characteristics were analyzed. RESULTS 466 endometrial cancers were classified; 75% as MMR proficient, 20% epigenetic MMR defects, and 5% as probable MMR mutations. Epigenetic MMR defects were associated with advanced stage, higher grade, presence of lymphovascular space invasion, and older age. MMR class was significantly associated with tumor volume, an association not previously reported. The epigenetic MMR defect tumors median volume was 10,220mm3 compared to 3321mm3 and 2,846mm3, for MMR proficient and probable MMR mutations respectively (P<0.0001). Higher tumor volume was associated with lymph node involvement. Endometrioid EC cases with epigenetic MMR defects had significantly reduced recurrence-free survival (RFS). Among advanced stage (III/IV) endometrioid EC the epigenetic MMR defect group was more likely to recur compared to the MMR proficient group (47.7% vs 3.4%) despite receiving similar adjuvant therapy. In contrast, there was no difference in the number of early stage recurrences for the different MMR classes. CONCLUSIONS MMR testing that includes MLH1 methylation analysis defines a subset of tumors that have worse prognostic features and reduced RFS.
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Affiliation(s)
- Casey M Cosgrove
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - David E Cohn
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Heather Hampel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Dan Jones
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Joseph P McElroy
- The Ohio State University, College of Medicine Department of Biomedical Informatics, Center for Biostatistics, Columbus, United States
| | - Adrian A Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Ritu Salani
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Larry J Copeland
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - David M O'Malley
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Jeffrey M Fowler
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Ahmet Yilmaz
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Alexis S Chassen
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States.
| | - Floor J Backes
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, United States
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29
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Le Gallo M, Rudd ML, Urick ME, Hansen NF, Zhang S, Lozy F, Sgroi DC, Vidal Bel A, Matias-Guiu X, Broaddus RR, Lu KH, Levine DA, Mutch DG, Goodfellow PJ, Salvesen HB, Mullikin JC, Bell DW. Somatic mutation profiles of clear cell endometrial tumors revealed by whole exome and targeted gene sequencing. Cancer 2017; 123:3261-3268. [PMID: 28485815 DOI: 10.1002/cncr.30745] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The molecular pathogenesis of clear cell endometrial cancer (CCEC), a tumor type with a relatively unfavorable prognosis, is not well defined. We searched exome-wide for novel somatically mutated genes in CCEC and assessed the mutational spectrum of known and candidate driver genes in a large cohort of cases. METHODS We conducted whole exome sequencing of paired tumor-normal DNAs from 16 cases of CCEC (12 CCECs and the CCEC components of 4 mixed histology tumors). Twenty-two genes-of-interest were Sanger-sequenced from another 47 cases of CCEC. Microsatellite instability (MSI) and microsatellite stability (MSS) were determined by genotyping 5 mononucleotide repeats. RESULTS Two tumor exomes had relatively high mutational loads and MSI. The other 14 tumor exomes were MSS and had 236 validated nonsynonymous or splice junction somatic mutations among 222 protein-encoding genes. Among the 63 cases of CCEC in this study, we identified frequent somatic mutations in TP53 (39.7%), PIK3CA (23.8%), PIK3R1 (15.9%), ARID1A (15.9%), PPP2R1A (15.9%), SPOP (14.3%), and TAF1 (9.5%), as well as MSI (11.3%). Five of 8 mutations in TAF1, a gene with no known role in CCEC, localized to the putative histone acetyltransferase domain and included 2 recurrently mutated residues. Based on patterns of MSI and mutations in 7 genes, CCEC subsets molecularly resembled serous endometrial cancer (SEC) or endometrioid endometrial cancer (EEC). CONCLUSION Our findings demonstrate molecular similarities between CCEC and SEC and EEC and implicate TAF1 as a novel candidate CCEC driver gene. Cancer 2017;123:3261-8. © 2017 American Cancer Society.
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Affiliation(s)
- Matthieu Le Gallo
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Meghan L Rudd
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary Ellen Urick
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nancy F Hansen
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Suiyuan Zhang
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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- National Institutes of Health Intramural Sequencing Center, National Institutes of Health, Bethesda, Maryland
| | - Fred Lozy
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Dennis C Sgroi
- Molecular Pathology Unit, Massachusetts General Hospital, Charlestown, Massachusetts.,Center for Cancer Research, Massachusetts General Hospital, Charlestown, Massachusetts.,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - August Vidal Bel
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain.,Department of Pathology and Molecular Genetics/Oncological Pathology Group, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRB Lleida, Lleida, Spain
| | - Russell R Broaddus
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen H Lu
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Douglas A Levine
- Gynecologic Oncology, Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Helga B Salvesen
- Department of Clinical Science, Center for Cancer Biomarkers, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - James C Mullikin
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland.,National Institutes of Health Intramural Sequencing Center, National Institutes of Health, Bethesda, Maryland
| | - Daphne W Bell
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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30
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Pearlman R, Frankel WL, Swanson B, Zhao W, Yilmaz A, Miller K, Bacher J, Bigley C, Nelsen L, Goodfellow PJ, Goldberg RM, Paskett E, Shields PG, Freudenheim JL, Stanich PP, Lattimer I, Arnold M, Liyanarachchi S, Kalady M, Heald B, Greenwood C, Paquette I, Prues M, Draper DJ, Lindeman C, Kuebler JP, Reynolds K, Brell JM, Shaper AA, Mahesh S, Buie N, Weeman K, Shine K, Haut M, Edwards J, Bastola S, Wickham K, Khanduja KS, Zacks R, Pritchard CC, Shirts BH, Jacobson A, Allen B, de la Chapelle A, Hampel H. Prevalence and Spectrum of Germline Cancer Susceptibility Gene Mutations Among Patients With Early-Onset Colorectal Cancer. JAMA Oncol 2017; 3:464-471. [PMID: 27978560 DOI: 10.1001/jamaoncol.2016.5194] [Citation(s) in RCA: 428] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Hereditary cancer syndromes infer high cancer risks and require intensive cancer surveillance, yet the prevalence and spectrum of these conditions among unselected patients with early-onset colorectal cancer (CRC) is largely undetermined. Objective To determine the frequency and spectrum of cancer susceptibility gene mutations among patients with early-onset CRC. Design, Setting, and Participants Overall, 450 patients diagnosed with colorectal cancer younger than 50 years were prospectively accrued from 51 hospitals into the Ohio Colorectal Cancer Prevention Initiative from January 1, 2013, to June 20, 2016. Mismatch repair (MMR) deficiency was determined by microsatellite instability and/or immunohistochemistry. Germline DNA was tested for mutations in 25 cancer susceptibility genes using next-generation sequencing. Main Outcomes and Measures Mutation prevalence and spectrum in patients with early-onset CRC was determined. Clinical characteristics were assessed by mutation status. Results In total 450 patients younger than 50 years were included in the study, and 75 gene mutations were found in 72 patients (16%). Forty-eight patients (10.7%) had MMR-deficient tumors, and 40 patients (83.3%) had at least 1 gene mutation: 37 had Lynch syndrome (13, MLH1 [including one with constitutional MLH1 methylation]; 16, MSH2; 1, MSH2/monoallelic MUTYH; 2, MSH6; 5, PMS2); 1 patient had the APC c.3920T>A, p.I1307K mutation and a PMS2 variant; 9 patients (18.8%) had double somatic MMR mutations (including 2 with germline biallelic MUTYH mutations); and 1 patient had somatic MLH1 methylation. Four hundred two patients (89.3%) had MMR-proficient tumors, and 32 patients (8%) had at least 1 gene mutation: 9 had mutations in high-penetrance CRC genes (5, APC; 1, APC/PMS2; 2, biallelic MUTYH; 1, SMAD4); 13 patients had mutations in high- or moderate-penetrance genes not traditionally associated with CRC (3, ATM; 1, ATM/CHEK2; 2, BRCA1; 4, BRCA2; 1, CDKN2A; 2, PALB2); 10 patients had mutations in low-penetrance CRC genes (3, APC c.3920T>A, p.I1307K; 7, monoallelic MUTYH). Importantly, 24 of 72 patients (33.3%) who were mutation positive did not meet established genetic testing criteria for the gene(s) in which they had a mutation. Conclusions and Relevance Of 450 patients with early-onset CRC, 72 (16%) had gene mutations. Given the high frequency and wide spectrum of mutations, genetic counseling and testing with a multigene panel could be considered for all patients with early-onset CRC.
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Affiliation(s)
- Rachel Pearlman
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Benjamin Swanson
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Ahmet Yilmaz
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Kristin Miller
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Jason Bacher
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Christopher Bigley
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Lori Nelsen
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Paul J Goodfellow
- The Ohio State University Comprehensive Cancer Center, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus
| | - Richard M Goldberg
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Electra Paskett
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Peter G Shields
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Peter P Stanich
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Ilene Lattimer
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Mark Arnold
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Sandya Liyanarachchi
- The Ohio State University Comprehensive Cancer Center, Department of Cancer Biology and Genetics, The Ohio State University Wexner Medical Center, Columbus
| | - Matthew Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brandie Heald
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carla Greenwood
- Department of Digestive Diseases and Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ian Paquette
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marla Prues
- Cancer Center Research, The Christ Hospital Health Network, Cincinnati, Ohio
| | - David J Draper
- TriHealth Cancer Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Carolyn Lindeman
- TriHealth Cancer Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | | | - Kelly Reynolds
- Department of Cancer Services, Riverside Methodist Hospital, Columbus, Ohio
| | - Joanna M Brell
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Amy A Shaper
- Research Institute, MetroHealth Medical Center, Cleveland, Ohio
| | - Sameer Mahesh
- Department of Internal Medicine, Summa Cancer Institute, Summa Akron City Hospital, Akron, Ohio
| | - Nicole Buie
- Summa Center for Clinical Trials, Summa Akron City Hospital, Akron, Ohio
| | - Kisa Weeman
- Department of Hematology/Oncology, Aultman Hospital, Canton, Ohio
| | - Kristin Shine
- Department of Oncology Clinical Trials, Aultman Hospital, Canton, Ohio
| | | | | | - Shyamal Bastola
- Department of Oncology and Hematology, Genesis HealthCare System, Zanesville, Ohio
| | - Karen Wickham
- Department of Oncology and Hematology, Genesis HealthCare System, Zanesville, Ohio
| | - Karamjit S Khanduja
- Division of Colon and Rectal Surgery, Mount Carmel East Hospital, Columbus, Ohio
| | - Rosemary Zacks
- Department of Clinical Trials, Mount Carmel East Hospital, Columbus, Ohio
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Angela Jacobson
- Department of Laboratory Medicine, University of Washington, Seattle
| | | | - Albert de la Chapelle
- The Ohio State University Comprehensive Cancer Center, Department of Cancer Biology and Genetics, The Ohio State University Wexner Medical Center, Columbus
| | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
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Sunkel B, Wu D, Chen Z, Wang CM, Liu X, Ye Z, Horning AM, Liu J, Mahalingam D, Lopez-Nicora H, Lin CL, Goodfellow PJ, Clinton SK, Jin VX, Chen CL, Huang THM, Wang Q. Integrative analysis identifies targetable CREB1/FoxA1 transcriptional co-regulation as a predictor of prostate cancer recurrence. Nucleic Acids Res 2017; 45:6993. [PMID: 28419278 PMCID: PMC5499716 DOI: 10.1093/nar/gkx282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Sunkel
- Ohio State Biochemistry Program, The Ohio State University, Columbus, OH 43210, USA.,Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Dayong Wu
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Zhong Chen
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Chiou-Miin Wang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Xiangtao Liu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Zhenqing Ye
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Aaron M Horning
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Joseph Liu
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Devalingam Mahalingam
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Horacio Lopez-Nicora
- Department of Plant Pathology, The Ohio State University, Columbus, OH 43210, USA
| | - Chun-Lin Lin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Paul J Goodfellow
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Steven K Clinton
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA.,Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Victor X Jin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Chun-Liang Chen
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Tim H-M Huang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Qianben Wang
- Ohio State Biochemistry Program, The Ohio State University, Columbus, OH 43210, USA.,Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
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Jeske YW, Ali S, Byron SA, Gao F, Mannel RS, Ghebre RG, DiSilvestro PA, Lele SB, Pearl ML, Schmidt AP, Lankes HA, Ramirez NC, Rasty G, Powell M, Goodfellow PJ, Pollock PM. FGFR2 mutations are associated with poor outcomes in endometrioid endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 145:366-373. [PMID: 28314589 DOI: 10.1016/j.ygyno.2017.02.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Activating FGFR2 mutations have been identified in ~10% of endometrioid endometrial cancers (ECs). We have previously reported that mutations in FGFR2 are associated with shorter disease free survival (DFS) in stage I/II EC patients. Here we sought to validate the prognostic importance of FGFR2 mutations in a large, multi-institutional patient cohort. METHODS Tumors were collected as part of the GOG 210 clinical trial "Molecular Staging of Endometrial Cancer" where samples underwent rigorous pathological review and had more than three years of detailed clinical follow-up. DNA was extracted and four exons encompassing the FGFR2 mutation hotspots were amplified and sequenced. RESULTS Mutations were identified in 144 of the 973 endometrioid ECs, of which 125 were classified as known activating mutations and were included in the statistical analyses. Consistent with FGFR2 having an association with more aggressive disease, FGFR2 mutations were more common in patients initially diagnosed with stage III/IV EC (29/170;17%) versus stage I/II EC (96/803; 12%; p=0.07, Chi-square test). Additionally, incidence of progression (progressed, recurred or died from disease) was significantly more prevalent (32/125, 26%) among patients with FGFR2 mutation versus wild type (120/848, 14%; p<0.001, Chi-square test). Using Cox regression analysis adjusting for known prognostic factors, patients with FGFR2 mutation had significantly (p<0.025) shorter progression-free survival (PFS; HR 1.903; 95% CI 1.177-3.076) and endometrial cancer specific survival (ECS; HR 2.013; 95% CI 1.096-3.696). CONCLUSION In summary, our findings suggest that clinical trials testing the efficacy of FGFR inhibitors in the adjuvant setting to prevent recurrence and death are warranted.
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Affiliation(s)
- Yvette W Jeske
- Queensland University of Technology (QUT) at the Translational Research Institute, Brisbane, Australia
| | - Shamshad Ali
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sara A Byron
- Cancer and Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Feng Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Robert S Mannel
- Gynecologic Oncology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rahel G Ghebre
- University of Minnesota Medical Center - Fairview, Minneapolis, MN, USA
| | | | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Michael L Pearl
- Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Amy P Schmidt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Heather A Lankes
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Nilsa C Ramirez
- GOG Tissue Bank/NRG Oncology Biospecimen Bank - Columbus, Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Golnar Rasty
- Department of Laboratory Medicine, University of Toronto, ON, M5G2C, CANADA
| | - Matthew Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Pamela M Pollock
- Queensland University of Technology (QUT) at the Translational Research Institute, Brisbane, Australia; Cancer and Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA.
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Trimarchi MP, Yan P, Groden J, Bundschuh R, Goodfellow PJ. Identification of endometrial cancer methylation features using combined methylation analysis methods. PLoS One 2017; 12:e0173242. [PMID: 28278225 PMCID: PMC5344376 DOI: 10.1371/journal.pone.0173242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/18/2017] [Indexed: 01/13/2023] Open
Abstract
Background DNA methylation is a stable epigenetic mark that is frequently altered in tumors. DNA methylation features are attractive biomarkers for disease states given the stability of DNA methylation in living cells and in biologic specimens typically available for analysis. Widespread accumulation of methylation in regulatory elements in some cancers (specifically the CpG island methylator phenotype, CIMP) can play an important role in tumorigenesis. High resolution assessment of CIMP for the entire genome, however, remains cost prohibitive and requires quantities of DNA not available for many tissue samples of interest. Genome-wide scans of methylation have been undertaken for large numbers of tumors, and higher resolution analyses for a limited number of cancer specimens. Methods for analyzing such large datasets and integrating findings from different studies continue to evolve. An approach for comparison of findings from a genome-wide assessment of the methylated component of tumor DNA and more widely applied methylation scans was developed. Methods Methylomes for 76 primary endometrial cancer and 12 normal endometrial samples were generated using methylated fragment capture and second generation sequencing, MethylCap-seq. Publically available Infinium HumanMethylation 450 data from The Cancer Genome Atlas (TCGA) were compared to MethylCap-seq data. Results Analysis of methylation in promoter CpG islands (CGIs) identified a subset of tumors with a methylator phenotype. We used a two-stage approach to develop a 13-region methylation signature associated with a “hypermethylator state.” High level methylation for the 13-region methylation signatures was associated with mismatch repair deficiency, high mutation rate, and low somatic copy number alteration in the TCGA test set. In addition, the signature devised showed good agreement with previously described methylation clusters devised by TCGA. Conclusion We identified a methylation signature for a “hypermethylator phenotype” in endometrial cancer and developed methods that may prove useful for identifying extreme methylation phenotypes in other cancers.
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Affiliation(s)
- Michael P. Trimarchi
- Department of Cancer Biology & Genetics, The Ohio State University, Columbus, Ohio, United States of America
| | - Pearlly Yan
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Joanna Groden
- Department of Cancer Biology & Genetics, The Ohio State University, Columbus, Ohio, United States of America
| | - Ralf Bundschuh
- Center for RNA Biology, Department of Physics, Department of Chemistry & Biochemistry, and Department of Internal Medicine, and Center for RNA Biology, The Ohio State University, Columbus, OH, United States of America
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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34
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Walker CJ, Goodfellow PJ. Traditional Approaches to Molecular Genetic Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 943:99-118. [DOI: 10.1007/978-3-319-43139-0_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Cohen SA, Turner EH, Beightol MB, Jacobson A, Gooley TA, Salipante SJ, Haraldsdottir S, Smith C, Scroggins S, Tait JF, Grady WM, Lin EH, Cohn DE, Goodfellow PJ, Arnold MW, de la Chapelle A, Pearlman R, Hampel H, Pritchard CC. Frequent PIK3CA Mutations in Colorectal and Endometrial Tumors With 2 or More Somatic Mutations in Mismatch Repair Genes. Gastroenterology 2016; 151:440-447.e1. [PMID: 27302833 PMCID: PMC5016834 DOI: 10.1053/j.gastro.2016.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Some colorectal and endometrial tumors with microsatellite instability not attributable to MLH1 hypermethylation or germline mutations contain 2 or more somatic mutations in genes encoding mismatch repair (MMR) proteins. We sought to define the molecular phenotype of this newly recognized tumor subtype. METHODS From 2 prospective studies of the efficacy of screening for Lynch syndrome, we identified patients with colorectal and endometrial tumors who had 2 or more somatic (but not germline) mutations in genes encoding MMR proteins (double somatic). We determined the frequencies of tumor mutations in PIK3CA, BRAF, KRAS, NRAS, and PTEN by targeted next-generation sequencing and used logistic-regression models to compare them with those from patients with Lynch syndrome, MLH1-hypermethylated, or microsatellite-stable tumors. We validated our findings using independent data sets from The Cancer Genome Atlas. RESULTS Among colorectal cancer cases, we found that 14 of 21 (67%) patients with double somatic tumors also had PIK3CA mutations, compared with 4 of 18 (22%) tumors from patients with Lynch syndrome, 2 of 10 (20%) tumors with MLH1 hypermethylation, and 12 of 78 (15%) tumors with microsatellite stability (P < .0001 for patients with double somatic tumors vs other subgroups). Mutations in PIK3CA were detected in all 13 patients with double somatic endometrial cancers (P = .04 compared with other subgroups). We did not detect BRAF mutations in patients with double somatic colorectal tumors or Lynch syndrome. We found highly similar results in a validation cohort from The Cancer Genome Atlas (113 patients with colorectal tumors, 178 endometrial tumors); 100% of double somatic cases had a somatic mutation in PIK3CA (P < .0001 compared with other subgroups). CONCLUSIONS Most patients with colorectal or endometrial tumors with 2 or more somatic (but not germline) mutations in MMR proteins also have mutations in PIK3CA; mutations in PIK3CA are detected at substantially higher frequencies in these double somatic tumors than in other microsatellite-instability subgroups. PIK3CA mutation status might be used to identify a specific group of colorectal tumors, and to select treatment or determine prognosis.
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Affiliation(s)
- Stacey A. Cohen
- University of Washington, Department of Medicine, Division of Medical Oncology, Seattle, WA,Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Emily H. Turner
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | | | - Angela Jacobson
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Ted A. Gooley
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | | | | | - Christina Smith
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Sheena Scroggins
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Jonathan F. Tait
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - William M. Grady
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA,University of Washington, Department of Medicine, Division of Gastroenterology, Seattle, WA
| | - Edward H. Lin
- University of Washington, Department of Medicine, Division of Medical Oncology, Seattle, WA,Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - David E. Cohn
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH
| | - Paul J. Goodfellow
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH
| | - Mark W. Arnold
- The Ohio State University College of Medicine, Department of Surgery, Columbus, OH
| | - Albert de la Chapelle
- The Ohio State University Comprehensive Cancer Center, Department of Molecular Virology, Immunology, and Medical Genetics, Columbus, OH
| | - Rachel Pearlman
- The Ohio State University Comprehensive Cancer Center, Division of Human Genetics, Columbus, OH
| | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center, Division of Human Genetics, Columbus, OH
| | - Colin C. Pritchard
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
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36
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Smith B, Neff R, Cohn DE, Backes FJ, Suarez AA, Mutch DG, Rush CM, Walker CJ, Goodfellow PJ. The mutational spectrum of FOXA2 in endometrioid endometrial cancer points to a tumor suppressor role. Gynecol Oncol 2016; 143:398-405. [PMID: 27538367 DOI: 10.1016/j.ygyno.2016.08.237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Forkhead box protein A2 (FOXA2) plays an important in development, cellular metabolism and tumorigenesis. The Cancer Genome Atlas (TCGA) identified a modest frequency of FOXA2 mutations in endometrioid endometrial cancers (EEC). The current study sought to determine the relationship between FOXA2 mutation and clinicopathologic features in EEC and FOXA2 expression. METHODS Polymerase chain reaction (PCR) amplification and sequencing were used to identify mutations in 542 EEC. Western blot, quantitative reverse transcriptase PCR (qRT-PCR) and immunohistochemistry (IHC) were used to assess expression. Methylation analysis was performed using combined bisulfite restriction analysis (COBRA) and sequencing. Chi-squared, Fisher's exact, Student's t- and log-rank tests were performed. RESULTS Fifty-one mutations were identified in 49 tumors (9.4% mutation rate). The majority of mutations were novel, loss of function (LOF) (78.4%) mutations, and most disrupted the DNA-binding domain (58.8%). Six recurrent mutations were identified. Only two tumors had two mutations and there was no evidence for FOXA2 allelic loss. Mutation status was associated with tumor grade and not associated with survival outcomes. Methylation of the FOXA2 promoter region was highly variable. Most tumors expressed FOXA2 at both the mRNA and protein level. In those tumors with mutations, the majority of cases expressed both alleles. CONCLUSION FOXA2 is frequently mutated in EEC. The pattern of FOXA2 mutations and expression in tumors suggests complex regulation and a haploinsufficient or dominant-negative tumor suppressor function. In vitro studies may shed light on how mutations in FOXA2 affect FOXA2 pioneer and/or transcription factor functions in EEC.
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Affiliation(s)
- B Smith
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - R Neff
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - D E Cohn
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - F J Backes
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - A A Suarez
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH, United States
| | - D G Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - C M Rush
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - C J Walker
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States
| | - P J Goodfellow
- Division of Gynecologic Oncology, James Comprehensive Cancer Center at The Ohio State University, Columbus, OH, United States.
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Walker CJ, Miranda MA, O'Hern MJ, Blachly JS, Moyer CL, Ivanovich J, Kroll KW, Eisfeld AK, Sapp CE, Mutch DG, Cohn DE, Bundschuh R, Goodfellow PJ. MonoSeq Variant Caller Reveals Novel Mononucleotide Run Indel Mutations in Tumors with Defective DNA Mismatch Repair. Hum Mutat 2016; 37:1004-12. [PMID: 27346418 DOI: 10.1002/humu.23036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/07/2016] [Indexed: 01/23/2023]
Abstract
Next-generation sequencing has revolutionized cancer genetics, but accurately detecting mutations in repetitive DNA sequences, especially mononucleotide runs, remains a challenge. This is a particular concern for tumors with defective mismatch repair (MMR) that accumulate strand-slippage mutations. We developed MonoSeq to improve indel mutation detection in mononucleotide runs, and used MonoSeq to investigate strand-slippage mutations in endometrial cancers, a tumor type that has frequent loss of MMR. We performed extensive Sanger sequencing to validate both clonal and subclonal MonoSeq mutation calls. Eighty-one regions containing mononucleotide runs were sequenced in 540 primary endometrial cancers (223 with defective MMR). Our analyses revealed that the overall mutation rate in MMR-deficient tumors was 20-30-fold higher than in MMR-normal tumors. MonoSeq analysis identified several previously unreported mutations, including a novel hotspot in an A7 run in the terminal exon of ARID5B.The ARID5B indel mutations were seen in both MMR-deficient and MMR-normal tumors, suggesting biologic selection. The analysis of tumor mRNAs revealed the presence of mutant transcripts that could result in translation of neopeptides. Improved detection of mononucleotide run strand-slippage mutations has clear implications for comprehensive mutation detection in tumors with defective MMR. Indel frameshift mutations and the resultant antigenic peptides could help guide immunotherapy strategies.
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Affiliation(s)
- Christopher J Walker
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Mario A Miranda
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Matthew J O'Hern
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - James S Blachly
- James Comprehensive Cancer Center and the Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Cassandra L Moyer
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Jennifer Ivanovich
- Siteman Cancer Center and the Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Karl W Kroll
- James Comprehensive Cancer Center, Ohio State University, Columbus, OH
| | | | - Caroline E Sapp
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - David G Mutch
- Siteman Cancer Center and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - David E Cohn
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Ralf Bundschuh
- Department of Physics, Department of Chemistry and Biochemistry, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Paul J Goodfellow
- James Comprehensive Cancer Center and the Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
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Walker CJ, Rush C, Dama P, Stein M, Shakya R, O’Hern M, Mutch DG, Cohn DE, Goodfellow PJ. Abstract 2002: MAX mutations in endometrial cancer are associated with poor patient outcome, altered E-box binding, and increased tumor vascularity. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In contrast to aberrant MYC-signaling, MYC associated factor X (MAX) mutation is not common in many cancers but occurs in a limited number of specific tissue types, where it may be important. We sequenced MAX in 540 endometrioid endometrial cancer (EEC) DNAs. Mutations were seen 5.37% of samples with two hotspots, H28R (n = 12) and R60Q/W (n = 4 R60Q and n = 1 R60W), which accounted for ∼60% of the mutations seen. MAX mutation was associated with reduced recurrence-free survival (RFS) (P = 0.03; HR [95% CI] = 3.798 [1.10-13.0]) and with advanced stage (P = 0.024) and high tumor grade (P = 0.048). The association with reduced RFS remained significant in multivariable analysis (P = 0.05 HR = 2.40 [1.00-5.74]), strongly suggesting MAX mutation contributes to clinical aggressiveness in EEC.
Focusing on the H28R hotspot mutation, we performed whole transcriptome expression profiling using AN3CA endometrial cancer cell lines stably expressing exogenous long and short isoforms of flag-tagged MAX-WT and MAX-H28R. Unsupervised hierarchical clustering and principle component analysis proved that the expression profiles for the MAX-H28R long cells were strikingly different than the MAX-H28R short, MAX-WT and unmodified cells.
The MAX:DNA interface contains a predicted hydrogen bond between his28 and a guanine residue in the E-box motif. We hypothesized that the his-arg mutation seen in EECs would alter DNA binding, and assessed altered binding via chromatin immunoprecipitation/qPCR (ChIP). MAX-H28R had higher affinity for the NPM1 and CDK4 promoter regions, both of which include E-boxes that are well-established MYC/MAX targets. EMSAs for the same regions confirmed ChIP results, and showed that the supershifted MAX-WT and MAX-H28R complexes had different motilities, consistent with altered confirmation. We showed that an anti-MYC antibody was not able to supershift the EMSA fragment, indicating MYC is not part of the MAX:DNA complex. Co-IP, however, showed MAX-H28R retains MYC binding ability. Based on these findings, we conclude the differences seen in EMSA were with MAX homodimers. RNA-seq revealed differential gene expression in MAX-H28R mutated tumors, and ChIP showed enhanced MAX-H28R affinity for E-boxes in several of the differentially expressed genes.
In vivo, MAX-H28R AN3CA xenografts were markedly hemorrhagic compared to MAX-WT. MECA-32 (pan-endothelial marker) staining proved that the MAX-mutant tumors had significantly more vessels per field (2.4-fold increase, P = 0.002). Work is ongoing to test for paracrine factors elaborated by the H28R-mutant AN3CA cells that might contribute to the vascular phenotype.
Taken together these data implicate MAX mutation as a novel driver of endometrial tumorigenesis, contributing to tumor aggressiveness through enhanced tumor vascularity and potentially other mechanisms.
Citation Format: Christopher J. Walker, Craig Rush, Paola Dama, Maggie Stein, Reena Shakya, Matthew O’Hern, David G. Mutch, David E. Cohn, Paul J. Goodfellow. MAX mutations in endometrial cancer are associated with poor patient outcome, altered E-box binding, and increased tumor vascularity. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2002.
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Affiliation(s)
| | - Craig Rush
- 1The Ohio State University, Columbus, OH
| | - Paola Dama
- 1The Ohio State University, Columbus, OH
| | | | | | | | - David G. Mutch
- 2Washington University School of Medicine, St. Louis, MO
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McMeekin DS, Tritchler DL, Cohn DE, Mutch DG, Lankes HA, Geller MA, Powell MA, Backes FJ, Landrum LM, Zaino R, Broaddus RD, Ramirez N, Gao F, Ali S, Darcy KM, Pearl ML, DiSilvestro PA, Lele SB, Goodfellow PJ. Clinicopathologic Significance of Mismatch Repair Defects in Endometrial Cancer: An NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2016; 34:3062-8. [PMID: 27325856 DOI: 10.1200/jco.2016.67.8722] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The clinicopathologic significance of mismatch repair (MMR) defects in endometrioid endometrial cancer (EEC) has not been definitively established. We undertook tumor typing to classify MMR defects to determine if MMR status is prognostic or predictive. METHODS Primary EECs from NRG/GOG0210 patients were assessed for microsatellite instability (MSI), MLH1 methylation, and MMR protein expression. Each tumor was assigned to one of four MMR classes: normal, epigenetic defect, probable mutation (MMR defect not attributable to MLH1 methylation), or MSI-low. The relationships between MMR classes and clinicopathologic variables were assessed using contingency table tests and Cox proportional hazard models. RESULTS A total of 1,024 tumors were assigned to MMR classes. Epigenetic and probable mutations in MMR were significantly associated with higher grade and more frequent lymphovascular space invasion. Epigenetic defects were more common in patients with higher International Federation of Gynecology and Obstetrics stage. Overall, there were no differences in outcomes. Progression-free survival was, however, worse for women whose tumors had epigenetic MMR defects compared with the MMR normal group (hazard ratio, 1.37; P < .05; 95% CI, 1.00 to 1.86). An exploratory analysis of interaction between MMR status and adjuvant therapy showed a trend toward improved progression-free survival for probable MMR mutation cases. CONCLUSION MMR defects in EECs are associated with a number of well-established poor prognostic indicators. Women with tumors that had MMR defects were likely to have higher-grade cancers and more frequent lymphovascular space invasion. Surprisingly, outcomes in these patients were similar to patients with MMR normal tumors, suggesting that MMR defects may counteract the effects of negative prognostic factors. Altered immune surveillance of MMR-deficient tumors, and other host/tumor interactions, is likely to determine outcomes for patients with MMR-deficient tumors.
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Affiliation(s)
- D Scott McMeekin
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David L Tritchler
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David E Cohn
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David G Mutch
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Heather A Lankes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Melissa A Geller
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Matthew A Powell
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Floor J Backes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Lisa M Landrum
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Richard Zaino
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Russell D Broaddus
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nilsa Ramirez
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Feng Gao
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shamshad Ali
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Kathleen M Darcy
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Michael L Pearl
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul A DiSilvestro
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shashikant B Lele
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul J Goodfellow
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI.
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Kanchi KL, Johnson KJ, Lu C, McLellan MD, Leiserson MDM, Wendl MC, Zhang Q, Koboldt DC, Xie M, Kandoth C, McMichael JF, Wyczalkowski MA, Larson DE, Schmidt HK, Miller CA, Fulton RS, Spellman PT, Mardis ER, Druley TE, Graubert TA, Goodfellow PJ, Raphael BJ, Wilson RK, Ding L. Integrated analysis of germline and somatic variants in ovarian cancer. Nat Commun 2016; 5:3156. [PMID: 24448499 PMCID: PMC4025965 DOI: 10.1038/ncomms4156] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/19/2013] [Indexed: 01/05/2023] Open
Abstract
We report the first large-scale exome-wide analysis of the combined germline-somatic landscape in ovarian cancer. Here we analyse germline and somatic alterations in 429 ovarian carcinoma cases and 557 controls. We identify 3,635 high confidence, rare truncation and 22,953 missense variants with predicted functional impact. We find germline truncation variants and large deletions across Fanconi pathway genes in 20% of cases. Enrichment of rare truncations is shown in BRCA1, BRCA2 and PALB2. In addition, we observe germline truncation variants in genes not previously associated with ovarian cancer susceptibility (NF1, MAP3K4, CDKN2B and MLL3). Evidence for loss of heterozygosity was found in 100 and 76% of cases with germline BRCA1 and BRCA2 truncations, respectively. Germline-somatic interaction analysis combined with extensive bioinformatics annotation identifies 222 candidate functional germline truncation and missense variants, including two pathogenic BRCA1 and 1 TP53 deleterious variants. Finally, integrated analyses of germline and somatic variants identify significantly altered pathways, including the Fanconi, MAPK and MLL pathways.
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Affiliation(s)
- Krishna L Kanchi
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2]
| | - Kimberly J Johnson
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Brown School, Washington University, St. Louis, Missouri 63130, USA [3] Oregon Health and Science University, Portland, Oregon 97239, USA [4]
| | - Charles Lu
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2]
| | - Michael D McLellan
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | - Mark D M Leiserson
- Department of Computer Science, Brown University, Providence, Rhode Island 02912, USA
| | - Michael C Wendl
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA [3] Department of Mathematics, Washington University, St. Louis, Missouri 63108, USA
| | - Qunyuan Zhang
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA
| | - Daniel C Koboldt
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | - Mingchao Xie
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | - Cyriac Kandoth
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | - Joshua F McMichael
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | | | - David E Larson
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA
| | - Heather K Schmidt
- The Genome Institute, Washington University, St. Louis, Missouri 63108, USA
| | | | - Robert S Fulton
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA
| | - Paul T Spellman
- Oregon Health and Science University, Portland, Oregon 97239, USA
| | - Elaine R Mardis
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA [3] Siteman Cancer Center, Washington University, St. Louis, Missouri 63108, USA
| | - Todd E Druley
- 1] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA [2] Department of Pediatrics, Washington University, St. Louis, Missouri 63108, USA
| | - Timothy A Graubert
- 1] Siteman Cancer Center, Washington University, St. Louis, Missouri 63108, USA [2] Department of Medicine, Washington University, St. Louis, Missouri 63108, USA
| | - Paul J Goodfellow
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA
| | - Benjamin J Raphael
- Department of Computer Science, Brown University, Providence, Rhode Island 02912, USA
| | - Richard K Wilson
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA [3] Siteman Cancer Center, Washington University, St. Louis, Missouri 63108, USA
| | - Li Ding
- 1] The Genome Institute, Washington University, St. Louis, Missouri 63108, USA [2] Department of Genetics, Washington University, St. Louis, Missouri 63108, USA [3] Siteman Cancer Center, Washington University, St. Louis, Missouri 63108, USA [4] Department of Medicine, Washington University, St. Louis, Missouri 63108, USA
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Sunkel B, Wu D, Chen Z, Wang CM, Liu X, Ye Z, Horning AM, Liu J, Mahalingam D, Lopez-Nicora H, Lin CL, Goodfellow PJ, Clinton SK, Jin VX, Chen CL, Huang THM, Wang Q. Integrative analysis identifies targetable CREB1/FoxA1 transcriptional co-regulation as a predictor of prostate cancer recurrence. Nucleic Acids Res 2016; 44:4105-22. [PMID: 26743006 PMCID: PMC4872073 DOI: 10.1093/nar/gkv1528] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/22/2015] [Indexed: 01/22/2023] Open
Abstract
Identifying prostate cancer-driving transcription factors (TFs) in addition to the androgen receptor promises to improve our ability to effectively diagnose and treat this disease. We employed an integrative genomics analysis of master TFs CREB1 and FoxA1 in androgen-dependent prostate cancer (ADPC) and castration-resistant prostate cancer (CRPC) cell lines, primary prostate cancer tissues and circulating tumor cells (CTCs) to investigate their role in defining prostate cancer gene expression profiles. Combining genome-wide binding site and gene expression profiles we define CREB1 as a critical driver of pro-survival, cell cycle and metabolic transcription programs. We show that CREB1 and FoxA1 co-localize and mutually influence each other's binding to define disease-driving transcription profiles associated with advanced prostate cancer. Gene expression analysis in human prostate cancer samples found that CREB1/FoxA1 target gene panels predict prostate cancer recurrence. Finally, we showed that this signaling pathway is sensitive to compounds that inhibit the transcription co-regulatory factor MED1. These findings not only reveal a novel, global transcriptional co-regulatory function of CREB1 and FoxA1, but also suggest CREB1/FoxA1 signaling is a targetable driver of prostate cancer progression and serves as a biomarker of poor clinical outcomes.
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Affiliation(s)
- Benjamin Sunkel
- Ohio State Biochemistry Program, The Ohio State University, Columbus, OH 43210, USA Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Dayong Wu
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Zhong Chen
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Chiou-Miin Wang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Xiangtao Liu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Zhenqing Ye
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Aaron M Horning
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Joseph Liu
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Devalingam Mahalingam
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Horacio Lopez-Nicora
- Department of Plant Pathology, The Ohio State University, Columbus, OH 43210, USA
| | - Chun-Lin Lin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Paul J Goodfellow
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Steven K Clinton
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Victor X Jin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Chun-Liang Chen
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Tim H-M Huang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Qianben Wang
- Ohio State Biochemistry Program, The Ohio State University, Columbus, OH 43210, USA Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH 43210, USA The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
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Rocconi RP, Lankes HA, Brady WE, Goodfellow PJ, Ramirez NC, Alvarez RD, Creasman W, Fernández JR. The role of racial genetic admixture with endometrial cancer outcomes: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2015; 140:264-9. [PMID: 26603970 DOI: 10.1016/j.ygyno.2015.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Racial genetic admixture (RGA), a measure to account for ancestral genetic background that correlates with individual's racial classification, could provide insights on causation of racial disparity in endometrial cancer (EC). Our objective is to evaluate the association of RGA with EC outcomes. METHODS EC patients enrolled onto the GOG-210 protocol were eligible. A randomized subcohort stratified by stage and self-reported race/ethnicity of black or white was used. Genotyping was performed using custom-selected Ancestry Informative Markers to calculate individual admixture estimates of African and European ancestral background. RESULTS A total of 149 patients were evaluated (self-reported race: 70 black & 79 white). Mean RGA for African ancestry for self-reported black patients was 0.65 (range 0.04-0.86); while mean RGA for European ancestry for self-reported white patients was 0.77 (range 0.12-0.88). Progression-free survival (PFS) analysis using proportional hazards models stratified by stage and race revealed that each 0.10 increase in African ancestry was associated with worse PFS with hazard ratio (HR) of 1.11 (95% CI 0.90-1.37). Each 0.10 increase in European RGA was associated with improved PFS with HR of 0.86 (95% CI 0.69-1.07). Using tertiles of African RGA showed increasing risk of progression of death with increasing African RGA (with 0-5% as reference), HR (95% CIs) for top two tertiles are: 6%-66%: 1.38 (0.64, 2.97), and 67%-86%: 2.27 (0.74, 6.95). CONCLUSION RGA demonstrated a trend with PFS in self-reported black and white patients with EC. Patients with increased levels of African ancestry showed a trend towards worse survival after stratifying by stage/race.
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Affiliation(s)
- Rodney P Rocconi
- Mitchell Cancer Institute, University Of South Alabama, Mobile, AL, USA.
| | | | | | | | - Nilsa C Ramirez
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Goodfellow PJ, Billingsley CC, Lankes HA, Ali S, Cohn DE, Broaddus RJ, Ramirez N, Pritchard CC, Hampel H, Chassen AS, Simmons LV, Schmidt AP, Gao F, Brinton LA, Backes F, Landrum LM, Geller MA, DiSilvestro PA, Pearl ML, Lele SB, Powell MA, Zaino RJ, Mutch D. Combined Microsatellite Instability, MLH1 Methylation Analysis, and Immunohistochemistry for Lynch Syndrome Screening in Endometrial Cancers From GOG210: An NRG Oncology and Gynecologic Oncology Group Study. J Clin Oncol 2015; 33:4301-8. [PMID: 26552419 PMCID: PMC4678181 DOI: 10.1200/jco.2015.63.9518] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The best screening practice for Lynch syndrome (LS) in endometrial cancer (EC) remains unknown. We sought to determine whether tumor microsatellite instability (MSI) typing along with immunohistochemistry (IHC) and MLH1 methylation analysis can help identify women with LS. PATIENTS AND METHODS ECs from GOG210 patients were assessed for MSI, MLH1 methylation, and mismatch repair (MMR) protein expression. Each tumor was classified as having normal MMR, defective MMR associated with MLH1 methylation, or probable MMR mutation (ie, defective MMR but no methylation). Cancer family history and demographic and clinical features were compared for the three groups. Lynch mutation testing was performed for a subset of women. RESULTS Analysis of 1,002 ECs suggested possible MMR mutation in 11.8% of tumors. The number of patients with a family history suggestive of LS was highest among women whose tumors were classified as probable MMR mutation (P = .001). Lynch mutations were identified in 41% of patient cases classified as probable mutation (21 of 51 tested). One of the MSH6 Lynch mutations was identified in a patient whose tumor had intact MSH6 expression. Age at diagnosis was younger for mutation carriers than noncarriers (54.3 v 62.3 years; P < .01), with five carriers diagnosed at age > 60 years. CONCLUSION Combined MSI, methylation, and IHC analysis may prove useful in Lynch screening in EC. Twenty-four percent of mutation carriers presented with ECs at age > 60 years, and one carrier had an MSI-positive tumor with no IHC defect. Restricting Lynch testing to women diagnosed at age < 60 years or to women with IHC defects could result in missing a substantial fraction of genetic disease.
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Affiliation(s)
- Paul J Goodfellow
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Caroline C Billingsley
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather A Lankes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shamshad Ali
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David E Cohn
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Russell J Broaddus
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Nilsa Ramirez
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Colin C Pritchard
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather Hampel
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Alexis S Chassen
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Luke V Simmons
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Amy P Schmidt
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Feng Gao
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Louise A Brinton
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Floor Backes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lisa M Landrum
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Melissa A Geller
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Paul A DiSilvestro
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Michael L Pearl
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shashikant B Lele
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Matthew A Powell
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Richard J Zaino
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David Mutch
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Walker CJ, Miranda MA, O'Hern MJ, McElroy JP, Coombes KR, Bundschuh R, Cohn DE, Mutch DG, Goodfellow PJ. Patterns of CTCF and ZFHX3 Mutation and Associated Outcomes in Endometrial Cancer. J Natl Cancer Inst 2015; 107:djv249. [PMID: 26330387 DOI: 10.1093/jnci/djv249] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The genetic events responsible for tumor aggressiveness in endometrioid endometrial cancer (EEC) remain poorly understood. The chromosome 16q22 tumor suppressor genes CTCF and ZFHX3 are both frequently mutated in EEC, but their respective roles in outcome have not been determined. METHODS Targeted deep sequencing of CTCF and ZFHX3 was performed for 542 EEC samples. Copy number loss (CNL) was determined using microsatellite typing of paired tumor and normal DNA and a novel Bayesian method based on variant allele frequencies of germline polymorphisms. All statistical tests were two-sided. RESULTS Mutation rates for CTCF and ZFHX3 were 25.3% and 20.4%, respectively, and there was a statistically significant excess of tumors with mutation in both genes (P = .003). CNL rates were 17.4% for CTCF and 17.2% for ZFHX3, and the majority of CNLs included both CTCF and ZFHX3. Mutations were more frequent in tumors with microsatellite instability, and CNLs were more common in microsatellite-stable tumors (P < .001). Patients with ZFHX3 mutation and/or CNL had higher-grade tumors (P = .001), were older (P < .001), and tended to have more frequent lymphovascular space invasion (P = .07). These patients had reduced recurrence-free and overall survival (RFS: hazard ratio [HR] = 2.35, 95% confidence interval [CI] = 1.38 to 3.99, P = .007; OS: HR = 1.51, 95% CI = 1.11 to 2.07, P = .04). CONCLUSIONS Our data demonstrate there is strong selection for inactivation of both CTCF and ZFHX3 in EEC. Mutation occurs at high frequency in microsatellite-unstable tumors, whereas CNLs are common in microsatellite-stable cancers. Loss of these two tumor suppressors is a frequent event in endometrial tumorigenesis, and ZFHX3 defects are associated with poor outcome.
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Affiliation(s)
- Christopher J Walker
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Mario A Miranda
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Matthew J O'Hern
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Joseph P McElroy
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Kevin R Coombes
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Ralf Bundschuh
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - David E Cohn
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - David G Mutch
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM)
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology (CJW, MAM, MJO, DEC, PJG), Department of Biomedical Informatics, Center for Biostatistics, College of Medicine (JPM, KRC), The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (CJW, MAM, MJO, JPM, KRC, DEC, PJG), Department of Physics, Department of Chemistry & Biochemistry, Department of Internal Medicine, Division of Hematology, Center for RNA Biology (RB), The Ohio State University, Columbus, OH; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Washington University, St. Louis, MO (DGM).
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Walker CJ, Miranda MA, O'Hern M, Coombes K, Bundschuh R, Mutch DG, Goodfellow PJ. Abstract 5300: Loss of function of two closely linked tumor suppressors contributes to biologic aggressiveness in endometrial cancers: Co-mutation of CTCF and ZFHX3. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-5300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Therapies for recurrent or advanced endometrioid endometrial cancer (EEC) are ineffective, and no targeted therapies, or genetic markers to identify high-risk patients exist. There is an urgent need to identify factors contributing to aggressiveness.
We performed whole exome sequencing of 8 early stage endometrial cancers that subsequently recurred. Two chromosome 16q tumor suppressor genes, CTCF and ZFHX3, were identified as candidates associated with recurrence. The endometrial Cancer Genome Atlas proved that both of these genes are frequently mutated in EEC.
To further explore the relationship between CTCF and ZFHX3 mutations and ECC tumorigenesis/aggressiveness, targeted deep sequencing of both genes was performed on 541 EEC tumors. We relied on microsatellite typing and a novel Bayesian method to assess copy number alterations (CNAs). The Bayesian method's use of deep sequencing data to predict CNAs showed 97% concordance with microsatellite typing.
The overall mutation rate (SNVs and small indels) was 24% and 18% for CTCF and ZFHX3, respectively. The majority of mutations were loss of function (stop, frameshift or splice site), with CTCF at 89% and ZFHX3 at 59% loss of function defects. There was a significant excess of mutational co-occurrence in both genes (P = 0.003). Deletion/CNA was also common: 79 of 497 informative tumors had CNAs involving both genes (16%). Taken together, the high rate of co-mutation and co-deletion suggests selective advantage for inactivation of both tumor suppressors.
Patients with tumors having mutation or CNA of both CTCF and ZFHX3 had significantly shorter recurrence-free survival (RFS) compared to wt (P = 0.007, HR = 2.4, 95%CI = 1.3-4.4). Mutation/loss of both genes was significantly associated with features portending aggressive disease: high grade (P<0.001), lymphovascular space invasion (LVSI, P = 0.02), and advanced age (>60 years, P = 0.02). There was no association with stage.
Although our ability to determine the contributions of CTCF and ZFHX3 individually was limited by sample size and their frequent co-occurrence, we assessed them separately as independent prognostic markers. It is noteworthy that mutation/CNA of ZFHX3 significantly correlated with shorter RFS (P = 0.003, HR = 2.4, 95%CI = 1.4-4.0), whereas no such association was seen with CTCF. In a multivariable analysis including grade, stage, LVSI and therapy, ZFHX3 mutation/CNA remained an independent prognostic marker (P = 0.04). We are currently validating these results in a larger independent cohort.
Here we describe emerging markers that could be useful for identifying high-risk patients. Our data point to what may be a complex interplay between the ZFHX3 and CTCF tumor suppressors in EEC tumorigenesis.
Citation Format: Christopher J. Walker, Mario A. Miranda, Matthew O'Hern, Kevin Coombes, Ralf Bundschuh, David G. Mutch, Paul J. Goodfellow. Loss of function of two closely linked tumor suppressors contributes to biologic aggressiveness in endometrial cancers: Co-mutation of CTCF and ZFHX3. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5300. doi:10.1158/1538-7445.AM2015-5300
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Naidu S, Saini U, ElNaggar AC, Bid HK, Wanner R, Bixel K, Suarez AA, Bolyard C, Kaur B, Goodfellow PJ, Kuppusamy P, Cohn D, Selvendiran K. Abstract 1720: HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The lack of an efficient pre-clinical model predicting a drug's clinical response before it enters into clinical trials is a major reason behind the limited success or complete failure of most of the traditional anti-cancer compounds. In this study, we evaluate our novel, safe and selective STAT3 inhibitor HO-3867 for its anti-cancer efficacy/bio-availability using a pre-clinical relevant, orthotopic ovarian tumor model and ex-vivo human tumor tissue culture. Treatment with HO-3867 (100PPM) significantly suppressed ovarian tumor growth and metastasis when compared to the standard Cisplatin (4mg/kg). A substantial amount of HO-3867 was detected in the ovarian tumor tissues and quantified using EPR spectroscopy. Markers specific to cell proliferation (Ki-67, Cyclin D1), angiogenesis (VEGF and Kinase array) and apoptosis (caspase-3 activity) were significantly altered by treatment with HO-3867. In vivo histopathological evaluation of internal organs collected from treated tumor mice revealed no evidence of toxicity specific to HO-3867. Normal and malignant tissues were collected and TUNEL/8-OHdG staining revealed selective induction of apoptosis limited to neoplastic cells and concomitant increase in reactive oxygen species within the orthotopic tumor. Suppression of STAT3 and its downstream target proteins (cell proliferative, anti-apoptotic and angiogenic) was confirmed with proteomic array. HO-3867 treated samples had significantly reduced vessel formation (∼4 times) as compared to the untreated control as is evident by in vivo Matrigel assay. HO-3867 was also found to have cytotoxic effects in ex vivo culture of freshly collected human tumor samples, including patients with chemotherapy resistant form of the disease. Overall, these results highlight the clinical anti-cancer potential of HO-3867 using a relevant preclinical orthotopic ovarian tumor model, and provide a rationale for the inclusion of ex vivo patient tumor slice culture in oncologic drug development processes.
Citation Format: Shan Naidu, Uksha Saini, Adam C. ElNaggar, Hemant K. Bid, Ross Wanner, Kristin Bixel, Adrian A. Suarez, Chelsea Bolyard, Balveen Kaur, Paul J. Goodfellow, Periannan Kuppusamy, David Cohn, Karuppaiyah Selvendiran. HO-3867, a selective inhibitor of stat3, suppress ovarian tumor growth and metastasis in human tissue culture and in an orthotopic mouse model. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1720. doi:10.1158/1538-7445.AM2015-1720
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Shiovitz S, Turner E, Beightol M, Jacobson A, Gooley T, Salipante SJ, Haraldsdottir S, Tait JF, Grady WM, Lin EH, De La Chapelle A, Cohn DE, Goodfellow PJ, Arnold M, Hampel H, Pritchard CC. PIK3CA mutations in colorectal and endometrial cancer with double somatic mismatch repair mutations compared to Lynch syndrome. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Heather Hampel
- Division of Human Genetics, The Ohio State University, Columbus, OH
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48
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Kaphingst KA, Ivanovich J, Biesecker BB, Dresser R, Seo J, Dressler LG, Goodfellow PJ, Goodman MS. Preferences for return of incidental findings from genome sequencing among women diagnosed with breast cancer at a young age. Clin Genet 2015; 89:378-84. [PMID: 25871653 DOI: 10.1111/cge.12597] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 12/19/2022]
Abstract
While experts have made recommendations, information is needed regarding what genome sequencing results patients would want returned. We investigated what results women diagnosed with breast cancer at a young age would want returned and why. We conducted 60 semi-structured, in-person individual interviews with women diagnosed with breast cancer at age 40 or younger. We examined interest in six types of incidental findings and reasons for interest or disinterest in each type. Two coders independently coded interview transcripts; analysis was conducted using NVivo 10. Most participants were at least somewhat interested in all six result types, but strongest interest was in actionable results (i.e. variants affecting risk of a preventable or treatable disease and treatment response). Reasons for interest varied between different result types. Some participants were not interested or ambivalent about results not seen as currently actionable. Participants wanted to be able to choose what results are returned. Participants distinguished between types of individual genome sequencing results, with different reasons for wanting different types of information. The findings suggest that a focus on actionable results can be a common ground for all stakeholders in developing a policy for returning individual genome sequencing results.
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Affiliation(s)
- K A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - J Ivanovich
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - R Dresser
- School of Law, Washington University, St. Louis, MO, USA
| | - J Seo
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - P J Goodfellow
- College of Medicine, Ohio State University, Columbus, OH, USA
| | - M S Goodman
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Lin Y, Lin S, Baxter MD, Lin L, Kennedy SM, Zhang Z, Goodfellow PJ, Chapman WC, Davidson NO. Novel APC promoter and exon 1B deletion and allelic silencing in three mutation-negative classic familial adenomatous polyposis families. Genome Med 2015; 7:42. [PMID: 25941542 PMCID: PMC4418073 DOI: 10.1186/s13073-015-0148-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/27/2015] [Indexed: 12/11/2022] Open
Abstract
Background The overwhelming majority (approximately 80%) of individuals with classic familial adenomatous polyposis (FAP) exhibit mutations in the coding sequence of the adenomatous polyposis coli (APC) tumor suppressor gene. Families without detectable APC mutations are unable to benefit from the use of genetic testing for clinical management of this autosomal dominant syndrome. Methods We used exome sequencing and linkage analysis, coupled with second-generation sequencing of the APC locus including non-coding regions to investigate three APC mutation-negative classical FAP families. Results We identified a novel ~11 kb deletion localized 44 kb upstream of the transcription start site of APC that encompasses the APC 1B promoter and exon. This deletion was present only in affected family members of one kindred with classical FAP. Furthermore, this same deletion with identical breakpoints was found in the probands of two additional APC mutation-negative classical FAP kindreds. Phasing analysis of single nucleotide polymorphisms (SNPs) around the deletion site in the three probands showed evidence of a shared haplotype, suggesting a common founder deletion in the three kindreds. SNP analysis within the coding sequence of APC, revealed that this ~11 kb deletion was accompanied by silencing of one of the APC alleles in blood-derived RNA of affected individuals. Conclusions These results support the causal role of a novel promoter deletion in FAP and suggest that non-coding deletions, identifiable using second-generation sequencing methods, may account for a significant fraction of APC mutation-negative classical FAP families.
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Affiliation(s)
- Yiing Lin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri USA
| | - Shin Lin
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, California USA
| | | | - Lawrence Lin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri USA
| | - Susan M Kennedy
- Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8124, St. Louis, Missouri MO 63110 USA
| | - Zhengyan Zhang
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri USA
| | | | - William C Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri USA
| | - Nicholas O Davidson
- Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8124, St. Louis, Missouri MO 63110 USA
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Zhang B, Xing X, Li J, Lowdon RF, Zhou Y, Lin N, Zhang B, Sundaram V, Chiappinelli KB, Hagemann IS, Mutch DG, Goodfellow PJ, Wang T. Comparative DNA methylome analysis of endometrial carcinoma reveals complex and distinct deregulation of cancer promoters and enhancers. BMC Genomics 2014; 15:868. [PMID: 25286960 PMCID: PMC4198682 DOI: 10.1186/1471-2164-15-868] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/24/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Aberrant DNA methylation is a hallmark of many cancers. Classically there are two types of endometrial cancer, endometrioid adenocarcinoma (EAC), or Type I, and uterine papillary serous carcinoma (UPSC), or Type II. However, the whole genome DNA methylation changes in these two classical types of endometrial cancer is still unknown. RESULTS Here we described complete genome-wide DNA methylome maps of EAC, UPSC, and normal endometrium by applying a combined strategy of methylated DNA immunoprecipitation sequencing (MeDIP-seq) and methylation-sensitive restriction enzyme digestion sequencing (MRE-seq). We discovered distinct genome-wide DNA methylation patterns in EAC and UPSC: 27,009 and 15,676 recurrent differentially methylated regions (DMRs) were identified respectively, compared with normal endometrium. Over 80% of DMRs were in intergenic and intronic regions. The majority of these DMRs were not interrogated on the commonly used Infinium 450K array platform. Large-scale demethylation of chromosome X was detected in UPSC, accompanied by decreased XIST expression. Importantly, we discovered that the majority of the DMRs harbored promoter or enhancer functions and are specifically associated with genes related to uterine development and disease. Among these, abnormal methylation of transposable elements (TEs) may provide a novel mechanism to deregulate normal endometrium-specific enhancers derived from specific TEs. CONCLUSIONS DNA methylation changes are an important signature of endometrial cancer and regulate gene expression by affecting not only proximal promoters but also distal enhancers.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Aldehyde Dehydrogenase 1 Family
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/metabolism
- Chromosomes, Human, X
- CpG Islands
- DNA (Cytosine-5-)-Methyltransferases/genetics
- DNA (Cytosine-5-)-Methyltransferases/metabolism
- DNA Methylation
- DNA Transposable Elements/genetics
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/physiopathology
- Enhancer Elements, Genetic/genetics
- Female
- Humans
- Kruppel-Like Factor 4
- Kruppel-Like Transcription Factors/genetics
- MutL Protein Homolog 1
- Nuclear Proteins/genetics
- Polymorphism, Single Nucleotide
- Promoter Regions, Genetic/genetics
- RNA, Long Noncoding/genetics
- Retinal Dehydrogenase/genetics
- Sequence Analysis, DNA
- Uterine Neoplasms/genetics
- Uterine Neoplasms/physiopathology
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Affiliation(s)
- Bo Zhang
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
| | - XiaoYun Xing
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
| | - Jing Li
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
- />Shanghai International Joint Cancer Institute, The Second Military Medical University, Shanghai, 200433 P. R. China
| | - Rebecca F Lowdon
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
| | - Yan Zhou
- />Key Laboratory for Applied Statistics of MOE, School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin Province 130024 P. R. China
| | - Nan Lin
- />Department of Mathematics and Division of Biostatistics, Washington University in Saint Louis, Saint Louis, MO 63130 USA
| | - Baoxue Zhang
- />Key Laboratory for Applied Statistics of MOE, School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin Province 130024 P. R. China
| | - Vasavi Sundaram
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
| | - Katherine B Chiappinelli
- />Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21231 USA
| | - Ian S Hagemann
- />Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - David G Mutch
- />Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63124 USA
| | - Paul J Goodfellow
- />The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210 USA
| | - Ting Wang
- />Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63108 USA
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