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Thornblade LW, Wong P, Li D, Warner SG, Chang S, Raoof M, Kessler J, Amini A, Lin J, Chung V, Singh G, Fong Y, Melstrom LG. Patterns of Whole Exome Sequencing in Resected Cholangiocarcinoma. Cancers (Basel) 2021; 13:cancers13164062. [PMID: 34439216 PMCID: PMC8394619 DOI: 10.3390/cancers13164062] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Cholangiocarcinomas are rare cancers that harbor a significant number of potentially targetable mutations. In this study, we assessed the frequency of genomic profiling for resected cholangiocarcinomas. We found that, over the past decade, a third of patients underwent tumor genomic profiling, among whom 89% harbored a targetable mutation. Mutations were associated with a median of one approved drug. A quarter of eligible sequenced patients were treated with therapy targeting tumor-specific mutations. Abstract Background: With minimally effective chemotherapy options, cholangiocarcinoma patients have 5 year survival rate of 10%. Tumor genetic profiling (TGP) can identify mutations susceptible to targeted therapies. We sought to describe the use of TGP and frequency of actionable results in resected cholangiocarcinoma. Methods: A retrospective review of patients undergoing curative intent resection at a comprehensive cancer center (2010–2020). Clinicopathologic and partial or whole exome sequencing data were reviewed. Results: 114 patients (mean age 65 ± 11 years, 45% female) underwent resection of cholangiocarcinoma (46% poorly differentiated, 54% intrahepatic, 36% node positive, 75% margin negative). Additionally, 32% of patients underwent TGP, yielding a mean of 3.1 actionable mutations per patient (range 0–14). Mutations aligned with a median of one drug per patient (range 0–11). Common mutations included TP53 (33%), KRAS (31%), IDH1/2 (14%), FGFR (14%), and BRAF (8%). Targeted therapies were administered in only 4% of patients (23% of eligible sequenced patients). After a median 22 months, 23% had recurrence and 29% were deceased. Discussion: TGP for cholangiocarcinoma has increased over the last decade with targeted therapies identified in most sequenced tumors, impacting treatment in a quarter of eligible patients. Precision medicine will play a central role in the future care of cholangiocarcinoma.
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Affiliation(s)
- Lucas W. Thornblade
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Paul Wong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (D.L.); (V.C.)
| | - Susanne G. Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Sue Chang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA;
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Jonathan Kessler
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (J.K.); (A.A.)
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (J.K.); (A.A.)
| | - James Lin
- Division of Gastroenterology, City of Hope National Medical Center, Duarte, CA 91010, USA;
| | - Vincent Chung
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA; (D.L.); (V.C.)
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
| | - Laleh G. Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (L.W.T.); (P.W.); (S.G.W.); (M.R.); (G.S.); (Y.F.)
- Correspondence: ; Tel.: +1-626-218-0282
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