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Nakasone ES, Bustillos HC, Gui X, Konnick EQ, Sham JG, Cohen SA. Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas: A Case Report of an Exceptional Responder. Pancreas 2024:00006676-990000000-00129. [PMID: 38460151 DOI: 10.1097/mpa.0000000000002322] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
ABSTRACT Poorly differentiated pancreatic neuroendocrine carcinomas (pNECs) are rare, highly aggressive neoplasms. Frequently metastatic at diagnosis, prognosis is poor with median overall survival estimated to be less than 1 year. Although multidisciplinary management, including systemic medications and locoregional therapies aimed at reducing and preventing symptoms caused by mass effect, is the mainstay of treatment for patients with metastatic well-differentiated pancreatic neuroendocrine tumors, rapid progression, organ dysfunction, and poor performance status often preclude initiation of even single-modality palliative chemotherapy for patients with metastatic pNEC, limiting the use of and recommendation for multidisciplinary management.We describe the case of a 51-year-old male patient diagnosed with pNEC metastatic to liver and lymph nodes presenting with impending cholestatic liver failure for whom we were able to successfully initiate and dose-escalate cytotoxic chemotherapy with excellent radiographic response. After multidisciplinary review of his case, the patient underwent pancreaticoduodenectomy and hepatic wedge biopsies, with pathology demonstrating a pathologic complete response to chemotherapy in both the pancreas and liver. Surveillance scans at 2 years from initial diagnosis and 1 year from surgery remain without evidence of locoregional or distant recurrence, highlighting the importance and utility of multidisciplinary management in select cases.
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Affiliation(s)
| | - Hannah C Bustillos
- Clinical Pharmacy, University of Washington/Fred Hutchinson Cancer Center
| | - Xianyong Gui
- Departments of Laboratory Medicine and Pathology, and
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Pfau B, Opsahl J, Crew R, Best S, Han PD, Heidl S, McDermot E, Stone J, Schwabe-Fry K, MacMillan MP, O'Hanlon J, Sohlberg S, Acker Z, Ehmen B, Englund JA, Konnick EQ, Chu HY, Weil AA, Lockwood CM, Starita LM. Tiny swabs: nasal swabs integrated into tube caps facilitate large-scale self-collected SARS-CoV-2 testing. J Clin Microbiol 2024; 62:e0128523. [PMID: 38131692 PMCID: PMC10865831 DOI: 10.1128/jcm.01285-23] [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: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic spurred the development of innovative solutions for specimen collection and molecular detection for large-scale community testing. Among these developments is the RHINOstic nasal swab, a plastic anterior nares swab built into the cap of a standard matrix tube that facilitates automated processing of up to 96 specimens at a time. In a study of unsupervised self-collection utilizing these swabs, we demonstrate comparable analytic performance and shipping stability compared to traditional anterior nares swabs, as well as significant improvements in laboratory processing efficiency. The use of these swabs may allow laboratories to accommodate large numbers of sample collections during periods of high testing demand. Automation-friendly nasal swabs are an important tool for high-throughput processing of samples that may be adopted in response to future respiratory viral pandemics.
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Affiliation(s)
- Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jordan Opsahl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Ruben Crew
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sabrina Best
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sarah Heidl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Evan McDermot
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jeremy Stone
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | | | | | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Sohlberg
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Zack Acker
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Brenna Ehmen
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Janet A. Englund
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Eric Q. Konnick
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Helen Y. Chu
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Ana A. Weil
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Christina M. Lockwood
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - The Seattle Flu Alliance InvestigatorsBedfordTrevorBoeckhMichaelChuHelen Y.EnglundJanet A.LockwoodChristina M.LutzBarry R.PrenticeRobinShendureJayStaritaLea M.WaghmereAlpanaWeilAna A.
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
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Zehir A, Nardi V, Konnick EQ, Lockwood CM, Long TA, Sidiropoulos N, Souers RJ, Vasalos P, Lindeman NI, Moncur JT. SPOT/Dx Pilot Reanalysis and College of American Pathologists Proficiency Testing for KRAS and NRAS Demonstrate Excellent Laboratory Performance. Arch Pathol Lab Med 2024; 148:139-148. [PMID: 37776255 DOI: 10.5858/arpa.2023-0322-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT.— The Sustainable Predictive Oncology Therapeutics and Diagnostics quality assurance pilot study (SPOT/Dx pilot) on molecular oncology next-generation sequencing (NGS) reportedly demonstrated performance limitations of NGS laboratory-developed tests, including discrepancies with a US Food and Drug Administration-approved companion diagnostic. The SPOT/Dx pilot methods differ from those used in proficiency testing (PT) programs. OBJECTIVE.— To reanalyze SPOT/Dx pilot data using PT program methods and compare to PT program data.Also see p. 136. DESIGN.— The College of American Pathologists (CAP) Molecular Oncology Committee reanalyzed SPOT/Dx pilot data applying PT program methods, adjusting for confounding conditions, and compared them to CAP NGS PT program performance (2019-2022). RESULTS.— Overall detection rates of KRAS and NRAS single-nucleotide variants (SNVs) and multinucleotide variants (MNVs) by SPOT/Dx pilot laboratories were 96.8% (716 of 740) and 81.1% (129 of 159), respectively. In CAP PT programs, the overall detection rates for the same SNVs and MNVs were 97.2% (2671 of 2748) and 91.8% (1853 of 2019), respectively. In 2022, the overall detection rate for 5 KRAS and NRAS MNVs in CAP PT programs was 97.3% (1161 of 1193). CONCLUSIONS.— CAP PT program data demonstrate that laboratories consistently have high detection rates for KRAS and NRAS variants. The SPOT/Dx pilot has multiple design and analytic differences with established PT programs. Reanalyzed pilot data that adjust for confounding conditions demonstrate that laboratories proficiently detect SNVs and less successfully detect rare to never-observed MNVs. The SPOT/Dx pilot results are not generalizable to all molecular oncology testing and should not be used to market products or change policy affecting all molecular oncology testing.
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Affiliation(s)
- Ahmet Zehir
- From the Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Zehir)
| | - Valentina Nardi
- the Department of Pathology, Massachusetts General Hospital, Mass General Brigham, Harvard Medical School, Boston (Nardi)
| | - Eric Q Konnick
- the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Konnick, Lockwood)
| | - Christina M Lockwood
- the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Konnick, Lockwood)
| | - Thomas A Long
- Biostatistics (Long, Souers) Departments, College of American Pathologists, Northfield, Illinois
| | - Nikoletta Sidiropoulos
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington (Sidiropoulos)
| | - Rhona J Souers
- Biostatistics (Long, Souers) Departments, College of American Pathologists, Northfield, Illinois
| | - Patricia Vasalos
- Proficiency Testing (Vasalos) Departments, College of American Pathologists, Northfield, Illinois
| | - Neal I Lindeman
- the Department of Pathology, Weill Cornell Medicine, New York, New York (Lindeman)
| | - Joel T Moncur
- the Office of the Director, The Joint Pathology Center, Silver Spring, Maryland (Moncur)
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Konnick EQ. Point: The Need for Additional FDA Regulations in Laboratory Medicine. J Appl Lab Med 2024; 9:151-154. [PMID: 38167766 DOI: 10.1093/jalm/jfad084] [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] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
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Rodriguez IV, Strickland S, Wells D, Manhardt E, Konnick EQ, Garcia R, Swisher E, Kilgore M, Norquist B. Adoption of Universal Testing in Endometrial Cancers for Microsatellite Instability Using Next-Generation Sequencing. JCO Precis Oncol 2023; 7:e2300033. [PMID: 37856764 PMCID: PMC10861015 DOI: 10.1200/po.23.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/24/2023] [Revised: 06/28/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess implementation of a next-generation sequencing (NGS) assay to detect microsatellite instability (MSI) as a screen for Lynch syndrome (LS) in endometrial cancer (EC), while determining and comparing characteristics of the four molecular subtypes. METHODS A retrospective review was performed of 408 total patients with newly diagnosed EC: 140 patients who underwent universal screening with NGS and 268 patients who underwent screening via mismatch repair immunohistochemistry (MMR IHC) as part of a historical screening paradigm. In the NGS cohort, incidental POLE and TP53 mutations along with MSI were identified and used to characterize EC into molecular subtypes: POLE-ultramutated, MSI high (MSI-H), TP53-mutated, and no specific molecular profile (NSMP). In historical cohorts, age- and/or family history-directed screening was performed with MMR IHC. Statistical analysis was performed using a t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS In the NGS cohort, 38 subjects (27%) had MSI-H EC, 100 (71%) had microsatellite stable EC, and two (1%) had an indeterminate result. LS was diagnosed in two subjects (1%), and all but five patients completed genetic screening (96%). Molecular subtypes were ascertained: eight had POLE-ultramutated EC, 28 had TP53-mutated EC (20%), and 66 (47%) had NSMP. MSI-H and TP53-mutated EC had worse prognostic features compared with NSMP EC. Comparison with historical cohorts demonstrated a significant increase in follow-up testing after an initial positive genetic screen in the MSI NGS cohort (56% v 89%; P = .001). CONCLUSION MSI by NGS allowed for simultaneous screening for LS and categorization of EC into molecular subtypes with prognostic and therapeutic implications.
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Affiliation(s)
- Isabel V. Rodriguez
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Sarah Strickland
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - David Wells
- Department of Pathology and Laboratory Medicine, University of Washington, Seattle, WA
| | - Enna Manhardt
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Eric Q. Konnick
- Department of Pathology and Laboratory Medicine, University of Washington, Seattle, WA
| | - Rochelle Garcia
- Department of Pathology and Laboratory Medicine, University of Washington, Seattle, WA
| | - Elizabeth Swisher
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Mark Kilgore
- Department of Pathology and Laboratory Medicine, University of Washington, Seattle, WA
| | - Barbara Norquist
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
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Krumm N, Khasnavis NS, Radke M, Banda K, Davies HR, Pennil C, McLean K, Paulson VA, Konnick EQ, Johnson WC, Huff G, Nik-Zainal S, Swisher EM, Lockwood CM, Salipante SJ. Diagnosis of Ovarian Carcinoma Homologous Recombination DNA Repair Deficiency From Targeted Gene Capture Oncology Assays. JCO Precis Oncol 2023; 7:e2200720. [PMID: 37196218 PMCID: PMC10309534 DOI: 10.1200/po.22.00720] [Citation(s) in RCA: 1] [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: 12/30/2022] [Revised: 02/08/2023] [Accepted: 03/17/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE Homologous recombination DNA repair deficiency (HRD) is a therapeutic biomarker for sensitivity to platinum and poly(ADP-ribose) polymerase inhibitor therapies in breast and ovarian cancers. Several molecular phenotypes and diagnostic strategies have been developed to assess HRD; however, their clinical implementation remains both technically challenging and methodologically unstandardized. METHODS We developed and validated an efficient and cost-effective strategy for HRD determination on the basis of calculation of a genome-wide loss of heterozygosity (LOH) score through targeted, hybridization capture and next-generation DNA sequencing augmented with 3,000 common, polymorphic single-nucleotide polymorphism (SNP) sites distributed genome-wide. This approach requires minimal sequence reads and can be readily integrated into targeted gene capture workflows already in use for molecular oncology. We interrogated 99 ovarian neoplasm-normal pairs using this method and compared results with patient mutational genotypes and orthologous predictors of HRD derived from whole-genome mutational signatures. RESULTS LOH scores of ≥11% had >86% sensitivity for identifying tumors with HRD-causing mutations in an independent validation set (90.6% sensitivity for all specimens). We found strong agreement of our analytic approach with genome-wide mutational signature assays for determining HRD, yielding an estimated 96.7% sensitivity and 50% specificity. We observed poor concordance with mutational signatures inferred using only mutations detected by the targeted gene capture panel, suggesting inadequacy of the latter approach. LOH score did not significantly correlate with treatment outcomes. CONCLUSION Targeted sequencing of genome-wide polymorphic SNP sites can be used to infer LOH events and subsequently diagnose HRD in ovarian tumors. The methods presented here are readily generalizable to other targeted gene oncology assays and could be adapted for HRD diagnosis in other tumor types.
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Affiliation(s)
- Niklas Krumm
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Nithisha S. Khasnavis
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Marc Radke
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Kalyan Banda
- Department of Medicine, Oncology Division, University of Washington School of Medicine, Seattle, WA
| | - Helen R. Davies
- Academic Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Early Cancer Institute, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Pennil
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Kathryn McLean
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Vera A. Paulson
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Winslow C. Johnson
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Grogan Huff
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Serena Nik-Zainal
- Academic Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth M. Swisher
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Christina M. Lockwood
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Stephen J. Salipante
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
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Nourmohammadi Abadchi S, Sena LA, Antonarakis ES, Pritchard CC, Eshleman JR, Konnick EQ, Salipante SJ, Shenderov E, Lotan TL. MLH1 Loss in Primary Prostate Cancer. JCO Precis Oncol 2023; 7:e2200611. [PMID: 37196219 PMCID: PMC10309570 DOI: 10.1200/po.22.00611] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/01/2022] [Revised: 01/25/2023] [Accepted: 03/17/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE Among mismatch repair-deficient (MMRd) prostate cancers, loss of MLH1 is relatively uncommon and few cases have been reported in detail. METHODS Here, we describe the molecular features of two cases of primary prostate cancer with MLH1 loss detected by immunohistochemistry, and in one case, confirmed via transcriptomic profiling. RESULTS Both cases were microsatellite stable on standard polymerase chain reaction (PCR)-based microsatellite instability (MSI) testing, but showed evidence of MSI on a newer PCR-based long mononucleotide repeat (LMR) assay and by next-generation sequencing. Germline testing was negative for Lynch syndrome-associated mutations in both cases. Targeted or whole-exome tumor sequencing using multiple commercial/academic platforms (Foundation, Tempus, JHU, and UW-OncoPlex) showed modestly elevated, though variable, tumor mutation burden estimates (2.3-10 mutations/Mb) consistent with MMRd, but without identifiable pathogenic single-nucleotide or indel mutations in MLH1. Copy-number analysis confirmed biallelic MLH1 loss in one case and monoallelic MLH1 loss in the second case, without evidence of MLH1 promoter hypermethylation in either. The second patient was treated with single-agent pembrolizumab and demonstrated a short-lived prostate-specific antigen response. CONCLUSION These cases highlight the challenges in identifying MLH1-deficient prostate cancers using standard MSI testing and commercial sequencing panels, and support the utility of immunohistochemical assays and LMR- or sequencing-based MSI testing for detection of MMRd prostate cancers.
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Affiliation(s)
| | - Laura A. Sena
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emmanuel S. Antonarakis
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - James R. Eshleman
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Stephen J. Salipante
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Eugene Shenderov
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tamara L. Lotan
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD
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Hagemann IS, Zehir A, Suarez CJ, Furtado LV, Halley J, Kane M, Mot N, Vasalos P, Moncur JT, Konnick EQ. In silico approaches to proficiency testing: Considerations for continued feasibility. J Mol Diagn 2023:S1525-1578(23)00079-X. [PMID: 37088136 DOI: 10.1016/j.jmoldx.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carlos J Suarez
- Department of Pathology, Stanford University, Stanford, California
| | - Larissa V Furtado
- Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jaimie Halley
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Megan Kane
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Nicole Mot
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Patricia Vasalos
- Proficiency Testing, College of American Pathologists, Northfield, Illinois
| | - Joel T Moncur
- Office of the Director, Joint Pathology Center, Silver Spring, MD
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.
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Freitag CE, Chen W, Pearlman R, Hampel H, Stanich PP, Cosgrove CM, Konnick EQ, Pritchard CC, Frankel WL. Mismatch Repair Protein Status of Non-Neoplastic Uterine and Intestinal Mucosa in Patients with Lynch Syndrome and Double Somatic Mismatch Repair Protein Mutations. Hum Pathol 2023; 137:1-9. [PMID: 37030500 DOI: 10.1016/j.humpath.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
Abstract
Mismatch repair protein-deficient non-neoplastic colonic crypts and endometrial glands (dMMR crypts and glands) have been reported as a unique marker of underlying Lynch syndrome (LS). However, no large studies have directly compared the frequency of detection in cases with double somatic (DS) MMR mutations. We retrospectively analyzed 42 colonic resection specimens (24 LS, 18 DS) and 20 endometrial specimens (9 LS, 11 DS) including 19 hysterectomies and 1 biopsy for dMMR crypts and glands. All specimens were from patients with known primary cancers including colonic adenocarcinomas and endometrial endometrioid carcinomas (including two mixed carcinomas). Four blocks of normal mucosa away from tumor were selected from most cases, as available. MMR immunohistochemistry (IHC) specific to the primary tumor mutations were analyzed. dMMR crypts were found in 65% of LS and 0% of DS MMR mutated colonic adenocarcinomas (p < 0.001). Most dMMR crypts were detected in the colon (12 of 15) compared to ileum (3). dMMR crypts showed single and grouped loss of MMR IHC expression. dMMR glands were found in 67% of LS and 9% (1 of 11) of DS endometrial cases (p = 0.017). Most dMMR glands were found in the uterine wall, with 1 LS and 1 DS case exhibiting dMMR glands in the lower uterine segment. The majority of cases exhibited multifocal and grouped dMMR glands. No morphologic atypia was identified in dMMR crypts or glands. Overall, we demonstrate that dMMR crypts and glands are highly associated with underlying LS, while rarer in those with DS MMR mutations.
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Affiliation(s)
- C Eric Freitag
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, 43210
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, 43210
| | - Rachel Pearlman
- Department of Internal Medicine, Clinical Cancer Genetics Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, 43210
| | - Heather Hampel
- Division of Genetics and Genetic Counseling, City of Hope, Duarte, California, 91010
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, 43210
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, 43210
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, 43210.
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10
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Hunter N, Peterson LM, Muzi M, Konnick EQ, Reichel J, Kinahan P, Specht JM, Yung R, Gwin WR, Linden H, Tran C. Abstract P2-03-25: Pilot study to evaluate circulating tumor DNA (ctDNA) to PET/CT imaging using 18F-Fluorodeoxyglucose (FDG) and 18F-Fluoroestradiol (FES) PET/CT imaging as biomarkers in patients with metastatic breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-03-25] [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: 03/06/2023]
Abstract
Abstract
Background: 18F-FES is an FDA-approved estrogen analogue PET imaging tracer (Cerianna) which measures tumor estrogen receptor (ER) expression at multiple tumor sites simultaneously and predicts response to endocrine therapy. 18F-FDG is a commonly used glucose PET imaging tracer which measures glycolytic metabolic activity in tumors. Elevated plasma ctDNA has been associated with an increased risk of relapse and can identify actionable genomic alterations. This pilot research study explored the relationship between somatic copy-number variants (CNVs) and cell-free DNA mass using low-pass-whole-genome (LPWG) ctDNA in the blood to FES and FDG PET/CT findings with both qualitative and quantitative image analysis in metastatic breast cancer patients.
Methods: Two(2) 10ml Streck tubes were collected from 20 patients with metastatic ER+ breast cancer +/-30 days of their FDG-PET/CT scan (n=19) or their FES-PET/CT scan (n=9). 8 patients had both scans. Somatic mutations were assessed using comprehensive genomic profiling of tissue samples from 19 patients using the clinically validated UW-Oncoplex assay. Qualitative analysis included detection of LPWG ctDNA, presence of PIK3A mutations in tissue, and intensity of uptake in PET/CT imaging. LPWG ctDNA of blood samples evaluated ctDNA mass and CNVs that comprised at least 8% of total ctDNA. Total lesion glycolysis (TLG) in FDG scans and total lesion estrogen receptors (TLER) in FES scans were calculated using a dedicated workflow in MiM software (MiM Software Inc. Cleveland OH). Quantitative analysis included the circulating fraction (ctDNA), PET/CT SUVmax of the index lesion, number of lesions, TLG and TLER. For TLG, the threshold for determining measurable lesions was calculated using liver SULmean + 1.5*SD. The threshold for TLER was calculated using SUVmean of the mediastinal blood pool. The ctDNA fraction and the number of lesions for both FDG and FES were each ranked into 3 categories. FDG and FES data (SUVmax of index lesion, # of lesions, and TLG or TLER) were correlated to the calculated ctDNA fraction values. TLG and TLER were also correlated to each other.
Results: ctDNA was classified as no ctDNA present (n=9), ctDNA present (n=8) and indeterminate (n=3). Average neoplastic ctDNA fraction was 0.114 (range 0.03-0.423). PIKC3A mutations were: 10 absent and 9 present. Ranked categories for ctDNA fraction, FDG TLG and FES TLER are shown in Table 1. Table 2 shows results of FDG and FES analysis and correlation with ctDNA. Ranked ctDNA findings correlated with both the FDG number of lesions (R2=0.69) and TLG (R2=0.83), but not the SUVmax of the index lesion (R2=0.29). Correlation decreased for ctDNA versus FES number of lesions (R2=0.51), TLER (R2=0.61), and SUVmax of index lesion (R2=0.16). TLG and TLER significantly correlated with the 8 patients that had both an FDG and FES PET/CT scan (R2=0.77).
Conclusions: In this pilot study, FDG TLG showed a significant correlation with ctDNA. There is an encouraging association with ctDNA fraction and number of FDG lesions and with ctDNA fraction and extent of FES avid disease (TLER) in the 9 patients that had FES.
Research Support: RG1005258
Table 1. Categorical rankings for qualitative analysis of ctDNA, TLG and TLER
Table 2. FDG and FES imaging results and correlation with ctDNA
Citation Format: Natasha Hunter, Lanell M. Peterson, Mark Muzi, Eric Q. Konnick, Jonathan Reichel, Paul Kinahan, Jennifer M. Specht, Rachel Yung, William R. Gwin, Hannah Linden, Christina Tran. Pilot study to evaluate circulating tumor DNA (ctDNA) to PET/CT imaging using 18F-Fluorodeoxyglucose (FDG) and 18F-Fluoroestradiol (FES) PET/CT imaging as biomarkers in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-03-25.
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Affiliation(s)
| | | | - Mark Muzi
- 3University of Washington Medical Center, Seattle, Washington
| | | | | | | | | | - Rachel Yung
- 8University of Washintgon, Seattle, Washington
| | | | - Hannah Linden
- 10University of Washington, Fred Hutchison Cancer Center, Seattle, WA, USA
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11
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Furtado LV, Souers RJ, Vasalos P, Halley JG, Aisner DL, Nagarajan R, Voelkerding KV, Merker JD, Konnick EQ. Four-Year Laboratory Performance of the First College of American Pathologists In Silico Next-Generation Sequencing Bioinformatics Proficiency Testing Surveys. Arch Pathol Lab Med 2023; 147:137-142. [PMID: 35671151 DOI: 10.5858/arpa.2021-0384-cp] [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] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— In 2016, the College of American Pathologists (CAP) launched the first next-generation sequencing (NGS) in silico bioinformatics proficiency testing survey to evaluate the performance of clinical laboratory bioinformatics pipelines for the detection of oncology-associated variants at varying allele fractions. This survey focused on 2 commonly used oncology panels, the Illumina TruSeq Amplicon Cancer Panel and the Thermo Fisher Ion AmpliSeq Cancer Hotspot v2 Panel. OBJECTIVE.— To review the analytical performance of laboratories participating in the CAP NGS bioinformatics (NGSB) surveys, comprising NGSB1 for Illumina users and NGSB2 for Thermo Fisher Ion Torrent users, between 2016 and 2019. DESIGN.— Responses from 78 laboratories were analyzed for accuracy and associated performance characteristics. RESULTS.— The analytical sensitivity was 90.0% (1901 of 2112) for laboratories using the Illumina platform and 94.8% (2153 of 2272) for Thermo Fisher Ion Torrent users. Variant type and variant allele fraction were significantly associated with performance. False-negative results were seen mostly for multi-nucleotide variants and variants engineered at variant allele fractions of less than 25%. Analytical specificity for all participating laboratories was 99.8% (9303 of 9320). There was no statistically significant association between deletion-insertion length and detection rate. CONCLUSIONS.— These results demonstrated high analytical sensitivity and specificity, supporting the feasibility and utility of using in silico mutagenized NGS data sets as a supplemental challenge to CAP surveys for oncology-associated variants based on physical samples. This program demonstrates the opportunity and challenges that can guide future surveys inclusive of customized in silico programs.
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Affiliation(s)
- Larissa V Furtado
- From the Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee (Furtado)
| | - Rhona J Souers
- From the Biostatistics Department (Souers), College of American Pathologists, Northfield, Illinois
| | - Patricia Vasalos
- From Proficiency Testing (Vasalos, Halley), College of American Pathologists, Northfield, Illinois
| | - Jaimie G Halley
- From Proficiency Testing (Vasalos, Halley), College of American Pathologists, Northfield, Illinois
| | - Dara L Aisner
- From the Department of Pathology, University of Colorado School of Medicine, Aurora (Aisner)
| | | | | | - Jason D Merker
- From Departments of Pathology and Laboratory Medicine & Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill (Merker)
| | - Eric Q Konnick
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Konnick)
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12
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Diehl AC, Hannan LM, Zhen DB, Coveler AL, King G, Cohen SA, Harris WP, Shankaran V, Wong KM, Green S, Ng N, Pillarisetty VG, Sham JG, Park JO, Reddi D, Konnick EQ, Pritchard CC, Baker K, Redman M, Chiorean EG. KRAS Mutation Variants and Co-occurring PI3K Pathway Alterations Impact Survival for Patients with Pancreatic Ductal Adenocarcinomas. Oncologist 2022; 27:1025-1033. [PMID: 36124727 DOI: 10.1093/oncolo/oyac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/27/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND KRAS variant alleles may have differential biological properties which impact prognosis and therapeutic options in pancreatic ductal adenocarcinomas (PDA). MATERIALS AND METHODS We retrospectively identified patients with advanced PDA who received first-line therapy and underwent blood and/or tumor genomic sequencing at the University of Washington between 2013 and 2020. We examined the incidence of KRAS mutation variants with and without co-occurring PI3K or other genomic alterations and evaluated the association of these mutations with clinicopathological characteristics and survival using a Cox proportional hazards model. RESULTS One hundred twenty-six patients had genomic sequencing data; KRAS mutations were identified in 111 PDA and included the following variants: G12D (43)/G12V (35)/G12R (23)/other (10). PI3K pathway mutations (26% vs. 8%) and homologous recombination DNA repair (HRR) defects (35% vs. 12.5%) were more common among KRAS G12R vs. non-G12R mutated cancers. Patients with KRAS G12R vs. non-G12R cancers had significantly longer overall survival (OS) (HR 0.55) and progression-free survival (PFS) (HR 0.58), adjusted for HRR pathway co-mutations among other covariates. Within the KRAS G12R group, co-occurring PI3K pathway mutations were associated with numerically shorter OS (HR 1.58), while no effect was observed on PFS. CONCLUSIONS Patients with PDA harboring KRAS G12R vs. non-G12R mutations have longer survival, but this advantage was offset by co-occurring PI3K alterations. The KRAS/PI3K genomic profile could inform therapeutic vulnerabilities in patients with PDA.
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Affiliation(s)
- Adam C Diehl
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lindsay M Hannan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David B Zhen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Andrew L Coveler
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Gentry King
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Stacey A Cohen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - William P Harris
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Veena Shankaran
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kit M Wong
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Natasha Ng
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Jonathan G Sham
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Deepti Reddi
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | | | - Mary Redman
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - E Gabriela Chiorean
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
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13
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Jones PM, Dietzen DJ, Hoofnagle AN, Lockwood CM, Wiley CL, Konnick EQ. It’s VALID, but Is It Rational? J Appl Lab Med 2022; 7:1245-1250. [DOI: 10.1093/jalm/jfac075] [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] [Received: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Patricia M Jones
- Department of Pathology, University of Texas Southwestern Medical Center and Children’s Medical Center , Dallas, TX , USA
| | - Dennis J Dietzen
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children’s Hospital , St. Louis, MO , USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington , Seattle, WA , USA
- Department of Pathology, University of Washington , Seattle, WA , USA
- Department of Medicine, University of Washington , Seattle, WA , USA
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington , Seattle, WA , USA
- Department of Pathology, University of Washington , Seattle, WA , USA
- Brotman Baty Institute for Precision Medicine , Seattle, WA , USA
| | | | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington , Seattle, WA , USA
- Department of Pathology, University of Washington , Seattle, WA , USA
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14
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Paulson V, Konnick EQ, Lockwood CH. When Tissue Is the Issue. Clin Lab Med 2022; 42:485-496. [DOI: 10.1016/j.cll.2022.05.005] [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: 11/28/2022]
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15
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Bosch DE, Yeh MM, Salipante SJ, Jacobson A, Cohen SA, Konnick EQ, Paulson VA. Isolated MLH1 Loss by Immunohistochemistry Because of Benign Germline MLH1 Polymorphisms. JCO Precis Oncol 2022; 6:e2200227. [PMID: 36044719 PMCID: PMC9489174 DOI: 10.1200/po.22.00227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mismatch repair (MMR) immunohistochemistry (IHC) is frequently used to inform prognosis, select (immuno-)therapy, and identify patients for heritable cancer syndrome testing. However, false-negative and false-positive MMR IHC interpretations have been described.
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Affiliation(s)
- Dustin E Bosch
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA.,Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Angela Jacobson
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Stacey A Cohen
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Vera A Paulson
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
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16
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Patel RA, Coleman I, Roudier MP, Konnick EQ, Hanratty B, Dumpit R, Lucas JM, Ang LS, Low JY, Tretiakova MS, Ha G, Lee JK, True LD, De Marzo AM, Nelson PS, Morrissey C, Pritchard CC, Haffner MC. Comprehensive assessment of anaplastic lymphoma kinase in localized and metastatic prostate cancer reveals targetable alterations. Cancer Res Commun 2022; 2:277-285. [PMID: 36337169 PMCID: PMC9635400 DOI: 10.1158/2767-9764.crc-21-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 06/16/2023]
Abstract
Anaplastic lymphoma kinase (ALK) is a tyrosine kinase with genomic and expression changes in many solid tumors. ALK inhibition is first line therapy for lung cancers with ALK alterations, and an effective therapy in other tumor types, but has not been well-studied in prostate cancer. Here, we aim to delineate the role of ALK genomic and expression changes in primary and metastatic prostate cancer. We determined ALK expression by immunohistochemistry and RNA-Seq, and genomic alterations by NGS. We assessed functional consequences of ALK overexpression and pharmacological ALK inhibition by cell proliferation and cell viability assays. Among 372 primary prostate cancer cases we identified one case with uniformly high ALK protein expression. Genomic analysis revealed a SLC45A3-ALK fusion which promoted oncogenesis in in vitro assays. We observed ALK protein expression in 5/52 (9%) of metastatic prostate cancer cases, of which 4 of 5 had neuroendocrine features. ALK-expressing neuroendocrine prostate cancer had a distinct transcriptional program, and earlier disease progression. An ALK-expressing neuroendocrine prostate cancer model was sensitive to pharmacological ALK inhibition. In summary, we found that ALK overexpression is rare in primary prostate cancer, but more frequent in metastatic prostate cancers with neuroendocrine differentiation. Further, ALK fusions similar to lung cancer are an occasional driver in prostate cancer. Our data suggest that ALK-directed therapies could be an option in selected patients with advanced prostate cancer.
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Affiliation(s)
- Radhika A. Patel
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ilsa Coleman
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
- The Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Brian Hanratty
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ruth Dumpit
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jared M. Lucas
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa S. Ang
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jin-Yih Low
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Maria S. Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Gavin Ha
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- The Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - John K. Lee
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lawrence D. True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Angelo M. De Marzo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter S. Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
- The Brotman Baty Institute for Precision Medicine, Seattle, Washington
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Colm Morrissey
- Department of Urology, University of Washington, Seattle, Washington
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
- The Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Michael C. Haffner
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Wu B, Konnick EQ, Kimble EL, Hendrie PC, Shinohara MM, Moshiri AS. A Novel GAB2::BRAF Fusion in Cutaneous Non-Langerhans Cell Histiocytosis with Systemic Involvement. J Cutan Pathol 2022; 49:727-730. [PMID: 35332933 DOI: 10.1111/cup.14231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
Several mutations and gene fusions involved in the mitogen-activated protein kinase (MAPK) pathway have been reported in histiocytic neoplasms including Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (NLCH). We identified a GAB2::BRAF fusion in a cutaneous lesion from a 22-year-old woman who presented with central diabetes insipidus and red/brown papules on her face, oral mucosa, axilla, and groin. Skin biopsies showed a CD68+, S100-, and CD1a- histiocytic proliferation consistent with NLCH, best clinically classified as xanthoma disseminatum. Next-generation sequencing identified a GAB2::BRAF fusion involving exon 2 of GAB and exon 10 of BRAF. This case implicates a novel fusion in the MAPK signaling pathway, not previously reported in histiocytic neoplasms, as a possible driver of NLCH. Our findings underscore the utility of performing molecular studies on skin biopsies with NLCH to help identify potential targets for therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bicong Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Erik L Kimble
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Paul C Hendrie
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Michi M Shinohara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.,Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Ata S Moshiri
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.,Division of Dermatology, University of Washington, Seattle, WA, USA
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18
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Maxwell KN, Cheng HH, Powers J, Gulati R, Ledet EM, Morrison C, Le A, Hausler R, Stopfer J, Hyman S, Kohlmann W, Naumer A, Vagher J, Greenberg S, Naylor L, Laurino M, Konnick EQ, Shirts BH, Al-Dubayan SH, Van Allen EM, Nguyen B, Vijai J, Abida W, Carlo M, Dubard-Gault M, Lee DJ, Maese LD, Mandelker D, Montgomery B, Morris MJ, Nicolosi P, Nussbaum RL, Schwartz LE, Stadler Z, Garber JE, Offit K, Schiffman JD, Nelson PS, Sartor O, Walsh MF, Pritchard CC. Inherited TP53 Variants and Risk of Prostate Cancer. Eur Urol 2022; 81:243-250. [PMID: 34863587 PMCID: PMC8891030 DOI: 10.1016/j.eururo.2021.10.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 05/09/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inherited germline TP53 pathogenic and likely pathogenic variants (gTP53) cause autosomal dominant multicancer predisposition including Li-Fraumeni syndrome (LFS). However, there is no known association of prostate cancer with gTP53. OBJECTIVE To determine whether gTP53 predisposes to prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional retrospective study characterizes prostate cancer incidence in a cohort of LFS males and gTP53 prevalence in a prostate cancer cohort. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We evaluated the spectrum of gTP53 variants and clinical features associated with prostate cancer. RESULTS AND LIMITATIONS We identified 31 prostate cancer cases among 163 adult LFS males, including 26 of 54 aged ≥50 yr. Among 117 LFS males without prostate cancer at the time of genetic testing, six were diagnosed with prostate cancer over a median (interquartile range [IQR]) of 3.0 (1.3-7.2) yr of follow-up, a 25-fold increased risk (95% confidence interval [CI] 9.2-55; p < 0.0001). We identified gTP53 in 38 of 6850 males (0.6%) in the prostate cancer cohort, a relative risk 9.1-fold higher than that of population controls (95% CI 6.2-14; p < 0.0001; gnomAD). We observed hotspots at the sites of attenuated variants not associated with classic LFS. Two-thirds of available gTP53 prostate tumors had somatic inactivation of the second TP53 allele. Among gTP53 prostate cancer cases in this study, the median age at diagnosis was 56 (IQR: 51-62) yr, 44% had Gleason ≥8 tumors, and 29% had advanced disease at diagnosis. CONCLUSIONS Complementary analyses of prostate cancer incidence in LFS males and gTP53 prevalence in prostate cancer cohorts suggest that gTP53 predisposes to aggressive prostate cancer. Prostate cancer should be considered as part of LFS screening protocols and TP53 considered in germline prostate cancer susceptibility testing. PATIENT SUMMARY Inherited pathogenic variants in the TP53 gene are likely to predispose men to aggressive prostate cancer.
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Affiliation(s)
- Kara N. Maxwell
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Heather H. Cheng
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jacquelyn Powers
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elisa M. Ledet
- Tulane Cancer Center, Tulane Medical School, New Orleans, LA, USA
| | - Casey Morrison
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anh Le
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Hausler
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jill Stopfer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sophie Hyman
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anne Naumer
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jennie Vagher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Brian H. Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Saud H. Al-Dubayan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,Cancer Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eliezer M. Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,Cancer Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bastien Nguyen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Vijai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Abida
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Carlo
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Daniel J. Lee
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Luke D. Maese
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Diana Mandelker
- Diagnostic Molecular Genetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael J. Morris
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lauren E. Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zsofia Stadler
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judy E. Garber
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua D. Schiffman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA,PEEL Therapeutics, Inc., Salt Lake City, UT, USA
| | - Peter S. Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane Medical School, New Orleans, LA, USA
| | - Michael F. Walsh
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA,Corresponding author. Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA. Tel. +1 (206) 598-6131; Fax: 1 (206) 543-3644. (C.C. Pritchard)
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19
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Colton MD, Tompkins K, O'Donnell E, Aisner D, Lieu CH, Konnick EQ, Fishbein L. Case of Metastatic Pheochromocytoma and Meningiomas in a Patient With Lynch Syndrome. JCO Precis Oncol 2022; 6:e2100251. [PMID: 35025617 PMCID: PMC9848592 DOI: 10.1200/po.21.00251] [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: 01/22/2023] Open
Affiliation(s)
| | - Kenneth Tompkins
- University of Colorado Department of Medicine, Aurora, CO,University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, Aurora, CO
| | - Emily O'Donnell
- University of Colorado School of Medicine, Department of Pathology, Aurora, CO
| | - Dara Aisner
- University of Colorado School of Medicine, Department of Pathology, Aurora, CO
| | - Christopher H. Lieu
- University of Colorado Department of Medicine, Aurora, CO,University of Colorado Anschutz Medical Campus, Division of Medical Oncology, Aurora, CO
| | - Eric Q. Konnick
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA
| | - Lauren Fishbein
- University of Colorado Department of Medicine, Aurora, CO,University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, Aurora, CO,University of Colorado School of Medicine, Division of Biomedical Informatics and Personalized Medicine, Aurora, CO,Lauren Fishbein, MD, PhD, University of Colorado School of Medicine, Division of Endocrinology, Metabolism, Diabetes, Division of Biomedical Informatics and Personalized Medicine, 12801 E. 17th Ave, MS 8106, Aurora, CO 80045; e-mail:
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20
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Konnick EQ, Laser J, Weck KE. The Role of Clinical Laboratories in Emerging Pathogens—Insights From the COVID-19 Pandemic. JAMA Health Forum 2021; 2:e213154. [DOI: 10.1001/jamahealthforum.2021.3154] [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: 11/14/2022] Open
Affiliation(s)
| | | | - Karen E. Weck
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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21
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Martin NA, Tepper JE, Giri VN, Stinchcombe TE, Cheng HH, Javle MM, Konnick EQ. Adopting Consensus Terms for Testing in Precision Medicine. JCO Precis Oncol 2021; 5:PO.21.00027. [PMID: 34651094 PMCID: PMC8509918 DOI: 10.1200/po.21.00027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/22/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Despite the well-understood benefits of biomarker and genetic testing in precision medicine, uptake remains low, particularly for patients with low socioeconomic status and minority ethnic backgrounds. Patients report having limited familiarity with testing terminology and may not be able to accurately explain testing's role in treatment decisions. Patient confusion and lack of understanding is exacerbated by a multiplicity of overlapping terms used in communicating about testing. A LUNGevity Foundation–led working group composed of five professional societies, 23 patient advocacy groups, and 19 industry members assessed and recommended specific terms for communicating with patients on testing for tumor characteristics and germline mutations.
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Affiliation(s)
| | - Joel E Tepper
- Department of Radiation Oncology, UNC/Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC
| | - Veda N Giri
- Cancer Risk Assessment and Clinical Cancer Genetics, Departments of Medical Oncology, Cancer Biology, and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Heather H Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Medicine, Division of Oncology, University of Washington, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Q Konnick
- Seattle Cancer Care Alliance, Seattle, WA.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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22
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Srivatsan S, Heidl S, Pfau B, Martin BK, Han PD, Zhong W, van Raay K, McDermot E, Opsahl J, Gamboa L, Smith N, Truong M, Cho S, Barrow KA, Rich LM, Stone J, Wolf CR, McCulloch DJ, Kim AE, Brandstetter E, Sohlberg SL, Ilcisin M, Geyer RE, Chen W, Gehring J, Kosuri S, Bedford T, Rieder MJ, Nickerson DA, Chu HY, Konnick EQ, Debley JS, Shendure J, Lockwood CM, Starita LM. SwabExpress: An end-to-end protocol for extraction-free covid-19 testing. Clin Chem 2021; 68:143-152. [PMID: 34286830 DOI: 10.1093/clinchem/hvab132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The urgent need for massively scaled clinical testing for SARS-CoV-2, along with global shortages of critical reagents and supplies, has necessitated development of streamlined laboratory testing protocols. Conventional nucleic acid testing for SARS-CoV-2 involves collection of a clinical specimen with a nasopharyngeal swab in transport medium, nucleic acid extraction, and quantitative reverse transcription PCR (RT-qPCR) (1). As testing has scaled across the world, the global supply chain has buckled, rendering testing reagents and materials scarce (2). To address shortages, we developed SwabExpress, an end-to-end protocol developed to employ mass produced anterior nares swabs and bypass the requirement for transport media and nucleic acid extraction. METHODS We evaluated anterior nares swabs, transported dry and eluted in low-TE buffer as a direct-to-RT-qPCR alternative to extraction-dependent viral transport media. We validated our protocol of using heat treatment for viral inactivation and added a proteinase K digestion step to reduce amplification interference. We tested this protocol across archived and prospectively collected swab specimens to fine-tune test performance. RESULTS After optimization, SwabExpress has a low limit of detection at 2-4 molecules/uL, 100% sensitivity, and 99.4% specificity when compared side-by-side with a traditional RT-qPCR protocol employing extraction. On real-world specimens, SwabExpress outperforms an automated extraction system while simultaneously reducing cost and hands-on time. CONCLUSION SwabExpress is a simplified workflow that facilitates scaled testing for COVID-19 without sacrificing test performance. It may serve as a template for the simplification of PCR-based clinical laboratory tests, particularly in times of critical shortages during pandemics.
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Affiliation(s)
- Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Sarah Heidl
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Brian Pfau
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Beth K Martin
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Weizhi Zhong
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | | | - Evan McDermot
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Jordan Opsahl
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Luis Gamboa
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Nahum Smith
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Melissa Truong
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Shari Cho
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Kaitlyn A Barrow
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Lucille M Rich
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jeremy Stone
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Caitlin R Wolf
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Denise J McCulloch
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Ashley E Kim
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | - Sarah L Sohlberg
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Wei Chen
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Jase Gehring
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Sriram Kosuri
- Octant, Inc. Emeryville CA, USA.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Trevor Bedford
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark J Rieder
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Helen Y Chu
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Eric Q Konnick
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Jason S Debley
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Howard Hughes Medical Institute. Seattle, WA, USA
| | - Christina M Lockwood
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Lea M Starita
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
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23
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Perrone ME, Alvarez R, Vo TT, Chung MW, Chhieng DC, Paulson VA, Colbert BG, Q Konnick E, Huang EC. Validating cell-free DNA from supernatant for molecular diagnostics on cytology specimens. Cancer Cytopathol 2021; 129:956-965. [PMID: 34265180 DOI: 10.1002/cncy.22491] [Citation(s) in RCA: 2] [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: 05/26/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cytology specimens are often used for biomarker testing in the setting of neoplasia. On occasion, formalin-fixed paraffin-embedded (FFPE) cell blocks unfortunately may not yield sufficient material for testing. Recent studies have suggested that residual supernatant fluid from cell block preparation is a valuable source of DNA: both cellular and cell-free DNA (cfDNA). In the present study, the use of cfDNA from supernatant is compared against DNA from FFPE materials. METHODS cfDNA was extracted prospectively from residual supernatants of 30 cytology samples (29 neoplastic cases and 1 benign ascitic fluid from a patient with a history of melanoma). Samples were tested using clinically validated next-generation-sequencing platforms and the results were compared with data from paired FFPE cell blocks in a real-time prospective clinical setting. Thirteen samples were tested on an amplicon-based assay (Solid Tumor Hotspot), and 17 samples were tested using a comprehensive capture-based assay (UW-Oncoplex). RESULTS Neoplastic content was estimated by mutational variant allele fraction, with a mean content of 24.0% and 25.8% in supernatant and FFPE, respectively. The variant concordance between paired samples was 90%, and identical results were detected in both supernatant and FFPE samples in 74% of cases. CONCLUSIONS This study confirmed that cfDNA from supernatant is a viable alternative to FFPE cell blocks for molecular biomarker testing using both amplicon-based and capture-based assays with potential for decreasing additional tissue sampling and faster turnaround time.
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Affiliation(s)
- Marie E Perrone
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Rebeca Alvarez
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Tawnie T Vo
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Moon-Wook Chung
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - David C Chhieng
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Vera A Paulson
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Brice G Colbert
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Eric C Huang
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington
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24
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Schweizer MT, Sivakumar S, Tukachinsky H, Coleman I, De Sarkar N, Yu EY, Konnick EQ, Nelson PS, Pritchard CC, Montgomery B. Concordance of DNA Repair Gene Mutations in Paired Primary Prostate Cancer Samples and Metastatic Tissue or Cell-Free DNA. JAMA Oncol 2021; 7:2780857. [PMID: 34086042 PMCID: PMC8446811 DOI: 10.1001/jamaoncol.2021.2350] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
IMPORTANCE DNA damage repair (DDR) gene mutations represent actionable alterations that can guide precision medicine strategies for advanced prostate cancer. However, acquisition of contemporary tissue samples for molecular testing can be a barrier to deploying precision medicine approaches. We hypothesized that most DDR alterations represent truncal events in prostate cancer and that primary tissue would faithfully reflect mutations found in cell-free circulating tumor DNA (ctDNA) and/or metastatic tissue. OBJECTIVE To assess concordance in DDR gene alterations between primary prostate cancer and metastases or ctDNA specimens. DESIGN, SETTING, AND PARTICIPANTS Patients were included if a DDR pathway mutation was detected in metastatic tissue or ctDNA and primary tissue sequencing was available for comparison. Sequencing data from 3 cohorts were analyzed: (1) FoundationOne, (2) University of Washington clinical cases (University of Washington-OncoPlex or Stand Up to Cancer-Prostate Cancer Foundation International Dream Team sequencing pipelines), and (3) University of Washington rapid autopsy series. Only pathogenic somatic mutations were included, and more than 30 days between primary tumor tissue and ctDNA and/or metastatic tissue acquisition was required. Clonal hematopoiesis of indeterminate potential (CHIP) and germline events were adjudicated by an expert molecular pathologist and excluded. MAIN OUTCOMES AND MEASURES The DDR gene alterations detected in primary prostate tissue matched with metastatic tissue and/or ctDNA findings. RESULTS A total of 72 men with known DDR alterations were included in the analysis, and primary samples with paired ctDNA and/or metastatic tissue were sequenced. After excluding patients with ctDNA where only CHIP and/or germline events (n = 21) were observed, 51 patients remained and were included in the final analysis. The median (range) time from acquisition of primary tissue to acquisition of ctDNA or tumor tissue was 55 (5-193) months. Concordance in DDR gene mutation status across samples was 84% (95% CI, 71%-92%). Rates of concordance between metastatic-primary and ctDNA-primary pairs were similar when patients with CHIP events were excluded. Multiclonal BRCA2 reversion mutations associated with resistance to PARP inhibitors and platinum chemotherapy were detected in ctDNA from 2 patients. CONCLUSIONS AND RELEVANCE In this genetic association study of 3 patient cohorts, primary prostate tissue accurately reflected the mutational status of actionable DDR genes in metastatic tissue, consistent with DDR alterations being truncal in most patients. After excluding likely CHIP events, ctDNA profiling accurately captured these DDR mutations while also detecting reversion alterations that may suggest resistance mechanisms.
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Affiliation(s)
- Michael T. Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Ilsa Coleman
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Navonil De Sarkar
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Evan Y. Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Peter S. Nelson
- Division of Oncology, Department of Medicine, University of Washington, Seattle
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle
- Prostate Cancer Foundation Precision Oncology Program for Cancer of the Prostate,VA Puget Sound Health Care System, Seattle, Washington
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25
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Srivatsan S, Heidl S, Pfau B, Martin BK, Han PD, Zhong W, van Raay K, McDermot E, Opsahl J, Gamboa L, Smith N, Truong M, Cho S, Barrow KA, Rich LM, Stone J, Wolf CR, McCulloch DJ, Kim AE, Brandstetter E, Sohlberg SL, Ilcisin M, Geyer RE, Chen W, Gehring J, Kosuri S, Bedford T, Rieder MJ, Nickerson DA, Chu HY, Konnick EQ, Debley JS, Shendure J, Lockwood CM, Starita LM. SwabExpress: An end-to-end protocol for extraction-free COVID-19 testing. bioRxiv 2021:2020.04.22.056283. [PMID: 32511368 PMCID: PMC7263496 DOI: 10.1101/2020.04.22.056283] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The urgent need for massively scaled clinical testing for SARS-CoV-2, along with global shortages of critical reagents and supplies, has necessitated development of streamlined laboratory testing protocols. Conventional nucleic acid testing for SARS-CoV-2 involves collection of a clinical specimen with a nasopharyngeal swab in transport medium, nucleic acid extraction, and quantitative reverse transcription PCR (RT-qPCR) (1). As testing has scaled across the world, the global supply chain has buckled, rendering testing reagents and materials scarce (2). To address shortages, we developed SwabExpress, an end-to-end protocol developed to employ mass produced anterior nares swabs and bypass the requirement for transport media and nucleic acid extraction. METHODS We evaluated anterior nares swabs, transported dry and eluted in low-TE buffer as a direct-to-RT-qPCR alternative to extraction-dependent viral transport media. We validated our protocol of using heat treatment for viral activation and added a proteinase K digestion step to reduce amplification interference. We tested this protocol across archived and prospectively collected swab specimens to fine-tune test performance. RESULTS After optimization, SwabExpress has a low limit of detection at 2-4 molecules/uL, 100% sensitivity, and 99.4% specificity when compared side-by-side with a traditional RT-qPCR protocol employing extraction. On real-world specimens, SwabExpress outperforms an automated extraction system while simultaneously reducing cost and hands-on time. CONCLUSION SwabExpress is a simplified workflow that facilitates scaled testing for COVID-19 without sacrificing test performance. It may serve as a template for the simplification of PCR-based clinical laboratory tests, particularly in times of critical shortages during pandemics.
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Affiliation(s)
- Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Sarah Heidl
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Brian Pfau
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Beth K. Martin
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Peter D. Han
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Weizhi Zhong
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | | | - Evan McDermot
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Jordan Opsahl
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Luis Gamboa
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Nahum Smith
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Melissa Truong
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Shari Cho
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Kaitlyn A. Barrow
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Lucille M. Rich
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Jeremy Stone
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Caitlin R. Wolf
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Denise J. McCulloch
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Ashley E. Kim
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | | | - Sarah L. Sohlberg
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Wei Chen
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Jase Gehring
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | | | - Sriram Kosuri
- Octant, Inc. Emeryville CA, USA
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles CA, USA
| | - Trevor Bedford
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark J. Rieder
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Helen Y. Chu
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Eric Q. Konnick
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Laboratory Medicine and Pathology, Seattle WA, USA
| | - Jason S. Debley
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Howard Hughes Medical Institute. Seattle WA, USA
| | - Christina M. Lockwood
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Laboratory Medicine and Pathology, Seattle WA, USA
| | - Lea M. Starita
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
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26
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Burton KA, Konnick EQ, Blau S, Dorschner MO, Gralow J, Parulkar R, Mahen E, Spilman P, Parker S, Senecal FM, Pritchard C, Szeto C, Zhu J, Gadi VK, Benz SC, Rabizadeh S, Soon-Shiong P, Blau CA. Abstract PS11-13: Multidimensional molecular profiling of repeated metastatic TNBC biopsies in the intensive trial of omics <ITOMIC> safely guides treatment decisions. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-13] [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
Background Metastatic triple negative breast cancer (mTNBC) is an inherently diverse disease and while molecular classification of mTNBC has assisted in treatment decisions, if based on only an initial biopsy, it does not take into account the evolution of metastatic cancer. Characterization of emerging metastases is needed to reveal both new resistance or sensitivity to available therapeutics. The goal of “Intensive Trial of OMics in Cancer (ITOMIC) - Intensive Longitudinal Monitoring in Subjects With Triple-Negative Breast Cancer” (NCT01957514) - was to determine the feasibility of longitudinal collection of patient biopsies that would be subjected to molecular analysis to provide actionable, relevant and timely information to guide treatment decisions.Methods Multiple biopsies were collected longitudinally, including pre- and post-treatment, from 29 mTNBC patients enrolled in the ITOMIC study and subjected to multi-dimensional molecular profiling including WES, WGS, cancer gene panel sequencing, RNA-seq, and proteomics and/or IHC for tumor biomarkers. This information was used to guide iterative, patient- and tumor- individualized treatment recommendations made by a multi-institutional ITOMIC Tumor Board (ITB) and conveyed to each subject’s oncologist.Results Longitudinal biopsy collection was found to be safe. Molecular profiling revealed that 2 of an original 31 enrolled subjects likely had lung cancer rather than mTNBC, supporting the merit of repeated tissue analysis. While the other 29 subjects had all been given a diagnosis of mTNBC before entering the trial, estrogen receptor, progesterone receptor, and/or HER2 were found to be over-expressed in at least one sample for 12 subjects; appearance of receptor positivity suggests targeted therapy may be effective. Tumor evolution in response to the first on-study treatment for most subjects (cisplatin) was revealed by copy number alterations, changes in single nucleotide variants, and insertions/deletions in pre-/post-treatment biopsies. Over the course of the study, the ITB convened 54 times and 39 of 182 recommended treatments were evaluated and accessed through either an existing clinical trial, a single patient IND, approved off label or label indication. While not all ITB treatment recommendations were followed, 24 subjects did receive at least one ITB-recommended drug, frequently as part of a clinical trial. Currently, for 27 subjects (2 withdrew) median survival is ~31 months. There are 4 surviving patients in treatment with a remarkable median survival of >51 months.Conclusion Collection and molecular analysis of multiple biopsies during the course of patient’s disease, shown here to be safe and feasible, provides information vital to appropriate treatment choice and reveals new targets for and resistance to therapy in metastatic TNBC.
Citation Format: Kimberly A Burton, Eric Q Konnick, Sibel Blau, Michael O Dorschner, Julie Gralow, Rahul Parulkar, Elisabeth Mahen, Patricia Spilman, Stephanie Parker, Francis M Senecal, Colin Pritchard, Christopher Szeto, Jing Zhu, Vijayakrishna K Gadi, Stephen C Benz, Shahrooz Rabizadeh, Patrick Soon-Shiong, Carl Anthony Blau. Multidimensional molecular profiling of repeated metastatic TNBC biopsies in the intensive trial of omics <ITOMIC> safely guides treatment decisions [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-13.
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Affiliation(s)
| | | | - Sibel Blau
- 1Northwest Medical Specialties, Tacoma, WA
| | | | | | | | | | | | | | | | | | | | - Jing Zhu
- 5University of California at Santa Cruz, Santa Cruz, CA
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Jensen K, Konnick EQ, Schweizer MT, Sokolova AO, Grivas P, Cheng HH, Klemfuss NM, Beightol M, Yu EY, Nelson PS, Montgomery B, Pritchard CC. Association of Clonal Hematopoiesis in DNA Repair Genes With Prostate Cancer Plasma Cell-free DNA Testing Interference. JAMA Oncol 2021; 7:107-110. [PMID: 33151258 PMCID: PMC7645740 DOI: 10.1001/jamaoncol.2020.5161] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Question How often are cell-free DNA (cfDNA) studies in prostate cancer confounded by clonal hematopoiesis (CHIP) variants in genes used for poly(ADP) ribose polymerase inhibitor (PARPi) eligibility? Findings In this case series study of 69 men with advanced prostate cancer, 7 (10%) had CHIP variants in genes used for US Food and Drug Administration-approved indications of PARPi treatment, most frequently in ATM. Meaning Men with prostate cancer are at high risk of being misdiagnosed as being eligible for PARPi therapy using current cfDNA tests; assays should use a whole-blood control sample to distinguish CHIP variants from prostate cancer. Importance Cell-free DNA (cfDNA) testing is increasingly used in the treatment of patients with advanced prostate cancer. Clonal hematopoiesis of indeterminate potential (CHIP) can interfere with cfDNA testing and cause incorrect interpretation of results. There is an urgent need to better understand this problem following recent US Food and Drug Administration approval of poly(ADP) ribose polymerase inhibitors (PARPi) for metastatic prostate cancer based on variants in DNA repair genes that can be affected by CHIP. Objective To determine the prevalence of clinically relevant CHIP interference in prostate cancer cfDNA testing. Design, Setting, and Participants We report a case series of 69 patients with advanced prostate cancer (metastatic disease or with rising PSA following localized therapy) who had cfDNA variant testing with a large panel cancer next generation sequencing assay (UW-OncoPlexCT). To determine the source of variants in plasma, we tested paired cfDNA and whole blood control samples. The study was carried out in an academic medical center system reference laboratory. Main Outcomes and Measures Prevalence and gene spectrum of CHIP interference in patients with prostate cancer undergoing cfDNA testing. Results We detected CHIP variants at 2% or more variant fraction in cfDNA from 13 of 69 men with prostate cancer (19%; 95% CI, 10%-30%). Seven men (10%; 95% CI, 4%-20%) had CHIP variants in DNA repair genes used to determine PARPi candidacy, including ATM (n = 5), BRCA2 (n = 1), and CHEK2 (n = 1). Overall, CHIP variants accounted for almost half of the somatic DNA repair gene variants detected. Participant CHIP variants were exponentially correlated with older age (R2 = 0.82). CHIP interference variants could be distinguished from prostate cancer variants using a paired whole-blood control. Conclusions and Relevance In this case series, approximately 10% of men with advanced prostate cancer had CHIP interference in plasma cfDNA in DNA repair genes that are used for eligibility of PARPi therapy, most frequently in ATM. Clinical cfDNA testing should include a paired whole-blood control to exclude CHIP variants and avoid misdiagnosis.
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Affiliation(s)
- Kendal Jensen
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Michael T Schweizer
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Brotman Baty Institute for Precision Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alexandra O Sokolova
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle
| | - Petros Grivas
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Heather H Cheng
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Brotman Baty Institute for Precision Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nola M Klemfuss
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mallory Beightol
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Evan Y Yu
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Peter S Nelson
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Brotman Baty Institute for Precision Medicine, Seattle, Washington.,Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bruce Montgomery
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle.,Brotman Baty Institute for Precision Medicine, Seattle, Washington
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Truong M, Pfau B, McDermot E, Han PD, Brandstetter E, Richardson M, Kim AE, Rieder MJ, Chu HY, Englund JA, Nickerson DA, Shendure J, Lockwood CM, Konnick EQ, Starita LM. Comparable specimen collection from both ends of at-home mid-turbinate swabs. medRxiv 2020:2020.12.05.20244632. [PMID: 33330895 PMCID: PMC7743106 DOI: 10.1101/2020.12.05.20244632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unsupervised upper respiratory specimen collection is a key factor in the ability to massively scale SARS-CoV-2 testing. But there is concern that unsupervised specimen collection may produce inferior samples. Across two studies that included unsupervised at-home mid-turbinate specimen collection, ~1% of participants used the wrong end of the swab. We found that molecular detection of respiratory pathogens and a human biomarker were comparable between specimens collected from the handle of the swab and those collected correctly. Older participants were more likely to use the swab backwards. Our results suggest that errors made during home-collection of nasal specimens do not preclude molecular detection of pathogens and specialized swabs may be an unnecessary luxury during a pandemic.
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Affiliation(s)
- Melissa Truong
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Brian Pfau
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Evan McDermot
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Peter D Han
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | | | | | | | - Mark J Rieder
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
| | - Helen Y Chu
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
| | - Janet A Englund
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Seattle Children's Research Institute
| | - Deborah A Nickerson
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
| | - Jay Shendure
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
- Howard Hughes Medical Institute. Seattle WA, USA
| | - Christina M Lockwood
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
| | - Eric Q Konnick
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
| | - Lea M Starita
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- University of Washington, Seattle WA, USA
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29
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Sokolova AO, Shirts BH, Konnick EQ, Tsai GJ, Goulart BHL, Montgomery B, Pritchard CC, Yu EY, Cheng HH. Complexities of Next-Generation Sequencing in Solid Tumors: Case Studies. J Natl Compr Canc Netw 2020; 18:1150-1155. [PMID: 32886903 DOI: 10.6004/jnccn.2020.7569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/31/2020] [Indexed: 11/17/2022]
Abstract
With the promise and potential of clinical next-generation sequencing for tumor and germline testing to impact treatment and outcomes of patients with cancer, there are also risks of oversimplification, misinterpretation, and missed opportunities. These issues risk limiting clinical benefit and, at worst, perpetuating false conclusions that could lead to inappropriate treatment selection, avoidable toxicity, and harm to patients. This report presents 5 case studies illustrating challenges and opportunities in clinical next-generation sequencing interpretation and clinical application in solid tumor oncologic care. First is a case that dissects the origin of an ATM mutation as originating from a hematopoietic clone rather than the tumor. Second is a case illustrating the potential for tumor sequencing to suggest germline variants associated with a hereditary cancer syndrome. Third are 2 cases showing the potential for variant reclassification of a germline variant of uncertain significance when considered alongside family history and tumor sequencing results. Finally, we describe a case illustrating challenges with using microsatellite instability for predicting tumor response to immune checkpoint inhibitors. The common theme of the case studies is the importance of examining clinical context alongside expert review and interpretation, which together highlight an expanding role for contextual examination and multidisciplinary expert review through molecular tumor boards.
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Affiliation(s)
- Alexandra O Sokolova
- 1Department of Medicine, University of Washington.,2Clinical Research Division, Fred Hutchinson Cancer Research Center.,4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Brian H Shirts
- 4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Eric Q Konnick
- 4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ginger J Tsai
- 4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Bernardo H L Goulart
- 1Department of Medicine, University of Washington.,2Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Bruce Montgomery
- 1Department of Medicine, University of Washington.,2Clinical Research Division, Fred Hutchinson Cancer Research Center.,4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Colin C Pritchard
- 4Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Evan Y Yu
- 1Department of Medicine, University of Washington.,2Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Heather H Cheng
- 1Department of Medicine, University of Washington.,2Clinical Research Division, Fred Hutchinson Cancer Research Center
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Konnick EQ. The regulatory landscape of precision oncology laboratory medicine in the United States - Perspective on the past 5 years and considerations for future regulation. Pract Lab Med 2020; 21:e00172. [PMID: 32509953 PMCID: PMC7261109 DOI: 10.1016/j.plabm.2020.e00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 05/02/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023] Open
Abstract
The regulatory landscape for precision oncology in the United States is complicated, with multiple governmental regulatory agencies with different scopes of jurisdiction. Several regulatory proposals have been introduced since the Food and Drug Administration released a draft guidance to regulate laboratory-developed tests in 2014. Key aspects of the most recent proposals and discussion of central arguments related to the regulation of precision oncology laboratory tests provides insight to stakeholders for future discussions related to regulation of laboratory tests.
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31
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Kuo AJ, Paulson VA, Hempelmann JA, Beightol M, Todhunter S, Colbert BG, Salipante SJ, Konnick EQ, Pritchard CC, Lockwood CM. Validation and implementation of a modular targeted capture assay for the detection of clinically significant molecular oncology alterations. Pract Lab Med 2020; 19:e00153. [PMID: 32123717 PMCID: PMC7038441 DOI: 10.1016/j.plabm.2020.e00153] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 09/04/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The rapid discovery of clinically significant genetic variants has translated to next-generation sequencing assays becoming out-of-date by the time they are designed, validated, and implemented. UW-OncoPlex addresses this through the adoption of a modular panel capable of redesign as significant alterations are identified. We describe the validation of OncoPlex version 6 (OPXv6) for the detection of single nucleotide variants (SNVs), insertions and deletions (indels), copy number variants (CNVs), structural variants (SVs), microsatellite instability (MSI), and tumor mutational burden (TMB) in a panel of 340 genes. DESIGN One hundred twelve samples with diverse diagnoses were comprised of formalin-fixed-paraffin-embedded tissue, fresh-frozen tissue, plasma, peripheral blood, bone marrow, saliva, and cell-line DNA. Libraries were prepared from genomic and cell-free DNA, hybridized to a custom panel of xGen Lockdown probes, and sequenced on Illumina platforms. Sequences were processed through a custom bioinformatics pipeline, and variant calls were compared to prior orthogonal clinical results. RESULTS Accuracy was 99% for SNVs ≥5% allele frequency, 98% for indels, 97% for SVs, 99% for CNVs, 100% for MSI, and 100% for TMB (compared to previous OncoPlex versions). Library preparation turnaround time decreased by 40%, and sequencing quality improved with a 2.5-fold increase in average sequencing coverage and 4-fold increase in percent on-target. CONCLUSIONS OPXv6 demonstrates improvements over prior UW-OncoPlex versions including reduced capture cost, improved sequencing quality, and decreased time to results. The modular capture probe design also provides a nimble laboratory response in addressing the expansions necessary to meet the needs of the continuously evolving field of molecular oncology.
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32
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Cheeney G, Pac LJ, Gopal P, Landis CS, Konnick EQ, Swanson PE, Greene DN, Lockwood CM, Westerhoff M. Increased Frequency of Heterozygous Alpha-1-Antitrypsin Deficiency in Liver Explants From Nonalcoholic Steatohepatitis Patients. Liver Transpl 2020; 26:17-24. [PMID: 31597010 DOI: 10.1002/lt.25652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Cirrhotic explanted livers occasionally have unexpected periodic acid-Schiff-diastase (PASD)-positive globules within the hepatocyte cytoplasm. It is often unclear whether this finding is a nonspecific consequence of cirrhosis or is indicative of an underlying alpha-1-antitrypsin deficiency (A1ATD) contributing to the cirrhosis. In this study, explanted livers were retrospectively evaluated for histopathology (including PASD status with confirmatory alpha-1-antitrypsin [A1AT] immunohistochemistry [IHC]), and chart review provided etiology of liver failure and general clinical parameters. Real-time polymerase chain reaction was used to detect A1AT genotype (SERPINA1 S and Z alleles) by melting curve analysis on liver explant tissue from selected cases. Of 196 explanted livers, 21 (11%) had PASD+ globules, which were significantly enriched in patients with a clinical diagnosis of nonalcoholic steatohepatitis (NASH; 47%) compared with other causes (P < 0.001). IHC confirmed all PASD+ globules were A1AT+, with 20 of 21 cases demonstrating diffuse A1AT staining. In an expanded NASH cohort, 42% (14/33) of explants had PASD+ globules, 92% of which were homozygous (n = 1) or heterozygous (n = 11) for the SERPINA1 Z allele, corresponding to nearly 40% of all NASH patients. Overall, the Z allele was present in 10% of all tested liver explants, with 85% of PASD+ cases genotyping homozygous (n = 2) or heterozygous (n = 20), which is far in excess of the estimated 2% in the general population. These results indicate PASD+ A1AT globules (with confirmatory genotyping showing at least 1 Z allele) are commonly observed in NASH, suggesting a synergistic relationship toward liver fibrosis. In addition, the high frequency of SERPINA1 Z alleles in liver transplantation patients supports the utility of pretransplant genotyping.
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Affiliation(s)
- Gregory Cheeney
- Department of Pathology, University of Washington School of Medicine, Seattle, WA.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA
| | - Lincoln J Pac
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Purva Gopal
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Charles S Landis
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA
| | - Paul E Swanson
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI
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Abstract
Paragangliomas are rare neuroendocrine tumors which originate from embryonic neural crest cells. These tumors may arise from parasympathetic or sympathetic paraganglia, may secrete catecholamines, and can occur in varied anatomic locations, with some locations being less common than others. Hereditary paraganglioma-pheochromocytoma (PGL/PCC) syndromes are characterized by paragangliomas and pheochromocytomas and have been associated with germline heterozygous mutations in MAX, SDHA, SDHAF2, SDHB, SDHC, SDHD, or TMEM127. Herein, we report a case of a middle-aged male who was diagnosed with an intrarenal/renal pelvis paraganglioma after presenting in hypertensive crisis with palpitations, headache, and diaphoresis. He was later found to have extensive metastatic disease, as well as genetic testing that showed biallelic inactivation of SDHB and a co-occurring somatic ATRX mutation. Respectively, these germline and somatic mutations have been associated with increased risk of metastatic spread and clinical aggressiveness. Despite multiple surgical resections and various treatment modalities, the patient eventually elected for palliative care measures and died of disease. Together, the findings seen in this patient are unique and serve as an appropriate catalyst for discussing the unusual locations, interesting genetic profiles, and metastatic risk factors that may be associated with paragangliomas.
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Affiliation(s)
- Trent Irwin
- Department of Pathology, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
- , Seattle, USA.
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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Joshi RP, Steiner DF, Konnick EQ, Suarez CJ. Pharma-Oncogenomics in the Era of Personal Genomics: A Quick Guide to Online Resources and Tools. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1168:103-115. [DOI: 10.1007/978-3-030-24100-1_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Hsu J, Reilly A, Hayes BJ, Clough CA, Konnick EQ, Torok-Storb B, Gulsuner S, Wu D, Becker PS, Keel SB, Abkowitz JL, Doulatov S. Reprogramming identifies functionally distinct stages of clonal evolution in myelodysplastic syndromes. Blood 2019; 134:186-198. [PMID: 31010849 PMCID: PMC6624967 DOI: 10.1182/blood.2018884338] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 11/07/2018] [Accepted: 04/01/2019] [Indexed: 12/16/2022] Open
Abstract
Myeloid neoplasms, including myelodysplastic syndromes (MDS), are genetically heterogeneous disorders driven by clonal acquisition of somatic mutations in hematopoietic stem and progenitor cells (HPCs). The order of premalignant mutations and their impact on HPC self-renewal and differentiation remain poorly understood. We show that episomal reprogramming of MDS patient samples generates induced pluripotent stem cells from single premalignant cells with a partial complement of mutations, directly informing the temporal order of mutations in the individual patient. Reprogramming preferentially captured early subclones with fewer mutations, which were rare among single patient cells. To evaluate the functional impact of clonal evolution in individual patients, we differentiated isogenic MDS induced pluripotent stem cells harboring up to 4 successive clonal abnormalities recapitulating a progressive decrease in hematopoietic differentiation potential. SF3B1, in concert with epigenetic mutations, perturbed mitochondrial function leading to accumulation of damaged mitochondria during disease progression, resulting in apoptosis and ineffective erythropoiesis. Reprogramming also informed the order of premalignant mutations in patients with complex karyotype and identified 5q deletion as an early cytogenetic anomaly. The loss of chromosome 5q cooperated with TP53 mutations to perturb genome stability, promoting acquisition of structural and karyotypic abnormalities. Reprogramming thus enables molecular and functional interrogation of preleukemic clonal evolution, identifying mitochondrial function and chromosome stability as key pathways affected by acquisition of somatic mutations in MDS.
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Affiliation(s)
- Jasper Hsu
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Andreea Reilly
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Brian J Hayes
- Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | - Courtnee A Clough
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - David Wu
- Department of Laboratory Medicine
| | - Pamela S Becker
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Institute for Stem Cell and Regenerative Medicine, and
| | - Siobán B Keel
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Janis L Abkowitz
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Institute for Stem Cell and Regenerative Medicine, and
- Department of Genome Sciences, University of Washington, Seattle, WA
| | - Sergei Doulatov
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Institute for Stem Cell and Regenerative Medicine, and
- Department of Genome Sciences, University of Washington, Seattle, WA
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36
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Schweizer MT, Gulati R, Beightol M, Konnick EQ, Cheng HH, Klemfuss N, Sarkar ND, Yu EY, Montgomery RB, Nelson PS, Pritchard CC. Clinical determinants for successful circulating tumor DNA analysis in prostate cancer. Prostate 2019; 79:701-708. [PMID: 30865311 PMCID: PMC6589085 DOI: 10.1002/pros.23778] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/31/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plasma-based cell-free DNA is an attractive biospecimen for assessing somatic mutations due to minimally-invasive real-time sampling. However, next generation sequencing (NGS) of cell-free DNA (cfDNA) may not be appropriate for all patients with advanced prostate cancer (PC). METHODS Blood was obtained from advanced PC patients for plasma-based sequencing. UW-OncoPlex, a ∼2 Mb multi-gene NGS panel performed in the CLIA/CAP environment, was optimized for detecting cfDNA mutations. Tumor tissue and germline samples were sequenced for comparative analyses. Multivariate logistic regression was performed to determine the clinical characteristic associated with the successful detection of somatic cfDNA alterations (ie detection of at least one clearly somatic PC mutation). RESULTS Plasma for cfDNA sequencing was obtained from 93 PC patients along with tumor tissue (N = 67) and germline (N = 93) controls. We included data from 76 patients (72 prostate adenocarcinoma; 4 variant histology PC) in the analysis. Somatic DNA aberrations were detected in 34 cfDNA samples from patients with prostate adenocarcinoma. High PSA level, high tumor volume, and castration-resistance were significantly associated with successful detection of somatic cfDNA alterations. Among samples with somatic mutations detected, the cfDNA assay detected 93/102 (91%) alterations found in tumor tissue, yielding a clustering-corrected sensitivity of 92% (95% confidence interval 88-97%). All germline pathogenic variants present in lymphocyte DNA were also detected in cfDNA (N = 12). Somatic mutations from cfDNA were detected in 30/33 (93%) instances when PSA was >10 ng/mL. CONCLUSIONS Disease burden, including a PSA >10 ng/mL, is strongly associated with detecting somatic mutations from cfDNA specimens.
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Affiliation(s)
- Michael T. Schweizer
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | | | | | - Heather H. Cheng
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Nola Klemfuss
- Division of Human Biology, Fred Hutchinson Cancer Research Center
- Brotman Baty Institute for Precision Medicine
| | - Navonil De Sarkar
- Department of Medicine, University of Washington
- Division of Human Biology, Fred Hutchinson Cancer Research Center
| | - Evan Y. Yu
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - R. Bruce Montgomery
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Peter S. Nelson
- Department of Medicine, University of Washington
- Division of Human Biology, Fred Hutchinson Cancer Research Center
| | - Colin C. Pritchard
- Department of Laboratory Medicine, University of Washington
- Brotman Baty Institute for Precision Medicine
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Schweizer MT, Antonarakis ES, Bismar TA, Guedes LB, Cheng HH, Tretiakova MS, Vakar-Lopez F, Klemfuss N, Konnick EQ, Mostaghel EA, Hsieh AC, Nelson PS, Yu EY, Montgomery RB, True LD, Epstein JI, Lotan TL, Pritchard CC. Genomic Characterization of Prostatic Ductal Adenocarcinoma Identifies a High Prevalence of DNA Repair Gene Mutations. JCO Precis Oncol 2019; 3. [PMID: 31123724 DOI: 10.1200/po.18.00327] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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
PURPOSE Ductal prostate cancer (dPC) is a rare variant of prostatic adenocarcinoma associated with poor outcomes. Although its histopathologic features are well characterized, the underlying molecular hallmarks of this aggressive subtype are not well described. We sought to provide a comprehensive overview of the spectrum of mutations associated with dPC. METHODS Three case series across multiple institutions were assembled. All patients had a diagnosis of dPC, and histopathologic classification was confirmed by an expert genitourinary pathologist. Case series 1 included men who were prospectively enrolled in a tumor sequencing study at the University of Washington (n = 22). Case series 2 and 3 included archival samples from men treated at Johns Hopkins Hospital (n = 21) and University of Calgary (n = 8), respectively. Tumor tissue was sequenced on a targeted next-generation sequencing assay, UW-OncoPlex, according to previously published methods. The frequency of pathogenic/likely pathogenic mutations are reported. RESULTS Overall, 25 patients (49%) had at least one DNA damage repair gene alteration, including seven (14%) with a mismatch repair gene mutation and 16 (31%) with a homologous repair mutation. Germline autosomal dominant mutations were confirmed or suspected in 10 patients (20%). Activating mutations in the PI3K pathway (n = 19; 37%), WNT pathway (n = 16; 31%), and MAPK pathway (n = 8; 16%) were common. CONCLUSION This study strongly suggests that dPCs are enriched for actionable mutations, with approximately 50% of patients demonstrating DNA damage repair pathway alteration(s). Patients with dPC should be offered next-generation sequencing to guide standard-of-care treatment (eg, immune checkpoint inhibitors) or triaged toward an appropriate clinical trial (eg, poly [ADP-ribose] polymerase inhibitors).
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Affiliation(s)
- Michael T Schweizer
- University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Heather H Cheng
- University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | - Elahe A Mostaghel
- University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Evan Y Yu
- University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
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Byers HM, Jacobson A, McFaddin AS, Ussakli CH, Newlin A, Stanich PP, More S, Hamblett A, Tait JF, Shirts B, Pritchard CC, Konnick EQ, Lockwood CM. Postmortem Somatic Sequencing of Tumors From Patients With Suspected Lynch Syndrome Has Clinical Utility for Surviving Relatives. JCO Precis Oncol 2018; 2:1800108. [PMID: 32913991 DOI: 10.1200/po.18.00108] [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 M Byers
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Angela Jacobson
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Andrew S McFaddin
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Cigdem H Ussakli
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Anna Newlin
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Peter P Stanich
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Stephanie More
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Amanda Hamblett
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Jonathan F Tait
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Brian Shirts
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Colin C Pritchard
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Eric Q Konnick
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
| | - Christina M Lockwood
- , Stanford University, Palo Alto, CA; , , , , , , and , University of Washington, Seattle, WA; , NorthShore University HealthSystem, Evanston, IL; , Ohio State University, Columbus, OH; , Sarah Lawrence College, Calgary, Alberta, Canada; and , Middlesex Hospital Cancer Center, Middletown, CT
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Harbison RA, Kubik M, Konnick EQ, Zhang Q, Lee SG, Park H, Zhang J, Carlson CS, Chen C, Schwartz SM, Rodriguez CP, Duvvuri U, Méndez E. The mutational landscape of recurrent versus nonrecurrent human papillomavirus-related oropharyngeal cancer. JCI Insight 2018; 3:99327. [PMID: 30046007 DOI: 10.1172/jci.insight.99327] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 12/18/2017] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Human papillomavirus-related (HPV-related) oropharyngeal squamous cell carcinomas (OPSCCs) have an excellent response rate to platinum-based chemoradiotherapy. Genomic differences between primary HPV-related OPSCCs that do or do not recur are unknown. Furthermore, it is unclear if HPV-related OPSCCs that recur share a genomic landscape with HPV-negative head and neck cancers (HNCs). METHODS We utilized whole exome sequencing to analyze somatic nucleotide (SNVs) and copy number variants (CNVs) among a unique set of 51 primary HPV-related OPSCCs, including 35 that did not recur and 16 that recurred. We evaluated 12 metachronous recurrent OPSCCs (7 with paired primary OPSCCs) and 33 primary HPV-unrelated oral cavity and OPSCCs. RESULTS KMT2D was the most frequently mutated gene among primary HPV-related OPSCCs (n = 51; 14%) and among metachronous recurrent OPSCCs (n = 12; 42%). Primary HPV-related OPSCCs that recurred shared a genomic landscape with primary HPV-related OPSCCs that did not recur. However, TSC2, BRIP1, NBN, and NFE2L2 mutations occurred in primary OPSCCs that recurred but not in those that did not recur. Moreover, primary HPV-related OPSCCs that recur harbor features of HPV-unrelated HNCs, notably including MAPK, JAK/STAT, and differentiation signaling pathway aberrations. Metachronous recurrent OPSCCs shared a genomic landscape with HPV-unrelated HNCs, including a high frequency of TP53, CASP8, FAT1, HLA-A, AJUBA, and NSD1 genomic alterations. CONCLUSION Overall, primary HPV-related OPSCCs that recur share a genomic landscape with nonrecurrent OPSCCs. Metachronous recurrent OPSCCs share genomic features with HPV-negative HNCs. These data aim to guide future deescalation endeavors and functional experiments. FUNDING This study is supported by the American Cancer Society (RSG TBG-123653), funding support for RAH (T32DC00018, Research Training in Otolaryngology, University of Washington), funds to EM from Seattle Translational Tumor Research (Fred Hutchinson Cancer Research Center), and center funds from the Fred Hutchinson Cancer Research Center to EM. UD is supported by the Department of Veterans Affairs, Biomedical Laboratory Research and Development (BLR&D), grant IO1-oo23456, and funds from the Pittsburgh Foundation and PNC Foundation.
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Affiliation(s)
- R Alex Harbison
- Departments of Otolaryngology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mark Kubik
- Veterans Affairs Pittsburgh Health System, Pittsburgh PA
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Qing Zhang
- Genomics & Bioinformatics Shared Resources, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Seok-Geun Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Science in Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Heuijoon Park
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jianan Zhang
- Solid Tumor Translational Research/Human Biology and
| | - Christopher S Carlson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chu Chen
- Departments of Otolaryngology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Stephen M Schwartz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Cristina P Rodriguez
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Eduardo Méndez
- Departments of Otolaryngology, University of Washington School of Medicine, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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40
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Shirts BH, Konnick EQ, Upham S, Walsh T, Ranola JMO, Jacobson AL, King MC, Pearlman R, Hampel H, Pritchard CC. Using Somatic Mutations from Tumors to Classify Variants in Mismatch Repair Genes. Am J Hum Genet 2018; 103:19-29. [PMID: 29887214 DOI: 10.1016/j.ajhg.2018.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 02/06/2018] [Accepted: 05/01/2018] [Indexed: 01/28/2023] Open
Abstract
Present guidelines for classification of constitutional variants do not incorporate inferences from mutations seen in tumors, even when these are associated with a specific molecular phenotype. When somatic mutations and constitutional mutations lead to the same molecular phenotype, as for the mismatch repair genes, information from somatic mutations may enable interpretation of previously unclassified variants. To test this idea, we first estimated likelihoods that somatic variants in MLH1, MSH2, MSH6, and PMS2 drive microsatellite instability and characteristic IHC staining patterns by calculating likelihoods of high versus low normalized variant read fractions of 153 mutations known to be pathogenic versus those of 760 intronic passenger mutations from 174 paired tumor-normal samples. Mutations that explained the tumor mismatch repair phenotype had likelihood ratio for high variant read fraction of 1.56 (95% CI 1.42-1.71) at sites with no loss of heterozygosity and of 26.5 (95% CI 13.2-53.0) at sites with loss of heterozygosity. Next, we applied these ratios to 165 missense, synonymous, and splice variants observed in tumors, combining in a Bayesian analysis the likelihood ratio corresponding with the adjusted variant read fraction with pretest probabilities derived from published analyses and public databases. We suggest classifications for 86 of 165 variants: 7 benign, 31 likely benign, 22 likely pathogenic, and 26 pathogenic. These results illustrate that for mismatch repair genes, characterization of tumor mutations permits tumor mutation data to inform constitutional variant classification. We suggest modifications to incorporate molecular phenotype in future variant classification guidelines.
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Affiliation(s)
- Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Sarah Upham
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Tom Walsh
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | | | - Angela L Jacobson
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Mary-Claire King
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Rachel Pearlman
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43221, USA
| | - Heather Hampel
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43221, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
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41
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Pac LJ, Cheeney G, Westerhoff M, Konnick EQ, Greene DN, Lockwood CM. Real-Time PCR to Detect α-1 Antitrypsin S and Z Alleles in Formalin-Fixed Paraffin-Embedded Tissue. J Appl Lab Med 2018; 3:18-25. [PMID: 33626829 DOI: 10.1373/jalm.2017.025858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND α-1 Antitrypsin (A1AT) deficiency is an autosomal recessive genetic disease with incomplete penetrance that can cause pulmonary and liver disease. Multiple methods are available to determine A1AT genotype using peripheral blood specimens, but none are validated to detect A1AT alleles in formalin-fixed paraffin-embedded (FFPE) tissue. METHODS A real-time PCR assay was validated to detect the SERPINA1 S and Z alleles (NM_000295.4: c.863A>T, p.E288V and c.1096G>A, p.E366K, respectively) in FFPE liver tissue using allele-specific dual hybridization probes and melting curve analysis. Validation experiments were performed on genomic DNA samples (n = 11) with A1AT genotypes previously determined by orthogonal methods. RESULTS The S and Z allele assays accurately genotyped all FFPE validation specimens that had a threshold cycle <32. Validation samples produced mean melting temperatures of 55.4 °C (SD = 0.30) for mutant S alleles, 48.6 °C (SD = 0.28) for non-S alleles, 61.2 °C (SD = 0.34) for mutant Z alleles, and 54.7 °C (SD = 0.19) for non-Z alleles. Samples failing to meet quality control parameters were infrequent. CONCLUSIONS Poor PCR amplification because of low nucleic acid concentration in small biopsy specimens and time-dependent degradation in specimens stored for extended periods were the most common reasons for assay failure. The ability to determine A1AT genotype from archived surgical pathology specimens can facilitate research on the role of A1AT globules in liver disease.
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Affiliation(s)
- Lincoln J Pac
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Department of Pathology, University of Washington, Seattle, WA
| | - Gregory Cheeney
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Department of Pathology, University of Washington, Seattle, WA
| | | | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA
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42
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Hempelmann JA, Lockwood CM, Konnick EQ, Schweizer MT, Antonarakis ES, Lotan TL, Montgomery B, Nelson PS, Klemfuss N, Salipante SJ, Pritchard CC. Microsatellite instability in prostate cancer by PCR or next-generation sequencing. J Immunother Cancer 2018; 6:29. [PMID: 29665853 PMCID: PMC5904988 DOI: 10.1186/s40425-018-0341-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/04/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Microsatellite instability (MSI) is now being used as a sole biomarker to guide immunotherapy treatment for men with advanced prostate cancer. Yet current molecular diagnostic tests for MSI have not been evaluated for use in prostate cancer. METHODS We evaluated two next-generation sequencing (NGS) MSI-detection methods, MSIplus (18 markers) and MSI by Large Panel NGS (> 60 markers), and compared the performance of each NGS method to the most widely used 5-marker MSI-PCR detection system. All methods were evaluated by comparison to targeted whole gene sequencing of DNA mismatch-repair genes, and immunohistochemistry for mismatch repair genes, where available. RESULTS In a set of 91 prostate tumors with known mismatch repair status (29-deficient and 62-intact mismatch-repair) MSIplus had a sensitivity of 96.6% (28/29) and a specificity of 100% (62/62), MSI by Large Panel NGS had a sensitivity of 93.1% (27/29) and a specificity of 98.4% (61/62), and MSI-PCR had a sensitivity of 72.4% (21/29) and a specificity of 100% (62/62). CONCLUSIONS We found that the widely used 5-marker MSI-PCR panel has inferior sensitivity when applied to prostate cancer and that NGS testing with an expanded panel of markers performs well. In addition, NGS methods offer advantages over MSI-PCR, including no requirement for matched non-tumor tissue and an automated analysis pipeline with quantitative interpretation of MSI-status.
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Affiliation(s)
| | | | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Michael T Schweizer
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Emmanuel S Antonarakis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce Montgomery
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Peter S Nelson
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nola Klemfuss
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
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43
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Waalkes A, Smith N, Penewit K, Hempelmann J, Konnick EQ, Hause RJ, Pritchard CC, Salipante SJ. Accurate Pan-Cancer Molecular Diagnosis of Microsatellite Instability by Single-Molecule Molecular Inversion Probe Capture and High-Throughput Sequencing. Clin Chem 2018; 64:950-958. [PMID: 29632127 DOI: 10.1373/clinchem.2017.285981] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/08/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Microsatellite instability (MSI) is an emerging actionable phenotype in oncology that informs tumor response to immune checkpoint pathway immunotherapy. However, there remains a need for MSI diagnostics that are low cost, highly accurate, and generalizable across cancer types. We developed a method for targeted high-throughput sequencing of numerous microsatellite loci with pan-cancer informativity for MSI using single-molecule molecular inversion probes (smMIPs). METHODS We designed a smMIP panel targeting 111 loci highly informative for MSI across cancers. We developed an analytical framework taking advantage of smMIP-mediated error correction to specifically and sensitively detect instability events without the need for typing matched normal material. RESULTS Using synthetic DNA mixtures, smMIPs were sensitive to at least 1% MSI-positive cells and were highly consistent across replicates. The fraction of identified unstable microsatellites discriminated tumors exhibiting MSI from those lacking MSI with high accuracy across colorectal (100% diagnostic sensitivity and specificity), prostate (100% diagnostic sensitivity and specificity), and endometrial cancers (95.8% diagnostic sensitivity and 100% specificity). MSI-PCR, the current standard-of-care molecular diagnostic for MSI, proved equally robust for colorectal tumors but evidenced multiple false-negative results in prostate (81.8% diagnostic sensitivity and 100% specificity) and endometrial (75.0% diagnostic sensitivity and 100% specificity) tumors. CONCLUSIONS smMIP capture provides an accurate, diagnostically sensitive, and economical means to diagnose MSI across cancer types without reliance on patient-matched normal material. The assay is readily scalable to large numbers of clinical samples, enables automated and quantitative analysis of microsatellite instability, and is readily standardized across clinical laboratories.
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Affiliation(s)
- Adam Waalkes
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Nahum Smith
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Kelsi Penewit
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | | | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Ronald J Hause
- Department of Genome Sciences, University of Washington, Seattle, WA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA
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44
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Méndez E, Rodriguez CP, Kao MC, Raju S, Diab A, Harbison RA, Konnick EQ, Mugundu GM, Santana-Davila R, Martins R, Futran ND, Chow LQM. A Phase I Clinical Trial of AZD1775 in Combination with Neoadjuvant Weekly Docetaxel and Cisplatin before Definitive Therapy in Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2018. [PMID: 29535125 DOI: 10.1158/1078-0432.ccr-17-3796] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: The WEE1 tyrosine kinase regulates G2-M transition and maintains genomic stability, particularly in p53-deficient tumors which require DNA repair after genotoxic therapy. Thus, a need arises to exploit the role of WEE1 inhibition in head and neck squamous cell carcinoma (HNSCC) mostly driven by tumor-suppressor loss. This completed phase I clinical trial represents the first published clinical experience using the WEE1 inhibitor, AZD1775, with cisplatin and docetaxel.Patients and Methods: We implemented an open-label phase I clinical trial using a 3+3 dose-escalation design for patients with stage III/IVB HNSCC with borderline-resectable or -unresectable disease, but who were candidates for definitive chemoradiation. Escalating AZD1775 was administered orally twice a day over 2.5 days on the first week, then in combination with fixed cisplatin (25 mg/m2) and docetaxel (35 mg/m2) for 3 additional weeks. The primary outcome measure was adverse events to establish MTD. Secondary measures included response rates, pharmacokinetics (PK), pharmacodynamics, and genomic data.Results: The MTD for AZD1775 was established at 150 mg orally twice per day for 2.5 days. RECISTv1.1 responses were seen in 5 of 10 patients; histologic adjustment revealed three additional responders. The only drug-limiting toxicity was grade 3 diarrhea. The PK C8hr target of 240 nmol/L was achieved on day 4 at all three doses tested. Pharmacodynamic analysis revealed a reduction in pY15-Cdk, and increases in γH2AX, CC3, and RPA32/RPA2 were noted in responders versus nonresponders.Conclusions: The triplet combination of AZD1775, cisplatin, and docetaxel is safe and tolerable. Preliminary results show promising antitumor efficacy in advanced HNSCC, meriting further investigation at the recommended phase II dose. Clin Cancer Res; 24(12); 2740-8. ©2018 AACR.
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Affiliation(s)
- Eduardo Méndez
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Michael C Kao
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Sharat Raju
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Ahmed Diab
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - R Alex Harbison
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ganesh M Mugundu
- AstraZeneca, Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, Waltham, Massachusetts
| | | | - Renato Martins
- Department of Medicine, University of Washington, Seattle, Washington
| | - Neal D Futran
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Laura Q M Chow
- Department of Medicine, University of Washington, Seattle, Washington.
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Schweizer MT, Cheng HH, Tretiakova MS, Vakar-Lopez F, Klemfuss N, Konnick EQ, Mostaghel EA, Nelson PS, Yu EY, Montgomery B, True LD, Pritchard CC. Mismatch repair deficiency may be common in ductal adenocarcinoma of the prostate. Oncotarget 2018; 7:82504-82510. [PMID: 27756888 PMCID: PMC5347709 DOI: 10.18632/oncotarget.12697] [Citation(s) in RCA: 58] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/12/2016] [Indexed: 01/21/2023] Open
Abstract
Precision oncology entails making treatment decisions based on a tumor's molecular characteristics. For prostate cancer, identifying clinically relevant molecular subgroups is challenging, as molecular profiling is not routine outside of academic centers. Since histologic variants of other cancers correlates with specific genomic alterations, we sought to determine if ductal adenocarcinoma of the prostate (dPC) – a rare and aggressive histopathologic variant – was associated with any recurrent actionable mutations. Tumors from 10 consecutive patients with known dPC were sequenced on a targeted next-generation DNA sequencing panel. The median age at diagnosis was 59 years (range, 40–73). Four (40%) patients had metastases upon presentation. Archival tissue from formalin-fixed paraffin-embedded prostate tissue samples from nine patients and a biopsy of a metastasis from one patient with castration-resistant prostate cancer were available for analysis. Nine of 10 samples had sufficient material for tumor sequencing. Four (40%) patients' tumors had a mismatch repair (MMR) gene alteration (N = 2, MSH2; N = 1, MSH6; and N = 1, MLH1), of which 3 (75%) had evidence of hypermutation. Sections of the primary carcinomas of three additional patients with known MMR gene alterations/hypermutation were histologically evaluated; two of these tumors had dPC. MMR mutations associated with hypermutation were common in our cohort of dPC patients. Since hypermutation may predict for response to immune checkpoint blockade, the presence of dPC may be a rapid means to enrich populations for further screening. Given our small sample size, these findings require replication.
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Affiliation(s)
- Michael T Schweizer
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Heather H Cheng
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Nola Klemfuss
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric Q Konnick
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Elahe A Mostaghel
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter S Nelson
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Bruce Montgomery
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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46
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Harbison RA, Kubik M, Konnick EQ, Lee SG, Kao M, Mason M, Yu T, Xu C, Faden D, Pritchard CC, Rodriguez CP, Chen C, Guinney J, Duvvuri U, Mendez E. Abstract 2713: The mutational landscape of recurrent and nonrecurrent human papillomavirus-associated head and neck squamous cell carcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2713] [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
Background: Despite the better prognosis for human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) compared to HPV-negative HNSCC, 10% to 25% of HPV-associated cases recur within 3 years of completing therapy. We sought to compare the mutational profiles of primary tumors among recurrent and non-recurrent HPV-associated HNSCC. We hypothesized that the mutational profile of primary tumors from recurrent cases resembles that of HPV-negative HNSCC.
Methods: Sequencing was performed on DNA extracted from the primary tumors of p16-positive recurrent and non-recurrent HNSCC cases utilizing a high-coverage (>500X), CLIA-certified, 262 multiplexed gene sequencing panel (i.e., UW OncoPlex). Primary tumors from 11 recurrent and 13 non-recurrent cases were included in our sample. Mutational differences between the primary tumors of recurrent and non-recurrent tumors were evaluated.
Results: 88% of patients were male with a mean (standard deviation; SD) age of 60.3 (11) years. Among the recurrent cases, 100% arose from the oropharynx. Among the non-recurrent cases, 77% arose from the oropharynx with the remainder originating from the oral cavity, nasal cavity, and larynx. 83% of patients presented with stage III or higher disease, and the median survival time was 21 months and 19 months among the recurrent and non-recurrent cases, respectively. The mean (SD) number of somatic nucleotide variants per tumor among the recurrent cases was 16.4 (12.2) compared to 4.3 (1.5) among non-recurrent cases (p < 0.05). The ratio of nonsynonymous to synonymous variants among primary tumors of recurrent cases was 2 vs 5 among the non-recurrent cases (p = 0.224). Among primary tumors of recurrent cases, 17% of variants included indels, splice site, and nonsense mutations vs 14% of variants among the non-recurrent cases. The mean (SD) number of tumor suppressor mutations per tumor was 1.2 (1.3) among recurrent cases vs 1.0 (1.0) among non-recurrent cases (p = 0.81). Interestingly, the mean (SD) number of mutations in DNA damage response (DDR) genes among the primary tumors of recurrent cases was 2.7 (2.4) compared to 0.7 (1.2) mutations per tumor among non-recurrent cases (p = 0.07).
Conclusion: We observed a greater mutational burden among the primary tumors of recurrent HPV-associated HNSCC compared to non-recurrent HNSCC. Moreover, among the primary tumors of recurrent cases, there were more mutations in DNA damage response genes coupled and relatively fewer deleterious mutations compared to non-recurrent cases. Dysregulation of DDR genes may select for advantageous mutations via genomic instability. Alternatively, gain of function of DDR genes may promote treatment resistance. Future work aims to further characterize mutational differences between the primary tumors of HPV-associated recurrent and non-recurrent HNSCC and evaluate mechanisms promoting treatment resistance.
Citation Format: Richard A. Harbison, Mark Kubik, Eric Q. Konnick, Seok-Geun Lee, Michael Kao, Michael Mason, Thomas Yu, Chang Xu, Daniel Faden, Colin C. Pritchard, Cristina P. Rodriguez, Chu Chen, Justin Guinney, Umamaheswar Duvvuri, Eduardo Mendez. The mutational landscape of recurrent and nonrecurrent human papillomavirus-associated head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2713. doi:10.1158/1538-7445.AM2017-2713
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Affiliation(s)
| | - Mark Kubik
- 2University of Pittsburgh, Pittsburgh, PA
| | | | - Seok-Geun Lee
- 3Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Chang Xu
- 3Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Chu Chen
- 3Fred Hutchinson Cancer Research Center, Seattle, WA
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Pac L, Konnick EQ, Lockwood C. Using a Laboratory Information System Intervention to Monitor and Improve Turnaround Time of Epidermal Growth Factor Receptor Gene Mutation Testing. Am J Clin Pathol 2017. [DOI: 10.1093/ajcp/aqw191.005] [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: 11/15/2022] Open
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Konnick EQ, Pritchard CC. Germline, hematopoietic, mosaic, and somatic variation: interplay between inherited and acquired genetic alterations in disease assessment. Genome Med 2016; 8:100. [PMID: 27716394 PMCID: PMC5050638 DOI: 10.1186/s13073-016-0350-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/24/2022] Open
Abstract
Advances in genetic analysis have revealed new complexities in the interpretation of genetic variants. Correct assessment of a genetic variant relies on the clinical context and knowledge of the underlying biology. We outline four scenarios encountered in genetic testing where careful consideration of the origin of genetic variation is required for variant interpretation.
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Affiliation(s)
- Eric Q Konnick
- Department of Laboratory Medicine, University of Washington Medical Center, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195-7110, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington Medical Center, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195-7110, USA.
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Konnick EQ. Response to the Proposed Food and Drug Administration Regulation of Laboratory-Developed Tests: It Is Past Time for Professional Consensus. J Appl Lab Med 2016; 1:239-241. [DOI: 10.1373/jalm.2016.020909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Eric Q Konnick
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, WA
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Mathias PC, Conta JH, Konnick EQ, Sternen DL, Stasi SM, Cole BL, Astion ML, Dickerson JA. Preventing Genetic Testing Order Errors With a Laboratory Utilization Management Program. Am J Clin Pathol 2016; 146:221-6. [PMID: 27473740 DOI: 10.1093/ajcp/aqw105] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To characterize error rates for genetic test orders between medical specialties and in different settings by examining detailed order information. METHODS We performed a retrospective analysis of a detailed utilization management case database, comprising 2.5 years of data and almost 1,400 genetic test orders. After review by multiple reviewers, we categorized order modifications and cancellations, quantified rates of positive results and order errors, and compared genetics with nongenetics providers and inpatient with outpatient orders. RESULTS High cost or problems with preauthorization were the most common reasons for modification and cancellation, respectively. The cancellation rate for nongenetics providers was three times the rate for geneticists, but abnormal result rates were similar between the two groups. The approval rate for inpatient orders was not significantly lower than outpatient orders, and abnormal result rates were similar for these two groups as well. Order error rates were approximately 8% among tests recommended by genetics providers in the inpatient setting, and tests ordered or recommended by nongeneticists had error rates near 5% in both inpatient and outpatient settings. CONCLUSIONS Clinicians without specialty training in genetics make genetic test order errors at a significantly higher rate than geneticists. A laboratory utilization management program prevents these order errors from becoming diagnostic errors and reaching the patient.
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Affiliation(s)
- Patrick C Mathias
- From the Department of Laboratory Medicine, University of Washington, Seattle
| | - Jessie H Conta
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Eric Q Konnick
- From the Department of Laboratory Medicine, University of Washington, Seattle
| | - Darci L Sternen
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Shannon M Stasi
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Bonnie L Cole
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Michael L Astion
- From the Department of Laboratory Medicine, University of Washington, Seattle; Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Jane A Dickerson
- From the Department of Laboratory Medicine, University of Washington, Seattle; Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
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