Comprehensive genomic analysis of metastatic non–clear-cell renal cell carcinoma to identify therapeutic targets Journal Article
| Authors: | Carlo, M. I.; Khan, N.; Zehir, A.; Patil, S.; Ged, Y.; Redzematovic, A.; Coskey, D. T.; Hyman, D. M.; Ladanyi, M.; Chen, Y. B.; Robson, M.; Hakimi, A. A.; Lee, C. H.; Feldman, D. R.; Gao, J.; Chakravarty, D.; Motzer, R. J.; Voss, M. H. |
| Article Title: | Comprehensive genomic analysis of metastatic non–clear-cell renal cell carcinoma to identify therapeutic targets |
| Abstract: | PURPOSE Non–clear-cell renal cell carcinoma (nccRCC) encompasses approximately 20% of renal cell carcinomas and includes subtypes that vary in clinical and molecular biology. Compared with clear cell renal cell carcinoma, nccRCC demonstrates limited sensitivity to conventional vascular endothelial growth factor– and mammalian target of rapamycin–directed agents, indicating a need for better therapies. Characterizing the genomic landscape of metastatic nccRCC variants may help define novel therapeutic strategies. PATIENTS AND METHODS We retrospectively analyzed tumor tissue from patients with metastatic nccRCC who consented to genomic analysis of their tumor and germline DNA. A hybridization capture–based assay was used to identify single nucleotide variants and small insertions and deletions across more than 340 cancer-associated genes with germline comparison. Clinical actionability of somatic mutations was assessed using OncoKB levels of evidence. Microsatellite instability (MSI) in the tumor was investigated. RESULTS Of 116 patients included in the analysis, 57 (49%) presented with de novo metastatic disease, and 59 (51%) presented with localized disease that later metastasized. Subtype classifications included unclassified (n = 41; 35%), papillary (n = 26; 22%), chromophobe (n = 17; 15%), translocation associated (n = 13; 11%), and other (n = 19; 16%). Of all tumors, 15 (13%) had putative driver somatic alterations amenable to targeted therapies, including alterations in MET, TSC1/2, and an ALK translocation. Of 45 patients who had germline testing, 11 (24%) harbored mutations, seven of which could potentially guide therapy. Of 115 available tumors for analysis, two (1.7%) had high and six (5%) had intermediate MSI status. CONCLUSION The mutation profiles of metastatic nccRCC vary by subtype. Comprehensive analysis of somatic mutations, germline mutations, and MSI, interpreted via an annotated precision oncology knowledge base, identified potentially targetable alterations in 22% of patients, which merits additional investigation. © 2019 by American Society of Clinical Oncology |
| Keywords: | vasculotropin; adolescent; adult; child; human tissue; aged; unclassified drug; major clinical study; overall survival; single nucleotide polymorphism; somatic mutation; disease classification; genetic analysis; tumor localization; metastasis; progression free survival; protein; genetic variability; retrospective study; renal cell carcinoma; survival time; microsatellite instability; hamartin; mammalian target of rapamycin; tuberin; mutation rate; germline mutation; indel mutation; cancer prognosis; human; male; female; priority journal; article; alk protein; metastatic non clear cell renal cell carcinoma |
| Journal Title: | JCO Precision Oncology |
| Volume: | 3 |
| ISSN: | 2473-4284 |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2019-04-28 |
| Language: | English |
| DOI: | 10.1200/po.18.00372 |
| PROVIDER: | scopus |
| PMCID: | PMC7446347 |
| PUBMED: | 32914011 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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