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Haberberger JF, Pegram W, Britt N, Schiavone K, Severson E, Sharaf R, Albacker LA, Williams E, Lechpammer M, Hemmerich A, Lin D, Huang RSP, Hiemenz M, Elvin J, Graf R, Lesser G, Kram D, Strowd R, Bi WL, Ramkissoon LA, Cohen MB, Reddy P, Creeden J, Ross JS, Alexander BM, Ramkissoon SH. A Retrospective Genomic Landscape of 661 Young Adult Glioblastomas Diagnosed Using 2016 WHO Guidelines for Central Nervous System Tumors. Oncologist 2024; 29:e47-e58. [PMID: 37619245 PMCID: PMC10769808 DOI: 10.1093/oncolo/oyad224] [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: 08/01/2022] [Accepted: 05/21/2023] [Indexed: 08/26/2023] Open
Abstract
The authors present a cohort of 661 young adult glioblastomas diagnosed using 2016 WHO World Health Organization Classification of Tumors of the Central Nervous System, utilizing comprehensive genomic profiling (CGP) to explore their genomic landscape and assess their relationship to currently defined disease entities. This analysis explored variants with evidence of pathogenic function, common copy number variants (CNVs), and several novel fusion events not described in literature. Tumor mutational burden (TMB) mutational signatures, anatomic location, and tumor recurrence are further explored. Using data collected from CGP, unsupervised machine-learning techniques were leveraged to identify 10 genomic classes in previously assigned young adult glioblastomas. The authors relate these molecular classes to current World Health Organization guidelines and reference current literature to give therapeutic and prognostic descriptions where possible.
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Affiliation(s)
| | - Worthy Pegram
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Nicholas Britt
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Eric Severson
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Radwa Sharaf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Lee A Albacker
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Erik Williams
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | | | | | - Douglas Lin
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Matthew Hiemenz
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Julia Elvin
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Ryon Graf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Glenn Lesser
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - David Kram
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Roy Strowd
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lori A Ramkissoon
- Pathology Department, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael B Cohen
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prasanth Reddy
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - James Creeden
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Jeffrey S Ross
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
- Pathology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Shakti H Ramkissoon
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Graf RP, Fisher V, Weberpals J, Gjoerup O, Tierno MB, Huang RSP, Sayegh N, Lin DI, Raskina K, Schrock AB, Severson E, Haberberger JF, Ross JS, Creeden J, Levy MA, Alexander BM, Oxnard GR, Agarwal N. Comparative Effectiveness of Immune Checkpoint Inhibitors vs Chemotherapy by Tumor Mutational Burden in Metastatic Castration-Resistant Prostate Cancer. JAMA Netw Open 2022; 5:e225394. [PMID: 35357449 PMCID: PMC8972027 DOI: 10.1001/jamanetworkopen.2022.5394] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE The most useful biomarkers for clinical decision-making identify patients likely to have improved outcomes with one treatment vs another. OBJECTIVE To evaluate treatment class-specific outcomes of patients receiving immune checkpoint inhibitor (ICI) vs taxane chemotherapy by tumor mutational burden (TMB). DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness analysis of clinical variables and outcomes used prospectively defined biomarker-stratified genomic data from a deidentified clinicogenomic database. Data included men with previously treated metastatic castration-resistant prostate cancer (mCRPC) receiving ICI or single-agent taxane chemotherapy from January 2011 to April 2021 at approximately 280 US academic or community-based cancer clinics (approximately 800 sites of care). Data were analyzed from July to August 2021. EXPOSURES Single-agent ICI or single-agent taxanes. Treatments were assigned at discretion of physician and patient without randomization. Imbalances of known factors between treatment groups were adjusted with propensity weighting. MAIN OUTCOMES AND MEASURES Prostate-specific antigen (PSA) response, time to next therapy (TTNT), and overall survival (OS). RESULTS A total of 741 men (median [IQR], 70 [64-76] years) with mCRPC received comprehensive genomic profiling and were treated with ICI or single-agent taxane therapy. At baseline, the median (IQR) PSA level was 79.4 (19.0-254) ng/mL, 108 men (18.8%) had Eastern Cooperative Oncology Group Performance Status scores of 2 or greater, and 644 men (86.9%) had received prior systemic treatments for mCRPC. A total of 45 patients (6.1%) received ICI therapy and 696 patients (93.9%) received taxane therapy. Among patients with TMB of fewer than 10 mutations per megabase (mt/Mb) receiving ICI, compared with those receiving taxanes, had worse TTNT (median [IQR], 2.4 [1.1-3.2] months vs 4.1 [2.2-6.3] months; hazard ratio [HR], 2.65; 95% CI, 1.78-3.95; P < .001). In contrast, for patients with TMB of 10 mt/Mb or greater, use of ICIs, compared with use taxanes, was associated with more favorable TTNT (median [IQR], 8.0 [3.4 to unknown] months vs 2.4 [2.4-7.3] months; HR, 0.37, 95% CI, 0.15-0.87; P = .02) and OS (median 19.9 [8.06 to unknown] months vs 4.2 [2.69 - 6.12] months; HR, 0.23; 95% CI, 0.10-0.57; P = .001). Among all 741 patients, 44 (5.9%) had TMB of 10 mt/Mb or greater, 22 (3.0%) had high microsatellite instability, and 20 (2.7%) had both. Treatment interactions with TMB of 10 mt/Mb or greater (TTNT: HR, 0.10; 95% CI, 0.32-0.31; P < .001; OS: HR, 0.25; 95% CI, 0.076-0.81; P = .02) were stronger than high microsatellite instability alone (TTNT: HR, 0.12; 95% CI, 0.03-0.51; P = .004; OS: HR, 0.38; 95% CI, 0.13-1.12; P = .08). CONCLUSIONS AND RELEVANCE In this comparative effectiveness study, ICIs were more effective than taxanes in patients with mCRPC when TMB was 10 mt/Mb or greater but not when TMB was fewer than 10 mt/Mb. The results add validity to the existing TMB cutoff of 10 mt/Mb for ICI use in later lines of therapy, and suggest that ICIs may be a viable alternative to taxane chemotherapy for patients with mCRPC with high TMB.
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Affiliation(s)
| | | | - Janick Weberpals
- Real World Data Collaborations, Personalized Healthcare Data, Analytics and Imaging, F. Hoffmann-La Roche, Basel, Switzerland
| | - Ole Gjoerup
- Foundation Medicine, Cambridge, Massachusetts
| | | | | | - Nicolas Sayegh
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | | | | | | | | | | | - Jeffrey S. Ross
- Foundation Medicine, Cambridge, Massachusetts
- Upstate Medical University, Syracuse, New York
| | | | - Mia A. Levy
- Foundation Medicine, Cambridge, Massachusetts
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City
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